A diverticulum (single) is an outpouching of the wall of a hollow gut structure forming a sack or pouch. Diverticuli (pleural) can occur in many locations in the GI tract, but by far the most common are those that form in the colon (large intestine) and are called colonic diverticuli. If you have colonic diverticuli, you have a medical condition known as diverticulosis.
The incidence of diverticulosis increases with age. Its occurrence is estimated at 50% in people over 60 years of age and 80-90% of those over 80.
The diverticuli occur when high pressure exists inside the colon and this is complicated by straining to have bowel movements. This is much like straining and tightening of abdominal wall muscles which can cause abdominal wall hernias. The condition is noted more frequently in people who consume low fiber diets which results in infrequent small caliber stools that typically are desiccated (dry) and hard. The resulting increase in bowel lumen pressure is most prominent in the portion of the colon that is just above the rectum- the sigmoid colon. Weak areas exist in the wall of the colon where blood vessels and nerves enter the bowel and the weaker colon wall tends to balloon out causing the pouches (diverticuli).
Diverticulosis usually does not cause symptoms. However, fecal material and/or partially digested food particles can get trapped in a diverticulum causing inflammation and creating ideal conditions for bacteria to proliferate resulting in acute infection. Infection of a diverticulum is called diverticulitis.
As mentioned earlier, diverticulosis is most common in the sigmoid colon; therefore, typical acute diverticulitis causes severe abdominal pain in the left lower quadrant of the abdomen in the location of the sigmoid. Other symptoms include fever and chills, constipation and abdominal bloating, and occasional nausea and vomiting.
Treatment consist of a liquid diet for the first 48-72 hrs. with gradual progression to a low fiber diet. Antibiotics are prescribing for infection and possibly antispasmodics are given for pain. If constipation is present, avoid laxatives and enemas which can cause the involved diverticulum to perforate or rupture, spreading bowel contents and the infection throughout the abdominal cavity causing a serious illness called peritonitis. The constipation can be safely treated with stool softeners and increased fluid intake.
Other complications include rectal bleeding, bowel obstruction, and abscess formation. These situations frequently require surgery but their incidence is reduced by early antibiotic therapy.
Clinical studies have shown that dietary fiber is associated with a reduced risk of developing diverticulosis and decreasing attacks of diverticulitis. For many years, people known to have diverticular disease have been advised to avoid foods that are not completely digested, such as nuts, corn/pop -corn, and products that contain seeds such as tomatoes, cucumbers, and some berries. However, the most recent clinical investigations have shown that these types of foods are not a risk for developing diverticulitis. Unexpectedly, the studies have shown an increased diverticulitis risk with the ingestion of animal fats, particularly red meat.
Surprisingly, the studies have demonstrated that the risk for perforation is reduced in participants on statins (medications commonly used to treat elevated cholesterol).
Most important to remember is to prevent diverticulosis and diverticulitis eat a lot of fiber. Good sources include fruits, oats, beans, peas, and green leafy veggies.
Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers located at 1210 Commerce Dr. Suite 106, Greensboro, Ga. 30642. He can be reached at 706-510-3659. Visit his webpage at www.drtippett.com