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Diverticular Disease and Its Complications

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Diverticular diseases are the conditions that occur when small bulges develop in the large intestine. To learn more in detail, read the article.

Written by

Dr. Akanksha

Medically reviewed by

Dr. Ghulam Fareed

Published At October 13, 2022
Reviewed AtOctober 21, 2022

Introduction:

Diverticula are tiny protrusions that occur on the wall of the large intestine, extending outwards from the weak spots on the large intestine wall. Diverticula may vary in size, and they can be the size of a pea or much larger. They are commonly present on the sigmoid colon, the S-shaped colon segment located on the lower left side. It is common with the aging population. More than half of the people of 60 years of age have it. The majority of the people suffering from this do not show any symptoms. The few visible symptoms are cramps, bloating, and constipation. Painkillers are helpful in relieving the symptoms. Incorporating high-fiber food into the diet would also be beneficial.

What Are Diverticular Diseases?

Two conditions are related to diverticula, namely, diverticulosis and diverticulitis. These two conditions together are known as diverticular diseases. The presence of diverticula is called diverticulosis. Diverticulitis is the condition of infected and inflamed diverticula.

What Are the Symptoms of Diverticular Disease?

Symptoms of diverticulitis are pain in the abdomen on the left side, high body temperature, chills, vomiting, cramps, constipation, and nausea. In severe cases, bleeding, blockages, and tears are also noticed. People who are at higher risk of developing diverticular disease are men above 40 years of age, obese people, those who eat low fiber diet, eat a high-fat diet and red meat, those who smoke, who take medications like Aspirin, Ibuprofen, and those who do not exercise regularly.

What Are the Causes of Diverticular Diseases?

  • The cause of diverticular disease is not known clearly as of now. However, it is estimated that consuming a low-fiber diet may be the cause. This may lead to constipation and hard stools. Straining to pass hard stool may put increased pressure on the walls of the large intestine leading to the formation of bulges on the weakest spot of the intestine. This theory explains the cause of diverticulosis.

  • The cause of diverticulitis is also unknown. There is another theory to explain the cause of diverticulitis, which says the bacteria present in the stool are responsible for the inflammation of the diverticula.

  • Even though there is no substantial evidence, it is believed that the absence of good bacteria in the digestive tract can be a possible cause of diverticular disease.

How to Diagnose Diverticular Disease?

Diverticulosis, being asymptomatic, is usually diagnosed while running the test for some other condition. When symptoms are seen, seeking a doctor’s advice is recommended. The doctor would ask for medical history and questions related to the symptoms and would advise tests accordingly.

  • Blood Test - For the examination of any infection in the large intestine.

  • CT (Computed Tomography) Scan - CT scan of the abdomen and pelvis helps in detecting the presence of diverticula and any other abnormalities in the region.

  • Ultrasound of the Abdomen - This is a non-invasive procedure that helps in quick visualization of the organs in the region.

  • X-ray of the Abdomen - It uses ionizing radiation to produce images of the inside of the abdominal cavity.

  • Colonoscopy - This is a test in which the colonoscope (flexible tube with light and camera) is inserted into the rectum through the anus to examine the large intestine properly.

  • Lower GI (Gastrointestinal) Series - In this test, the doctor uses barium liquid to view the colon through the X-ray. It is also called a barium enema.

  • Fecal Occult Blood Test (FOBT) - Stool samples are collected to look for blood in the stool.

  • Angiography - This is helpful in cases with rectal bleeding.

What Are the Treatment Options for Diverticular Disease?

  • Diverticulosis usually does not need any treatment as the patients mostly do not notice any symptoms. Dietary changes are recommended by the doctor anyways, which is having a high-fiber diet. A high-fiber diet includes whole grains, legumes, nuts, avocados, berries, coconut, and peas.

  • In the case of diverticulitis, if mild symptoms are seen, doctors would prescribe oral antibiotics such as Amoxicillin, Metronidazole, and Augmentin. Other advice from the doctor includes taking proper rest, lying down on the bed, and using a heating pad on the abdomen. Over-the-counter painkillers can be taken to get some relief from pain. In addition, the patient is asked to be on a liquid diet until the symptoms get better. In case of severe symptoms, the patients are asked to get hospitalized and administered intravenous (IV) antibiotics and intravenous fluids, and the doctor may recommend surgery. A positive response to medication is seen in 70% of patients with the first attack of diverticulitis, and it decreases to 7.7% in recurrent cases.

  • Surgery is advised when the patient does not provide relief from the symptoms through medication. Surgery involves removing the infected part of the large intestine or colon and reattaching it to the rectum.

  • A colostomy may be advised in patients with recurrent attacks of diverticulitis. In this surgical procedure, an opening is made for the colon in the abdomen, and a bag is attached to it so that all the waste in the colon will be collected in this bag. This procedure is done for proper healing of the intestine and also to rule out the presence of any other abnormality that is triggering the recurrence of diverticulitis.

What Are the Complications of Diverticular Disease?

There can be multiple complications seen attached to the diverticular disease.

  • Abscess - It is the collection of infected fluid surrounded by inflamed tissue. The inflamed and infected area surrounding the abscess is called a phlegmon. It is formed along the wall of the colon due to diverticulitis. The symptoms are sore abdomen, fever, nausea, and vomiting. Up to 30% of the people who develop acute diverticulitis may also develop an abscess. A small abscess might be treated using antibiotics. The doctor must drain the pus and may even need to remove some of the damaged bowel tissue in case the abscess is large or it does not respond to the treatment.

