Diverticulosis


Disease Definition

In the large intestine, or colon, small outward bulges in the lining can occur in weak spots. These bulges, or pouches, are called diverticulum. The condition of having these pouches is referred to as diverticulosis. As we age, they become more common--about 10% of Americans older than 40 have diverticulosis, and it affects about half of those older than 60.

The pouches most often occur in the sigmoid colon, or the lower portion of the colon. If they become inflamed and painful, the condition is called diverticulitis. This occurs in 10 to 25% of those with diverticulosis, and together, the conditions are known as diverticular disease.

Drawing of the colon and an enlargement of it showing diverticula with colon (large intestine) and diverticula labeled.
Drawing of the colon and an enlargement of it showing diverticula with colon (large intestine) and diverticula labeled.

http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/


http://www.youtube.com/watch?v=3eZhxn6ybDA

Causes

Though not yet proven, it is thought that a low-fiber diet is the main reason diverticular disease develops. It tends to occur in developed countries like the United States, Australia, and England, where low-fiber, highly processed diets are most consumed. In Asia and Africa, where people tend to eat high-fiber diets, there is less prevalence. In the 1900's, processed foods were introduced in the United States, and it was around that time that diverticular disease was first noticed. Processed foods include white rice, white bread, crackers, most breakfast cereals, and pretzels.

Fiber is found in plant foods like fruits, vegetables and grains. It cannot be digested, so it adds bulk to the stool, making it easier to pass. Soluble fiber forms a soft, gel-like texture during digestion, whereas insoluble fiber passes through the intestines virtually unchanged. Both kinds of fiber are important to digestive health. A low fiber diet also may contribute to infrequent stools, which increases pressure in the colon.

Constipation can also contribute to diverticulosis. Defined as hard, infrequent stools, it may cause straining during a bowel movement, which increases intestinal pressure. This increase in pressure may cause the bulges in the colon wall to push out through weak spots.

There may also be a genetic predisposition to developing diverticulosis. If parents or grandparents had diverticulosis, you may be more prone to developing it. Additionally, a lack of exercise may also contribute.

The reason diverticula become inflamed is not fully understood. One theory is that bacteria or stool may become trapped in the pouches. Diverticulitis can develop quickly and with no warning.


Symptoms and Signs
Many people with diverticulosis do not present with any symptoms. For others, the signs and symptoms of diverticulosis include:
  • Pain on the lower left side of the abdomen
  • Abdominal Tenderness
  • Nausea and Vomiting
  • Diarrhea
  • Constipation
  • Bloating

The following increase your risk of developing diverticulosis:
  • Low fiber diet
  • Age greater than 70 years
  • Obesity
  • Male gender
  • High fat diet
  • Lack of physical activity


Medical Treatment
Antibiotics are recommend to treat mild symptoms. These medications include:
  • cephalexin ( Keflex)
  • doxycycline (Vibramycin)
  • ciprofloxacin (Cipro)
  • metronidazole (Flagyl)

For moderate to severe pain:
Acetaminophen, such as Tylenol

Surgery:
Primary bowel resection- diseased part of intestine is removed and healthy sections of colon are then reconnected. A good example of a bowel resection can be found at this site: Primary Bowel Resection
external image h9991263_003.jpg
Bowel resection (colostomy)- used when inflammation of the colon causes it to be unable to connect with the rectum. A hole (stoma) is made in the abdominal wall and connected to the healthy part of the colon. Waste products are passed from the hole into a bag. For answers to many questions patients have following their colostomy, go to this site: Ostomy Frequent Questions
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Dietary Treatment
To prevent constipation and formation of diverticula:
A diet high in fiber (whole grains, vegetables, and fruits)
Fiber supplements
A high liquid diet
external image Diverticulitis-Diet-Menu1.jpg

If bloating or gas occurs, high fiber foods should be avoided or reduced, such as:
Nut and seed items
Entire Grains
Coffee beans
Veggies in the cruciferous family (cauliflower and broccoli)


For more information regarding diverticulitis and your diet, browse this page: Diverticulitis Diet Menu


References
http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/
http://patients.gi.org/topics/diverticulosis-and-diverticulitis/
http://www.umm.edu/altmed/articles/diverticular-disease-000051.htm
http://www.mayoclinic.com/health/diverticulitis/DS00070/DSECTION=treatments-and-drugs
http://www.sutterhealth.org/health/healthinfo/index.cfm?A=C&type=info&hwid=zm6206&popup=1
http://www.appendix-cancer.com/Colostomy.htm
http://www.medicinenet.com/diverticulosis/page3.htm
http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000192.htm
http://youtu.be/If6hTFLlgHw