Diverticulosis

diverticular.jpg
http://images.medicinenet.com/images/illustrations/diverticular.jpg


Disease definition
Diverticulosis is the presence of small pouches in the large intestine that protrude outward through weakness in the muscular layers of the colon. Diverticulosis is a part of diverticular disease, which also includes the condition of inflamed pouches in the colon (diverticulitis).

Causes

The saclike herniations are a result from long-term constipation and pressure on the walls of the colon. The cause of this increased pressure in the colon is thought to be related to the structure of an individual's colon, motility, genetics and historically low fiber diet. Increased colonic pressure is commonly the greatest in the sigmoid colon, making it a susceptible location for diverticula to occur.



Symptoms and Signs

Most people do not have any symptoms with Diverticulosis. It may be present for many years before a person is diagnosed with this disease. It is mainly discovered by tests such as a barium enema X-ray or a colonoscopy. If the pouches become infected or inflamed it becomes known as diverticulitis. Diverticulitis has many symptoms that are very painful and often the same as irritable bowel syndrome. Some examples of these are listed below.

  • Sudden/severe pain located in the lower left side of the abdomen
  • Change in bowel habits
  • Abdominal tenderness
  • Fever
  • Nausea and vomiting
  • Constipation
  • Diarrhea
  • Bloating
  • Bleeding from the rectum (uncommon)





Medical Treatment

There is not any specific medical treatment associated with Diverticulosis. However, It may be recommended that an individual take fiber supplements to help soften the bowl movements. If a patient does have some mild symptoms of abdominal pain, then anti-spasmodic drugs may help. They are listed below:
  • Chloridiazepoxide (Librax)
  • Dicyclomine (Bentyl)
  • Antropine, scopolamine, phenobarb (Donnatal)
  • Hyoscyamine (Levsin)

Oral antibiotics are needed for people who have developed diverticulitis. Some common examples are:
  • Ciprofloxacin (Cipro)
  • Metronidazole (Flagyl)
  • Cephalexin (Keflex)
  • Doxycycline (Vibramycin)

Dietary treatment

The dietary treatment and the key to preventing diverticulosis is eating a diet high in fiber. A person with diverticulosis should consume an adequate amount of fiber, which can be determined by the dietary reference intake. The Dietary reference intake for fiber is:

Men: 30-38 grams/day

Women: 21-26 grams/day

A high fiber diet includes whole grains, oats, bran, vegetables, fruit, and legumes. These foods can be included into the diet by:
  • Replacing white bread with whole grain wheat
    http://www.foodmatters.tv/images/assets/sprouted-nuts-seeds.jpg
    http://www.foodmatters.tv/images/assets/sprouted-nuts-seeds.jpg
  • Replacing meat with legumes (beans,peas, and lentils) for some meals
  • Eating cereal with more than 5 gramsof fiber per serving
  • Eating vegetables and fruit with meals
  • Eating vegetables and fruit as snacks
  • Replacing pasta and white rice with whole grain pasta and brown rice
  • Adding a fiber supplement in addition to your dietary fiber intake
  • Not peeling, pureeing, choping, or processing foods (it reduces fiber content)
  • Adding 2-3 tablespoons of unprocessed wheat bran to baked goods
  • Using whole wheat flour instead of all-purpose when baking

Note: Fiber should be added to the diet slowly, rapid addition can cause painful gas and bloating.

Foods that should be avoided include:
  • Nuts
  • Popcorn hulls
  • Corn
  • Pumpkin seeds
  • Sesame seeds
  • Sunflower seeds
  • Caraway seeds
These foods can get caught in the diverticula and cause inflammation and infection.

Non-medical methods for easing the pain associated with diverticulosis include:
  • Resting in bed with a heating pad over the abdominal area
  • Drinking only fluids for a day or two, and then slowly progressing to thicker liquids, then to solid foods
  • Reducing the amount of fiber for a few days if bloating and gas are present

Disease Progression

A serious complication that can arise from diverticular disease is inflammation of diverticula known as diverticulitis. Approximately 10% to 25% of people with diverticulosis will develop diverticulitis. Treatment for this progression of the disease may include medication, diet modification and/ or bowel rest. Surgery may be required for about one third or one fourth of those admitted into the hospital for treatment.

References

Krause's Food & Nutrition Therapy Textbook
http://www.medicinenet.com/script/main/art.asp?articlekey=79101
http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/
http://www.nlm.nih.gov/medlineplus/ency/article/000257.htm
http://www.mayoclinic.com/health/diverticulitis/DS00070/DSECTION=symptoms
http://www.puristat.com/conditions/dietfordiverticulitis.aspx