A diverticulum is an abnormal protrusion of a pouch from the wall of a hollow organ. Diverticular disease refers to the presence of these pouch-like protrusions in the walls of the colon. At the same time, diverticulitis is the state in which there is an active inflammation, known as diverticular disease. When the bowel wall starts to lose its integrity, this can lead to various complications, discussed in this article.
INTRODUCTION
Diverticular disease is a disease occurring when pouches or out pouches are formed toward the lining of the large intestine or the colon that balloons through the outer wall. These pockets are called diverticula.
These diverticula can be present without noticeable symptoms but might be associated with constipation or diarrhea. This condition is very commonplace as we age but still affects young people. More than 65% of those 85 years of age and older have diverticular disease.
A person might have one diverticulum or more than hundreds of diverticula, which are typically less than one centimeter in diameter but tend to increase in number or size over time. In about 10 to 25% of people, the diverticula can become inflamed or infected, known as diverticulitis.
This results in a set of symptoms, including diarrhea, bowel irritability, cramping, intense pain, bloating, bleeding, and fever. The feeling of tenderness and pain are most apparent in the lower left part of the stomach. Serious complications may occur in rare cases; sometimes it requires immediate medical attention and surgery.
Studies carried out haven’t been able to pinpoint the etiology of diverticular disease, but it appears to be more prevalent in people who don’t ingest enough fiber. One theory is that pressure such as straining during constipation builds up inside the colon. This results in the ballooning of the intestine’s walls between different muscle packs which extend in both circular and longitudinal directions through the colon.
The parts of the large intestine, which can also be called the colon, includes:
- The rectum
- Cecum
- Transverse colon
- Anal canal
- Sigmoid colon
- Descending Colon and
- Ascending colon
The colon wall consists of the mucosa, submucosa, muscle layer, and outer serosa are the four primary layers. The “vasa recta” are blood arteries that carry blood to your colon.
When the diverticula become inflamed, it is called contrast diverticulitis. An abscess is a pus-filled collection that can form as a result of diverticulitis. Massive Swelling and pus accumulation can result in the formation of perforation; this allows pus and other material to enter your abdomen. It is a life-threatening emergency that necessitates prompt medical treatment.
Diverticula rarely occur in the rectum, or the teniae coli or those three longitudinal muscle bands that run the full length of the colon, spread out, and fuse to form a reinforced outer layer surrounding the rectum. That prevents protrusions of the diverticular disease from occurring in the rectum.
CAUSES OF DIVERTICULAR DISEASE
Diverticulosis is associated with a low fiber diet, despite the fact that the cause is unknown: constipation and frequent straining with bowel movements. Constipation causes increased pressure inside the colon. This increased pressure may cause the mucosa and submucosa to herniate through a weakened area of your colon’s wall and form a diverticulum. Diverticulosis is diagnosed when you have these diverticula but no other symptoms.
In diverticulitis, the opening of the diverticulum becomes blocked, typically by a faecolith. Subsequently, this obstruction lumen leads to the replication of bacteria and increased mucus secretion within the diverticulum. As a result, this causes increased intraluminal pressure within the diverticulum. This rising pressure results in venous congestion, which, in turn, leads to the development of ischemia of the wall of the diverticulum and subsequently perforation.
If this perforation is small, it will usually lead to some inflammation of the colonic wall surrounding it, but typically, the perforation will become sealed. It usually gets sealed by pericolic fat or the omentum. However, in cases where the perforation is large, this usually results in the development of pericolic or pelvic abscesses, which can lead to death.
The causes of diverticulitis are not completely understood. However, several risk factors can increase the risk of developing these conditions, and these may include:
- Genetics: People with a family history are likely to develop diverticulitis.
- Obesity
- Smoking
- Lack of Physical exercise
- Diet low in fiber
- Age
- Lack of Vitamin D
- Certain medications such as regular use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
SYMPTOMS OF DIVERTICULAR DISEASE
The usual symptoms of diverticulitis are:
Pain: which may persist for several days. This pain is usually felt on the right side of the abdomen and sometimes in the lower left part of your belly.
Fever
Constipation
Diarrhea
Other symptoms include:
- Decreased appetite.
- Tenderness,
- Nausea and vomiting.
- Increased urge to urinate.
- Burning sensation while urinating.
- Blood in stool.
- Bleeding from the rectum.
