Diverticulitis: Causes, Symptoms, Diagnosis, Treatments
Synopsis: Diverticulitis is infection and/or inflammation of small bulging pouches called diverticula that develop on walls of the intestines, formation of pouches themselves is called diverticulosis. A high-fiber diet, along with fiber supplements, are something that may prevent constipation and the formation of diverticula. Once a diverticulum ruptures and becomes infected the condition is then referred to as, 'Diverticulitis.'
In the Western world, Diverticular disease is common; it is rare in Asia and Africa. The muscular wall of a person's colon thickens as they age, potentially reflecting an increase in pressures required by their colon in order to eliminate waste. The disease is not common in persons younger than forty. Half of persons over the age of sixty years in America experience the disease. While most persons with the disease experience few or no symptoms, some persons develop bleeding, infection, rupture, abdominal cramps, constipation, or even obstruction of their colon. A recent study has discovered that diverticulitis is increasing among young, obese adults.
Diverticulitis involves a condition where diverticuli in the person's colon rupture, resulting in an infection of the tissues surrounding their colon. Pressure within a person's colon may cause pockets of tissue, referred to as, 'sacs,' to push out from the walls of their colon as they age. A small sac may push outward from their colon wall called a, 'diverticulum;' several of these sacs are referred to as, 'diverticula.' These diverticula (See Fig 1.) may occur throughout a person's colon, although they most commonly occur near the end of the left colon called the, 'Sigmoid Colon.' When a person has the condition where these diverticula are present, the condition is called, 'Diverticulosis.'
Persons with diverticulosis might present either few, or no symptoms at all. Once a diverticulum ruptures and becomes infected the condition is then referred to as, 'Diverticulitis.' Persons with diverticulitis experience abdominal tenderness, abdominal pain, as well as fever. Bleeding may start from a diverticulum. Persons who experience the consequences of diverticulosis in their colon are diagnosed with diverticular disease.
The main cause of diverticula is thought to be due to a lack of dietary fiber, which helps a person's stools to remain soft. People who do not eat enough dietary fiber and have hard stools may have more pressure or strain on their colon as muscles push stool down, causing diverticula to happen. Diverticula can happen when weak spots in the outside layer of the person's colon muscle give way because items in the inner layer have managed to squeeze through.
Bacteria in stool multiply and spread rapidly, causing infection. When a diverticulum becomes blocked, it can lead to infection. Other studies have suggested that there may also be a genetic factor involved. Medical science has not yet reached a full understanding of why diverticulitis occurs.
Diverticulosis is often found incidentally during testing for other intestinal issues the person is experiencing. Around twenty-percent of persons with diverticulosis develop symptoms related to it. Common symptoms of diverticular disease can include:
- Colon obstruction
- Abdominal cramping
- Bowel habit changes
- Bleeding into the colon
- Pain in the lower abdomen
- Collection of pus in the pelvis
- Small amounts of blood in stools
- Generalized infection of the abdominal cavity
A diverticulum may rupture, allowing the bacteria within the person's colon to spread into the tissues surrounding their colon and causing diverticulitis. The person may experience either diarrhea or constipation. Pus may collect around an inflamed diverticulum causing the formation of an abscess, commonly in the person's pelvis. Rarely, an inflamed diverticula may erode into the person's urinary bladder causing a bladder infection, as well as a passing of gas during urination. Inflammation of the person's colon may lead to a bowel obstruction. A diverticulum may also rupture into the person's abdominal cavity causing peritonitis; although this is not a frequent occurrence.
Diverticular bleeding is something that happens when an expanding diverticulum erodes into a person's blood vessel at the base of a diverticulum. The person may pass red, dark, or maroon colored clots or blood without associated abdominal pain. On rare occasion, the person may pass blood that is black from a diverticulum of their right colon. The bleeding a person experiences can be either intermittent or continuous, lasting for several days. Persons who are actively bleeding are hospitalized so they can be monitored. They are given intravenous fluids to support their blood pressure. If the amount of blood they have lost is severe enough, the person may be given a blood transfusion. Rarely, persons may experience rapid and severe bleeding and a drop in blood pressure that causes dizziness, shock, and loss of consciousness. For most persons the bleeding stops on its own and they are sent home after several days in the hospital. Persons who experience persistent and severe bleeding may require surgical removal of the bleeding diverticula.
A diagnosis of diverticular disease is complicated by the similarity of symptoms of other conditions such as irritable bowel syndrome. A doctor will ask the person about the symptoms they are experiencing, perform a physical examination, ask about the person's family medical history, and order some blood tests. The doctor will most likely pursue some additional tests as well; these test may include either a colonoscopy or a barium enema. A CT scan may be ordered as well to see if the person is experiencing an infection that has spread to other parts of their body, or the presence of an abscess. Ultrasound examination of the person's abdomen and pelvis may detect collections of pus.
A number of persons with diverticulosis present either minimal or no symptoms at all, and do not require any particular form of treatment. A high-fiber diet, along with fiber supplements, are something that may prevent constipation and the formation of diverticula. Those who have mild symptoms such as abdominal pain or muscle spasms in the area where diverticula are present can be treated with medications that include Dicycomine, Chlodiazepoxide, Hyoscyamine, Atropine, Scopolamine, and Phenobarb.
When diverticulitis occurs, antibiotics are usually needed. Oral antibiotics are sufficient when symptoms are mild. Some examples of commonly prescribed antibiotics include Ciprofloxacin, Cephalexin, Metronidazole, or Doxycycline. Consumption of foods that are low in fiber, or liquids, is advised for persons who are experiencing acute attacks of diverticulitis. Persons who experience a persistent bowel obstruction or abscess that is not responding to antibiotics may require surgery.
Surgery commonly involves draining collections of pus, as well as resection of the section of the person's colon containing the diverticuli; often the person's sigmoid colon. Surgical removal of the bleeding diverticula is needed for persons with bleeding that is persistent. People who have diverticula that erode into their bladder causing recurrent urine infection also require surgical intervention. Persons who experience recurrent attacks of diverticulitis which leads to multiple courses of antibiotics, lost days at work, as well as hospitalizations, may require surgery as well. The goal of surgical intervention is to remove all or nearly all of the part of the person's colon containing diverticula to prevent future episodes of diverticulitis. The surgery can be done laproscopically, and presents few long-term consequences.
A number of people are able to treat themselves where diverticular disease is concerned. The use of painkillers and consumption of dietary fiber helps them to do so. Tylenol, fruits and vegetables, as well as laxatives for persons who are experiencing constipation, along with plenty of fluids - can help.
People who experience either heavy or constant rectal bleeding need to see a doctor.
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