  • Perforation or Peritonitis - Diverticulitis causes a hole or tear in the walls of the large intestine. The colon walls get weak and, if they grow larger, can spill contents of the bowel into the abdominal cavity. This can lead to peritonitis (inflammation and infection of the abdomen). Peritonitis is a medical emergency requiring immediate surgery to clear the abdominal cavity. It can be deadly if left untreated. At times larger perforations can lead to a fistula or abscess.

  • Strictures - Intestinal stricture is also known as an intestinal blockage. Previous infections in the colon can cause scars to form, which can result in a partial or complete blockage or stricture. The passage of food gets difficult because the intestine gets narrow. The symptoms include severe constipation, bloating, vomiting, and abdominal pain. Emergency surgery is required to clear the path in case of a complete block, while a partial block can be surgically corrected later.

  • Fistula - It is an abnormal connection between two organs. In diverticulitis, a fistula connects the colon with the bladder, the small intestine, or the vagina. The symptoms are air or stool in the urine, pain while urinating, or abnormal vaginal discharge. An abscess that erodes into the surrounding tissue creates a fistula. Most fistulas do not close on their own, so surgery is the option to treat them.

  • Rectal Bleeding - Rectal bleeding caused by diverticulitis is not very common. When it happens, it can be severe. Diverticular pouches can damage the colon wall, resulting in bleeding. The symptoms are red or maroon-colored blood in the bowel movements. Sometimes the bleeding stops on its own if it is mild. A hospital stay, blood transfusion, and surgery may be required in severe cases.

Conclusion:

Diverticular disease has high morbidity and mortality. Not so severe cases can be managed effectively without surgery. Diverticular disease can be prevented by taking a high-fiber diet, drinking ample water, and exercising regularly. Proper diet and lifestyle are always good for good overall health.

Frequently Asked Questions

1.

Which Symptoms of Diverticulitis Occur Most Frequently?

The most common symptom of diverticulitis is abdominal pain, especially in the left lower side, along with fever, nausea, vomiting, and changes in bowel movement like constipation or diarrhea.

2.

Which At-Home Treatment Is Most Effective for Diverticulitis?

Treatment of diverticulitis includes antibiotics, pain management, dietary modifications, and rest so, if suspects of diverticulitis, seek medical attention to receive appropriate treatment.

3.

Who Is Afflicted With Diverticulitis?

Diverticulitis mostly affects individuals over the age of 40 years and people following a low-fiber diet; risk factors include obesity, smoking, and lack of physical activity.

4.

What Are the Foods Avoided by People With Diverticulitis?

Some common foods avoided during the episode of diverticulitis are nuts and seeds, spicy foods, foods high in fat, processed food, carbonated beverages, alcohol, and high-fiber foods such as strawberries, raspberries, cucumbers, and tomatoes.

5.

Is There a Nonsurgical Way to Treat Diverticulitis?

Treatment of diverticulitis involves a combination of medications, lifestyle changes, and dietary modifications in mild to moderate cases. But in severe cases, along with these, surgical intervention may also needed.

6.

How Dangerous Is Diverticular Disease?

Diverticulitis varies in severity from person to person. The potential complications of diverticulitis are abscess, infection, perforation, fistula formation, and bowel obstruction.

7.

What Is the Primary Method of Treating Diverticulitis?

The primary method involves the non-surgical interventions such as medications, lifestyle changes, hydration, and adequate rest, which alleviate the symptoms in severe cases.

8.

What Is the Most Effective Technique to Stop Diverticulitis?

The most effective way to prevent diverticulitis is consuming a High-fiber diet, staying hydrated, avoiding straining during bowel movements, and managing stress.

9.

What Foods Cause Diverticulitis?

Consuming a low-fiber diet, insufficient fluid intake, red and processed meat, and individual triggers like alcohol, beverages, and caffeine result in diverticulitis. 

10.

What Are Diverticulitis’s Worst Signs and Symptoms?

The signs and symptoms of diverticulitis are abdominal pain, fever, nausea, vomiting, change in bowel movements, abdominal tenderness, and bloating. Complications of the symptoms are abscess, perforation of the colon, etc.

11.

Is Diverticulitis a Chronic Condition?

Diverticulitis may be acute or chronic. In acute conditions, episodes of inflammation and infections occur frequently, but in chronic conditions, infection subsides but never clear up completely.

12.

Can Diverticular Illness Be Cured?

In uncomplicated cases, medications are not needed frequently. Dietary changes, a low-fiber diet, and lifestyle modifications help in reducing the symptoms. With timely treatment, diverticular illness can be healed.

13.

Can Cancer Develop From Diverticulitis?

Studies suggest that more than 1.9 % of the population develops colorectal cancer in people with acute diverticulitis. The risk of colorectal cancer is significantly high in people with complicated diverticulitis.

14.

If a Person With Diverticulitis, Can Still Get a Colonoscopy?

According to the American Gastrointestinal Association, colonoscopy must be performed only in the six to eight weeks once the acute infection subsides. Depending on the severity of the disease, a colonoscopy is prescribed by the doctor.
Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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