MEDICATION FOR DIVERTICULAR DISEASE
Diagnosis: Several illnesses and conditions, such as irritable bowel syndrome (IBS), have similar symptoms. The doctor will need to rule out such medical conditions, which may cause the observed symptoms. He will ask about your symptoms, health history, and medication you take.
The doctor will likely consider your symptoms and might use a colonoscopy to observe the shape and function of the colon. During periods of flare-up, the bowel might be too tender to perform these investigations, and the risk of bowel perforation might be too high.
The doctor then performs a physical examination, including checking the abdomen for tenderness. After which, the doctor will recommend a blood test to check for anemia, inflammation, kidney or liver problems.
Urine test to check for infections. A stool test is also performed to rule out infection in people with diarrhea. Pregnancy test to rule out pregnancy in women of childbearing age. A pelvic exam to rule out gynecological problems.
C.T. scan or a procedure is known as virtual colonoscopy, which can confirm a diagnosis of diverticulitis as it can indicate inflamed or infected pouches. It can also indicate the severity and guide treatment.
Treatment may depend on the severity of symptoms. Mild or uncomplicated diverticulitis can be treated at home, with:
- Antibiotics: Antibiotics can be used for treatment, although there is growing evidence that antibiotics might not be needed in uncomplicated diverticulitis.
- Over-the-counter pain medicine like acetaminophen or a liquid diet for a few days while the bowel heals.
With Severe or complicated diverticulitis, patients may need hospitalization, and treatment may include:
- Intravenous antibiotics: In severe cases, one might need to be hospitalized for intravenous feeding. So that the bowel may rest for few days.
- Abscess draining: if one has formed.
- Surgery may be recommended if you have complications and you have had several episodes of uncomplicated diverticulitis.
The surgical approach consists of primary bowel resection and bowel resection with colostomy.
Treatment for diverticulosis can also be found in increased consumption of fiber-rich foods to soften and bulk up stools, causing the colon to contract and eliminate them.
The best way to avoid diverticular disease and manage it is to consume a well-balanced diet, ensuring high fiber content and adequate fluid intake. The fluid and fiber aid in softening stool and allows it to be excreted more easily and quickly. This is helpful in alleviating excessive force pushing on the colon’s walls. Exercising regularly and drinking plenty of water help prevent diverticulitis. There are several illnesses that have similar symptoms, such as irritable bowel syndrome.
However, treatment is quite different if you are experiencing diverticulitis. A physician will likely recommend an immediate transition to a restricted fiber or liquid-only diet—physical rest, pain medications, and possibly antispasmodics.
SURGERIES AVAILABLE FOR DIVERTICULAR DISEASE
The following conditions may necessitate surgery for diverticular disease:
- Peritonitis is caused by a colon rupture that allows pus or stool to flow into the abdominal cavity. Colon rupture frequently needs immediate surgery.
- An abscess that can’t be drained properly.
- Severe cases that don’t respond to maximum medical therapy, like hospitalization and administering intravenous antibiotics.
- Patients battling immune system problems (related to an organ transplant or chemotherapy).
- A colonic fistula or stricture.
- With a history of numerous attacks, a patient can choose elective surgery that will prevent future episodes.
In case of severe diverticulitis, you may require an abscess draining procedure. If the condition worsens, you may need surgery to remove the affected portion of your colon during the procedure. Your surgeon will insert the remaining end of your colon through your abdominal wall, creating a stoma. After your colon has healed, it can be re-attached to your rectum.
Surgery carried out for diverticular disease normally involves removing the diseased portion of the colon. It may or may not include a colostomy or ileostomy, which entails bringing out a portion of the colon from the stomach wall to drain into a bag.
LIFESTYLE CHANGES FOR DIVERTICULAR DISEASE
If episodes become frequent, then surgical removal of the affected area may be necessary. Once a diverticulum forms, it does not go away on its own. Therefore it is best to prevent the disease from developing or ever-growing further by following a well-balanced, high fiber diet, drinking adequate fluids, and staying physically active.
Many people are able to live symptom-free having diverticular disease by making these lifestyle changes.
- Consume a Healthy Diet
Consult your doctor about a diverticular diet. They may advise you to consume a variety of fresh fruits and vegetables. Fruits and vegetables contain fiber, which aids in maintaining a healthy digestive system and preventing constipation. In case you are constipated and strain to have a bowel movement, your condition may worsen. It’s also a nice idea to stay hydrated.
