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?
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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.
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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.
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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.
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Blood Test - For the examination of any infection in the large intestine.
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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.
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Ultrasound of the Abdomen - This is a non-invasive procedure that helps in quick visualization of the organs in the region.
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X-ray of the Abdomen - It uses ionizing radiation to produce images of the inside of the abdominal cavity.
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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.
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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.
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Fecal Occult Blood Test (FOBT) - Stool samples are collected to look for blood in the stool.
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Angiography - This is helpful in cases with rectal bleeding.
What Are the Treatment Options for Diverticular Disease?
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.