Diverticular disease is an outpouching of the colon, usually the sigmoid. It develops from the musculature in the colon working against increased intraluminal pressures to move hard stools through. Other typical sites are the duodenum, near the pancreatic border or the ampulla of Vater, and the jejunum. Diverticular disease of the stomach is rare and is often a precursor of peptic or neoplastic disease. Diverticular disease of the ileum (Meckel's diverticulum) is the most common congenital anomaly of the GI tract.
Diverticular disease has two clinical forms. In diverticulosis, diverticula are present but usually the patient is asymptomatic or the symptoms (abdominal pain, fluctuating bowel habits, constipation) are questionable because they may be related to underlying irritable bowel syndrome. In diverticulitis. diverticula are inflamed and may cause potentially fatal obstruction, infection, or hemorrhage.
Diverticular disease is most prevalent in men over age 40. Diverticula probably result from high intraluminal pressure on areas of weakness in the GI wall, where blood vessels enter.
Diet may also be a contributing factor because lack of roughage reduces fecal residue, narrows the bowel lumen, and leads to higher intra-abdominal pressure during defecation. The fact that diverticulosis is most prevalent in Western industrialized nations, where processing removes much of the roughage from foods, supports this theory. Diverticulosis is less common in nations where the diet contains more natural bulk and fiber.
In diverticulitis, retained undigested food mixed with bacteria accumulates in the diverticular sac, forming a hard mass (fecalith). This substance cuts off the blood supply to the thin walls of the sac, making them more susceptible to attack by colonic bacteria.
Inflammation follows, possibly leading to perforation, abscess, peritonitis, obstruction, or hemorrhage. Occasionally, the inflamed colon segment may produce a fistula by adhering to the bladder or other organs.
Signs and symptoms
Symptoms are due to the muscle abnormality and consist of pain, usually in the left lower part of the abdomen, often abdominal distension, an irregular bowel habit with pellet-like stools, and sometimes small quantities of blood passed with bowel actions. These symptoms are similar to those of the irritable bowel syndrome which is not surprising because both disorders, at least in part, are due to abnormal muscle function.
In addition a complete medical history and physical examination, your doctor may perform a digital rectal exam (DRE) to feel for tenderness, blockage, or blood. A stool sample and x-rays may also be part of the diagnostic process.
The two forms of the disease call for different treatment regimens.
Asymptomatic diverticulosis generally doesn't require treatment. Diverticulosis with pain, nausea, or constipation may respond to a liquid or low-residue diet, stool softeners, and occasional doses of mineral oil. These measures relieve symptoms, minimize irritation, and lessen the risk of progression to diverticulitis.
After pain subsides, patients also benefit from a low-residue diet and bulk medication such as psyllium (1 teaspoon twice a day) and increased water consumption (8 glasses per day).
Occasionally, severe bleeding from a diverticulum can occur due to rupture of a blood vessel. Blood transfusion may be needed and, occasionally, surgery.
Treatment of mild diverticulitis without signs of perforation aims to prevent constipation and combat infection. This includes bed rest, a liquid diet, stool softeners or bulking agents, a broad-spectrum antibiotic (such as metronidazole and ciprofloxacin or cotrimoxazole), meperidine to control pain and relax smooth muscle, and an antispasmodic such as propantheline to control muscle spasms.
Diverticulitis that doesn't respond to medical treatment requires a colon resection to remove the involved segment.
There are several ways you can help prevent and manage diverticular disease. The following tips will help keep your colon functioning normally:
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