Diverticulitis

February 1, 2017

Diverticulitis occurs when small, bulging sacs or pouches that form on the inner wall of the intestine (diverticula) become inflamed or infected. Most often, these pouches are in the large intestine (colon).

Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid. Diverticula can form while straining during a bowel movement, such as with constipation. They are most common in the lower portion of the large intestine (called the sigmoid colon).

This disorder results when portions of the digestive tract called diverticula get infected or inflamed. Diverticula are small bulges or pouches that can form in the intestines, esophagus and stomach — anywhere within the digestive system. The condition of having diverticula — which occur most commonly in the large intestine, or colon — is known as diverticulosis. Diverticula usually develop in response to pressure on weak spots in the colon or other parts of the digestive tract. Doctors aren’t sure, though, why these pouches get inflamed or infected.

Diverticulosis is very common in Western populations and occurs in 10 percent of people over age 40 and in 50 percent of people over age 60. The occurrence of diverticulosis increases with age, and it affects almost everyone over age 80.

Causes

Most diverticula occur in the left colon; they also occur elsewhere, but not in the rectum. The common hypothesis is that relatively high pressures generated within the colon by muscular contractions force the inner mucosa to penetrate through the path of small blood vessels within the colon wall and to bulge beyond the serosa. The muscle layer along the site of left colon diverticula is commonly thickened, lending credibility to the notion of high intracolonic pressure. The result may be rows of bulges along the colon at the sites of the penetrating arteries.

Why such this may occur in one-half the North American and European populations and not the other half is a mystery. Perhaps the great prevalence in Western populations is related to the relative lack of dietary fiber consumed by these populations. Low dietary fiber results in small stools, and an undistended colon may generate more pressure within the colon. Whatever the cause, the presence of colonic diverticula – often discovered during the course of a barium enema x-ray, colonoscopy, or surgery – is almost always of no significance.

Risk Factors

  • Aging – The incidence of diverticulitis increases with age.
  • Obesity – Being seriously overweight increases your odds of developing diverticulitis. Morbid obesity may increase the risk of needing more-invasive treatments for diverticulitis.
  • Smoking – People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis.
  • Lack of exercise – Vigorous exercise appears to lower your risk of diverticulitis.
  • Diet high in animal fat and low in fiber, although the role of low fiber alone isn’t clear.
  • Certain medications – Several drugs are associated with an increased risk of diverticulitis, including steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).

Symptoms

Divericulitis causes uncomfortable or painful symptoms in most people who have it. Common diverticulitis symptoms include:

  • Abdominal pain (usually in the lower left side)
  • Blood in the stool or accompanying the stool
  • Constipation
  • Fever and chills
  • Nausea and vomiting

In very severe cases of diverticulitis, the wall of the intestine may become so infected and inflamed that it perforates, leading to peritonitis and life-threatening or fatal complications.

Complications

Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity, causing the following problems –

  • Peritonitis (a painful infection of the abdominal cavity)
  • Abscesses (“walled off” infections in the abdomen)
  • Obstruction (blockages of the intestine)

Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A complete blockage requires emergency surgery, although a partial blockage does not.

Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. The most common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.

Treatment

Medications – Mild cases of diverticulitis can generally be treated by the patient himself/herself. A doctor may prescribe antibiotics, plus paracetamol (acetaminophen, Tylenol) for the pain. It is important that all patients complete their whole course of antibiotics; even if they feel better half-way through. Some people may experience drowsiness, nausea, diarrhea, and/or vomiting while they are taking their antibiotics. Antibiotics may include ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex), and doxycycline (Vibramycin).

Surgery – Patients who have at least two diverticulitis episodes may benefit from surgery. Studies indicate that such patients are significantly more likely to have subsequent episodes, as well as complications if they do not have surgery. Colon resection removes part of the affected colon, and joins the remaining healthy parts together. Immediate surgery may be necessary when the patient has other complications, such as perforation, a large abscess, peritonitis, complete intestinal obstruction, or severe bleeding. In these cases, two surgeries may be needed because it is not safe to rejoin the colon right away.

Alternative Treatment

Probiotics, such as Lactobacillus acidophilus, Lactobacillus plantarum, Saccharomyces boulardii, and bifidobacteria help maintain the health of the intestines.

Omega-3 fatty acids, such as those found in fish oil, may help fight inflammation. (On the other hand, some omega-6 fatty acids, found in meats and dairy products, tend to increase inflammation.)

Glutamine is an amino acid found in the body that helps the intestine function properly. While there is no evidence that glutamine helps reduce symptoms of diverticular disease, it may be beneficial for overall intestinal health.

Acidophilus – Helps support a healthy intestinal tract (gut) and replaces the flora in the small intestine, primarily to improve assimilation.

Proteolytic Enzymes – Aids in digestion & reduces inflammation in the colon.

Fiber – Helps prevent constipation. Also prevents infection.

Vitamin C – Anti-inflammatory and boosts immunity.

Alfalfa – Natural source of vitamin K and essential minerals that most people with intestinal disorders are lacking. Also contains chlorophyll, which aids in healing.

Garlic – Aids in digestion and is a natural antibiotic.

Flaxseed may be helpful in treating diverticulosis. It contains fiber and works as a bulk forming laxative, softening stool and speeding transit time through the intestine.

Slippery elm is a demulcent (protects irritated tissues and promotes healing)

Licorice can reduce spasms and inflammation in the gastrointestinal tract.

Acupuncture may help relieve pain and other symptoms. Acupuncturists treat people with diverticular disease based on an individualized assessment of the excesses and deficiencies of qi (or energy) located in various meridians. Acupuncture and Chinese medicine in general may promote gastrointestinal health.

Reference –

https://my.clevelandclinic.org/health/diseases_conditions/hic_Diverticular_Disease

http://www.merckmanuals.com/home/digestive-disorders/diverticular-disease/diverticulitis

http://www.webmd.boots.com/digestive-disorders/understanding-diverticulitis-symptoms

http://www.drweil.com/drw/u/ART00345/Diverticulitis.html

http://www.nhs.uk/conditions/Diverticular-disease-and-diverticulitis/Pages/Introduction.aspx

http://www.mayoclinic.org/diseases-conditions/diverticulitis/basics/definition/con-20033495

http://www.webmd.com/digestive-disorders/tc/diverticulitis-topic-overview

http://www.healthline.com/health/diverticulitis

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diverticulosis-and-diverticulitis

http://patients.gi.org/topics/diverticulosis-and-diverticulitis/

http://www.everydayhealth.com/diverticulitis/diet/

http://www.drweil.com/drw/u/ART00345/Diverticulitis.html

http://www.nytimes.com/health/guides/disease/diverticulitis/overview.html

http://colorectal.surgery.ucsf.edu/conditions–procedures/diverticulitis.aspx

https://www.fascrs.org/patients/disease-condition/diverticular-disease

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