- Regular Exercise
Exercise and physical activity may help you prevent the risks of diverticular illness. It helps to maintain normal bowel function and lowers colon pressure. It also helps avoid constipation. If you have a resting lifestyle, it is advisable to exercise for a least 30 minutes on most days. Seek the doctor’s advice, always.
- Quit Smoking
Most individuals are knowledgeable regarding the health risks associated with cigarette smoking. While breaking the nicotine habit for good may be difficult, you should make a concerted effort to quit smoking for various reasons. According to health experts, people who inhale cigarettes are more prone to have diverticular disease as opposed to those who do not smoke.
- Keep a Healthy Weight
If you are above a healthy weight and have been diagnosed with diverticular disease, it is advisable to seriously consider losing the appropriate weight for your body type and age. Obesity may increase your risk of diverticulosis complications (an infection of the pouches within your large intestine).To avoid diverticulosis, maintain a healthy weight. Consult your doctor about safe methods of losing excess weight. Your doctor can also advise you on the ideal weight to aim for.
- See the Doctor Regularly
One of the most important lifestyle changes. This is because the colon can be checked regularly for infections, and this can avert potential problems. A colonoscopy may be recommended on a regular basis by your doctor to gain a better view of your intestines.
You might want to ask your doctor for a recommendation for a dietitian who can assist you in developing a special diet.
UNTREATED & LONG TERM CONSEQUENCES
“The majority of diverticulosis patients will not develop complications.” By William Stassen, a gastroenterologist. Based in Austin, Texas.
Complications can occur if diverticulitis is not taken seriously and caught early and treated. Such complications include:
Rectal Bleeding
Diverticulitis-related rectal bleeding is not very common. This occurs in approximately 17% of people with chronic diverticulitis, which is a form of the disease that never completely clears up. What happens is that around these herniated sacs are arteries. When the herniated area expands, the bowel wall becomes too thin, and these arteries can break down, and this break down releases blood.
Other than seeing red or maroon-colored blood in the bowel movements, there are no symptoms of bleeding. If the bleeding is minor, it may stop on its own.
Abscess
Perforation of the colon causes abscess development and peritonitis. An abscess can be defined as a collection of pus that the body has walled off. The inflammation of the peritoneum is referred to as peritonitis. It is typically a result of a probably life-threatening contagion that propagates freely throughout the abdomen, making patients very sick.
Fistula Formation
When a fistula is formed, it connects the colon to the bladder most commonly, although it can also connect the colon to the skin, uterus, vaginal canal, or another section of the bowel.
UPCOMING TREATMENTS/MEDICATION
Although medical practitioners have developed various ways to treat diverticulitis, research is still ongoing for a reliable cure.
This condition’s management has improved, and in the last five years, European countries and the United States have published guidelines and recommendations.
The most widely available treatment is the use of antibiotics, such as ciprofloxacin, metronidazole, Levofloxacin, TMP-SMX DS BD, Amoxicillin-clavulanate, moxifloxacin, Meropenem, Ertapenem, Piperacillin-tazobactam, Fluoroquinolone, Cephalosporine.
Recent developments are in the combination of these medications, and this is done based on the patient’s state.
Outpatient: 7-10 days, ciprofloxacin 500mg BID + metronidazole 500mg TID, Levofloxacin + metronidazole, TMP-SMX DS BD + metronidazole, Amoxicilin-clavulanate, moxifloxacin.
Inpatient: IV regimes, Meropenam 1g TID, Ertapenam 1g IV QD, Piperacillin-tazobactam 3.375 IV QID, metronidazole + Fluoroquinolone, metronidazole + Cephalosporine.
Upcoming treatments are in the methodology of managing diverticulitis. In various patients, in severe cases, surgery is performed.
CONCLUSION
About 50% of people over age 50 in the United States report experiencing Diverticulitis-related symptoms weekly. Many more U.S. adults report having diverticulitis symptoms daily. These symptoms include pain (which may persist for several days and is usually felt on the right side of the abdomen), fever, constipation, diarrhea, and many more.
Diverticula disease can have serious complications when left untreated, including rectal bleeding, fistula formation, abscess, and colon stricture. This condition’s management has improved, and in the last five years, European countries and the United States have published guidelines and recommendations.
External Links
MedicineNet, Diverticulitis. Jay W. Marks MD.
https://www.medicinenet.com/diverticulosis/article.html
nhs , diverticular disease, and diverticulitis.
https://www.nhs.uk/conditions/diverticular-disease-and-diverticulitis/
