Diverticulitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 9, 2016
StartDiseasesDiverticulitis

Diverticulosis occurs when small pouches, called diverticula, form along the wall of the digestive tract. Diverticula are common in people over the age of 40. In most cases, diverticula are asymptomatic; however, they can become infected, leading to diverticulitis.

Contents

Definition & Facts

Diverticulitis typically results in mild to severe abdominal pain. Approximately 25 percent of people with diverticulitis will experience complications, including:

Once diverticula form, they are present for the rest of the person’s life. This means that it is possible to suffer multiple bouts of diverticulitis. Lifestyle and dietary changes, as well as prompt medical treatment of symptoms, can limit the duration of the diverticulitis episodes and the possibility of serious complications.

Symptoms & Complaints

The most common complaint associated with diverticulitis is sudden, severe abdominal pain. The pain is normally located on the left side of the lower abdomen. The pain may last anywhere from a few hours to a few days. Other symptoms may include:

Symptoms of diverticulitis may be confused with other conditions, such as a urinary tract infection or irritable bowel syndrome. It is critical that anyone experiencing the above symptoms see a doctor as soon as possible for prompt diagnosis and proper treatment.

Causes

It is not exactly clear what causes diverticula to form in the digestive tract; however, it is believed that a lack of fiber may be a major contributor to the condition. Fiber promotes gastrointestinal health by helping the stool stay soft so that it can move through the colon easier. A lack of fiber can lead to constipation, which requires an individual to strain and use more force to move matter through the colon.

This increased pressure can cause any weakened areas of the colon to bulge outward. The pouches are most likely to develop where blood vessels pass through the bowel wall. If fecal matter becomes lodged in the pouch, an infection can develop leading to diverticulitis.

The reason some people with diverticula go on to develop diverticulitis and others do not isn’t entirely clear. However, a person’s risk for diverticulitis increases with age. This may be due to the fact that the bowel muscles weaken over time. Nonsteroidal anti-inflammatory drugs and family history may also contribute to the development of diverticulitis. Individuals suffering from morbid obesity are more likely to require invasive treatments for diverticulitis.

Diagnosis & Tests

The first step in diagnosing diverticulitis is a complete review of the patient’s symptoms and a physical examination to look for any signs of abdominal pain. A complete blood count may be ordered to check for an elevated white blood cell count, which could indicate possible infection.

A urinalysis may be ordered to rule out the possibility of a urinary tract infection. The doctor may also perform a fecal occult blood test to check for the presence of blood in stool. Female patients may also undergo a pelvic examination to rule out various pelvic diseases.

Depending on the exact symptoms, the doctor may also order liver function tests to rule out other causes of abdominal pain. A CT scan or abdominal X-ray may be used to check for evidence of diverticula or other conditions.

Diverticulitis has not been linked to an increased risk of colon cancer or rectal cancer, but it is important to rule out colon cancer as a possible cause of the symptoms. It is not possible to perform a colonoscopy during an episode of diverticulitis since the scope could cause a tear in the colon, allowing the infection to spill into the abdomen.

Treatment & Therapy

The treatment of diverticulitis depends on the severity of the symptoms. Mild cases may be treated with prescription antibiotics and over-the-counter or prescription pain medications. Typically, the patient will be ordered to rest and switch to a liquid diet to allow time for the colon to heal. A heating pad applied to the abdomen and relaxation techniques, such as breathing exercises or meditation, may help relieve the discomfort of diverticulitis.

Individuals with severe diverticulitis or who are at risk for complications may require hospitalization for intravenous antibiotics and draining of any abscesses. Anyone experiencing complications, such as a gastrointestinal perforation or bowel obstruction, will likely need surgery.

The two types of surgery used to treat diverticulitis are a primary bowel resection or a bowel resection with colostomy. During a bowel resection, the surgeon removes the diseased portion of the intestine and rejoins the two healthy ends. If the colon cannot be rejoined to the rectum due to inflammation, the surgeon will have to create an opening in the abdominal wall. This will allow waste to pass from the body into a colostomy bag. In most cases, the colostomy can be reversed once the inflammation has subsided.

Prevention & Prophylaxis

Lifestyle changes are the best way to prevent diverticula and to prevent possible diverticulitis. The following steps may prevent diverticulitis:

  • Exercise regularly—Physical activity encourages normal bowel function, which can reduce the pressure inside the colon.
  • Eat high-fiber foods—Fresh fruits, vegetables, and whole grains help to soften stool so that it can move through the colon.
  • Increase fluid intake—Fiber works by absorbing water into the gastrointestinal tract. If the fluid isn’t replenished, fiber can actually cause constipation.