Diverticulitis is an inflammation of the diverticula, which are small pouches found in the wall of the colon, or large intestine.
Diverticula are the result of years of the bowel contracting as it pushed stool down the colon toward the rectum and the anus. They are usually weak spots in the colon wall.
Diverticula are very common in older people and usually cause no symptoms, according to the American College of Gastroenterology.
Problems happen with these pouches become inflamed or infected. The resulting diverticulitis is a serious disease which can require hospitalization, though hospitalization is not common.
What are the Causes of Diverticulitis?
Some doctors believe that diverticulitis occurs when a dry, hard stool or bacteria are caught inside a diverticulum. Other than this, the exact cause of the disease is not known.
Some doctors believe that a person who has a diet that is low in fiber and who has chronic bouts of constipation is more at risk for diverticulitis. Watch this video by Dr. Buck Parker to learn more about diverticulitis.
How is Diverticulitis Diagnosed?
A doctor diagnoses diverticulitis by listening to their patient’s symptoms and performing a physical exam, including a digital rectal exam.
In this exam, the doctor puts on gloves, lubricates one of the fingers and inserts it into the patient’s rectum to search for inflamed diverticula. The doctor also asks questions about the patient’s diet and their bowel habits.
The doctor orders lab tests such as blood and stool tests, ultrasound, CT scans, and colonoscopy. An X-ray can show whether the patient’s large intestine has been perforated, but a CT scan reveals abscesses or a thickened colon wall. Blood tests often show an elevated white blood cell count, which indicates infection.
If the patient is not having an attack of diverticulitis, the doctor may conduct a colonoscopy, which involves a tiny camera attached to a flexible tube that is inserted into the colon.
Since the camera is attached to a monitor, it allows the doctor to see the state of the patient’s colon. Later, after the diverticulitis is healed, the doctor may order a barium enema, though this test is never done while the disease is active, says WebMD.
The doctor may also order tests to make sure that the problem is not caused by pregnancy, pelvic infections or a problem with the patient’s liver.
During one type of barium enema, the doctor may fill the colon with barium, an element that blocks out X-rays and allows the doctor to see the colon.
In another type of barium enema, the doctor fills up the large intestine with barium, allows the barium to drain then fills the colon with air. This technique makes it easier see the patient’s diverticula, though the first procedure is easier on older people.
What are Symptoms of Diverticulitis?
Symptoms of diverticulitis are:
- A constant, unrelievable pain in the abdomen. The pain might start slowly and increase or it may come on suddenly. The pain is often crippling in its intensity.
- Tender areas of the abdomen
- Nausea and vomiting
- Blood in the stool
- Diarrhea, though this is less likely than constipation
- Increased urge to urinate
- Burning upon urination
If the diverticulitis is untreated, it may lead to complications such as:
- Fistula. The is an abnormal opening in the wall of the large intestine. It can connect the colon to other organs in abnormal ways. These organs can include the bladder, the small intestine or even the reproductive organs.
- Perforation of the intestines
- Blockage in the intestines made by scar tissue
- Peritonitis. This is an inflammation of the membrane that lines the abdomen. It happens when infected diverticulum bursts and the abdominal cavity becomes contaminated with fecal matter. This is considered a medical emergency.
- Recurrent episodes of diverticulitis
- Intestinal bleeding and chronic infections
- Abscess. This is an infected area that is filled with pus.
- Phlegmon. This is another type of tissue infection, not as defined as an abscess.
About a quarter of people who have diverticulitis go on to develop complications, according to Mayo Clinic.
What are the Risk Factors for Diverticulitis?
Besides a low fiber diet and constipation, risks for diverticulitis include a sedentary lifestyle. This means the person does not exercise the way they should. Smokers are also more at risk for developing complications of the disorder.
Diverticulitis is also more likely to strike people who are over 50 since they are more likely to develop diverticula.
People who take medicines such as NSAIDs, opiates, and steroids are more at risk for getting diverticulitis, as are people who are obese. People who have close family members with diverticulitis are probably at risk of contracting the disease themselves.
Younger men tend to get diverticulitis more often than younger women, but the reverse is true after age 50. There’s some indication that people who are deficient in vitamin D are more likely to develop complications, though no one knows why.
What is the Treatment for Diverticulitis?
The good news about diverticulitis is that most cases are mild and respond well to conservative treatment. Many patients who have had more than one attack claim that their first one was the worst, according to Healthline.
The reasons the other attacks were milder is probably because scar tissue prevented complications. But even complications can be resolved if the patient receives medical care. Usually, when diverticulitis is treated it does not return.
If the diverticulitis is simple, the doctor may prescribe antibiotics to clear up any infection. The patient may need to be on bed rest for a few days and take a liquid diet. This includes drinking lots of fresh water.
Ironically, the doctor may recommend a low fiber diet that is gentle on the inflamed colon. The patient may need to use stool softeners while their colon heals and should not take laxatives. This home care usually resolves the great majority of cases of diverticulitis.
If the diverticulitis has complications, the patient needs to be hospitalized. Once there, they will be given antibiotics intravenously. If they have an abscess, it will be drained through a tube.
In very severe cases, the patient may need to have surgery. Surgery may need to be performed not only from complications but if the patient has undergone several bouts of diverticulitis or if their immune system is weakened.
There are Two Kinds of Surgery for Complicated Diverticulitis
The two types of surgery that treat complicated diverticulitis are primary bowel resection and colostomy. In the first surgery:
The surgeon resects those segments of the colon that have the diverticulitis, then sutures the ends of healthy segments together. This is called anastomosis and can be done laparoscopically.
This means smaller incisions, miniaturized surgical tools and usually, a shorter recovery time and fewer post-operative complications.
However, some patients with extensive diverticulitis may need an open procedure, where a larger incision is made to access the bowel.
If the disease is so extensive that anastomosis can’t be performed, the doctor will give the patient a colostomy. In this operation, an incision is made in the abdomen.
The colon segment that is to be opened is isolated and clamped on both sides, then resected in between the clamps. The end of the colon that’s closest to the stomach is brought out of the abdomen and camped outside the patient’s skin.
The end that is more distant from the stomach is sutured closed or can be brought out as another opening called a mucous fistula.
After that, the muscles and skin are closed around the first opening or the stoma. Feces will come out through this stoma into a bag. When the inflammation of the diverticulitis is eased, the operation can be reversed and the two ends of the colon sewn together.
What is the Aftercare for Diverticulitis?
About six weeks after the patient has recovered, the doctor may perform another colonoscopy to make sure that the patient has healed, and they do not have other problems such as colon polyps or colon cancer. However, doctors have found no link between diverticulitis and colon cancer.
The patient should be ready to perform self-care after they have diverticulitis. They should:
- Try to have regular bowel movements. Indeed, they should try to have a bowel movement at the same time every day.
- Check the stool for blood.
- Use a heating pad for mild pain.
After they heal, the patient should increase their levels of vitamin D, either by eating vitamin D enriched foods or spending more time in the sun.
They should adopt a diet that’s high in fiber, which can ease the symptoms of the disease if it returns, claims the National Institute of Diabetes and Digestive and Kidney Diseases. Avoid foods such as onions, garlic, dairy products and fermented foods.