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Doctors believe a low-fiber diet is the main cause of
diverticular disease. The disease was first noticed in the United
States in the early 1900's. At about the same time, processed foods
were introduced to the American diet. Many processed foods contain
refined, low-fiber flour. Unlike whole-wheat flour, refined flour
has no wheat bran.
Diverticular disease is common in developed or industrialized
countries - particularly the United States, England, and Australia -
where low-fiber diets are common. The disease is rare in countries
of Asia and Africa, where people eat high-fiber vegetable diets.
Fiber is the part of fruits, vegetables, and grains that the body
cannot digest. Some fiber dissolves easily in water (soluble fiber).
It takes on a soft, jelly-like texture in the intestines. Some fiber
passes almost unchanged through the intestines (insoluble fiber).
Both kinds of fiber help make stools soft and easy to pass. Fiber
also prevents constipation.
Constipation makes the muscles strain to move stool that is too
hard. This is the main cause of increased pressure in the colon. The
excess pressure causes the weak spots in the colon to bulge out and
become diverticula.
Doctors are not certain what causes the infection. It may begin
when stool or bacteria are caught in the diverticula. An attack of
diverticulitis can develop suddenly and without warning.
What are the symptoms?
Diverticulosis
Most people with diverticulosis do not have any discomfort or
symptoms. However, symptoms may include mild cramps, bloating, and
constipation. Other diseases such as irritable bowel syndrome (IBS)
and stomach ulcers cause similar problems, so these symptoms do not
always mean a person has diverticulosis. You should visit your
doctor if you have these troubling symptoms.
Diverticulitis
The most common symptom of diverticulitis is abdominal pain. The
most common sign is tenderness around the left side of the lower
abdomen. If infection is the cause, fever, nausea, vomiting, chills,
cramping, and constipation may occur as well. The severity of
symptoms depends on the extent of the infection and complications.
Are There Complications?
Diverticulitis can lead to complications such as infections, or
spread of infection outside the colon, perforations, blockages, or
bleeding. These complications always require treatment to prevent
them from progressing and causing more serious illness.
Bleeding
Bleeding from diverticula may occur. When diverticula bleed,
blood may appear in the toilet or in your stool. Bleeding can be
severe, but it may stop by itself and not require treatment. Doctors
believe bleeding diverticula are caused by a small blood vessel in a
diverticulum that weakens and finally bursts. If you have bleeding
from the rectum, you should see your doctor right away. If the
bleeding does not stop, surgery may be necessary.
Abscess, Perforation, and Peritonitis
The infection causing diverticulitis often clears up after a few
days of treatment with antibiotics. If the condition gets worse, an
abscess may form in the colon.
An abscess is an infected area with pus that may cause swelling
and destroy tissue. Sometimes, the infected diverticula may develop
small holes, called perforations. These perforations allow pus to
leak out of the colon into the abdominal area. If the abscess is
small and remains in the colon, it may clear up after treatment with
antibiotics. If the abscess does not clear up with antibiotics, the
doctor may need to drain it.
A large abscess can become a serious problem if the infection
leaks out and contaminates areas outside the colon. Infection that
spreads into the abdominal cavity is called peritonitis. Peritonitis
may require immediate surgery to clean the abdominal cavity and
remove the damaged part of the colon. Without surgery, peritonitis
can be fatal.
Fistula
A fistula is an abnormal connection of tissue between two organs
or between an organ and the skin. When damaged tissues come into
contact with each other during infection, they sometimes stick
together. If they heal that way, a fistula forms. When
diverticulitis-related infection spreads outside the colon, the
colon's tissue may stick to nearby tissues. The most common organs
involved are the urinary bladder, small intestine, and skin.
The most common type of fistula occurs between the bladder and
the colon. This type of fistula can result in a severe, long-lasting
infection of the urinary tract. The problem can be corrected with
surgery to remove the fistula and the affected part of the colon.
Intestinal Obstruction
The scarring caused by infection may cause partial or total
blockage of the large intestine. When this happens, the colon is
unable to move bowel contents normally. When the obstruction totally
blocks the intestine, emergency surgery is necessary. Partial
blockage is not any emergency, so the surgery to correct it can be
planned.
How does the doctor diagnose Diverticular Disease?
To diagnose diverticular disease, the doctor takes a medical
history, does a physical exam, and may perform one or more
diagnostic tests. Because most people do not have symptoms,
diverticulosis is often found through tests ordered for another
ailment.
What is the treatment for Diverticular Disease?
A high-fiber diet will help relieve symptoms in most cases.
Sometimes an attack of diverticulitis is serious enough to require a
hospital stay and possibly surgery.
Diverticulosis
Increasing the amount of fiber in the diet may reduce symptoms of
diverticulosis and prevent complications such as diverticulitis.
Fiber keeps stool soft and lowers pressure inside the colon so that
bowel contents can move through easily. The American Dietetic
Association recommends 20 to 35 grains of fiber each day.
Diverticulitis
Treatment for diverticulitis focuses on clearing up the infection
and inflammation, resting the colon, and preventing or minimizing
complications. An attack of diverticulitis without complications may
respond to antibiotics within a few days if treated early.
To help the colon rest, the doctor may recommend bed rest and a
liquid diet, along with a pain reliever or a drug to control muscle
spasms in the colon.
An acute attack with severe pain or severe infection may require
a hospital stay. Most acute cases of diverticulitis are treated with
antibiotics and a liquid diet. The antibiotics are given by
injection into a vein. In some cases, however, surgery may be
necessary.
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Diseases
and their Treatments - Diverticulosis and Diverticulitis