Diverticular Disease

What is diverticular disease?

In the colon, some people have small pouches that bulge outward through weak spots. Diverticular disease is an inflammation or infection in the pouches, known as diverticula, which are located in the colon.

True -but rare, diverticula occur in cecum or right colon Here all layers of the bowels are involved in the herniating process when inflamed they would simulate appendicitis.

High intraluminal pressure (Laplace law -in constricted segments) initiates and perpetuates herniation of colonic nucosa through weak spots in the mucsulature. Incidence of diverticla increases after age 35 .

* having diverticula is a condition called diverticulosis.

* having infected or inflamed diverticula is a condition is called diverticulitis.

The conditions of diverticulosis or diverticulitis are referred to as diverticular disease.

Diverticulitis occurs in 10 to 25 percent of people with diverticulosis.

Approximately half of all Americans age 60 to 80, and almost everyone over age 80, have diverticulosis at some time.

The disease is common in developed or industrialized countries -- particularly the United States, England, and Australia -- where low-fiber diets are common. It is rare in countries of Asia and Africa, where people eat high-fiber, vegetable diets.

What causes diverticular disease?
It is believed that a low-fiber diet is the main cause of diverticular disease. Fiber is the part of fruits, vegetables, and grains that the body cannot digest.

* Soluble fiber dissolves easily in water and takes on a soft, jelly-like texture in the intestines.

* Insoluble fiber passes almost unchanged through the intestines.

Both kinds of fiber help make stools soft and easy to pass, which helps to prevent constipation.

Constipation is the main cause of increased pressure in the colon, making the muscles strain to move stool that is too hard. The excess pressure caused by the straining makes the weak spots in the colon bulge out, forming diverticula.

Physicians do not know what causes the infection that causes diverticulitis, but believe it may begin when stool or bacteria are caught in the diverticula.

What are the symptoms of diverticular disease?

The following are the most common symptoms for diverticular disease, however, each individual may experience symptoms differently. Symptoms may include:

* Diverticulosis symptoms:
Diverticulosis may not cause any discomfort or symptoms, but could include mild cramps, bloating, and constipation. These symptoms may be caused by irritable bowel syndrome (IBS), stomach ulcers, or other problems, and do not always indicate diverticulosis.

Diverticulitis symptoms: The most common symptom is abdominal pain and the most common sign is tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may also occur.

*Dr Titus cites a case that initial diverticula bleed required 20+ units of blood to stabalize patient.

The symptoms of diverticular disease may resemble other conditions or medical problems. Consult your physician for a diagnosis.

How is diverticular disease diagnosed?

Medical History and Physical Exam
When taking a medical history, the healthcare provider may ask about bowel habits, symptoms, pain, diet, and medications. The physical exam usually involves a digital rectal exam. To perform this test, the healthcare provider inserts a gloved, lubricated finger into the rectum to detect tenderness, blockage, or blood. The healthcare provider may check stool for signs of bleeding and test blood for signs of infection. The healthcare provider may also order x-rays or other tests.

X-rays (barium Enema) saw-tooth appearance of bowels

Treatment for diverticular disease:

Specific treatment will be determined by your physician(s) based on:

* your age, overall health, and medical history
* extent of the disease
* your tolerance for specific medications, procedures, or therapies
* expectations for the course of the disease
* your opinion or preference

Treatment may include increasing dietary fiber intake by eating foods such as:

* whole grain breads, cereals, and other products
* fruit, such as berries, apples, and peaches
* vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, and squash
* beans

Dr East suggested that Metamucil seems a good fibre supplement.

In the past, avoiding foods with small seeds, such as tomatoes or strawberries, was suggested because it was believed that particles could lodge in the diverticula and cause inflammation. Consult your physician regarding which foods you should avoid.

Pain medication may also be prescribed.

Treatment for diverticulitis may also include:

* medications for infection and inflammation
* medications to control muscle spasms
* resting the colon, with liquid diet ( non alcoholic) and bed rest
* preventing or minimizing complications, such as

* infection ` * perforations or tears * blockages * bleeding

Disposable anoscopes are very handy for rectal examination

Hospitalization may be required for acute attacks with severe pain or infection. Surgery may be necessary in some cases.

Summary

1. Diverticulosis occurs when small pouches, called diverticula, bulge outward through weak spots in the colon (large intestine).

2. The pouches form when pressure inside the colon builds, usually because of constipation.

3. The main cause of diverticulosis is a low-fiber diet because it increases constipation and pressure inside the colon.

4. Most people with diverticulosis never have any discomfort or symptoms.

5. Diverticulitis occurs when the pouches get infected or inflamed and cause pain and tenderness around the left side of the lower abdomen.

6. For most people with diverticulosis, eating a high-fiber diet is the only treatment needed.

You can increase your fiber intake by eating these foods: whole grain breads, cereals, and other products; fruit such as berries, apples, and peaches; and vegetables such as broccoli, cabbage, spinach, carrots, asparagus, and squash; and beans.

Dr Ian Titus	Dr Jeffery East