Diverticulosis


 

Diverticulosis is quite common, especially as people age. Research suggests that about 35 percent of U.S. adults age 50 years or younger have diverticulosis, while about 58 percent of those older than age 60 have diverticulosis. Most people with diverticulosis will never develop symptoms or problems.

Experts used to think that 10 to 25 percent of people with diverticulosis would develop diverticulitis. However, newer research suggests that the percentage who develop diverticulitis may be much lower—less than 5 percent.

In the United States, about 200,000 people are hospitalized for diverticulitis each year. About 70,000 people are hospitalized for diverticular bleeding each year.

Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine (colon). Diverticula are common, especially after age 40, and seldom cause problems. Sometimes, however, one or more of the pouches become inflamed or infected. Diverticulitis occurs when you have diverticulosis and one or a few of the pouches in the wall of your colon become inflamed. Diverticulitis can lead to serious complications.

The cause is uncertain.. Doctors aren’t sure what causes diverticula in the colon (diverticulosis). But they think that a low-fiber diet may play a role. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon.

Most patients who are diagnosed with diverticulitis have sudden left lower quadrant abdominal pain. Other symptoms may include:

  • fever,
  • nausea,
  • diarrhea or constipation, and there may be blood in the stool.

If your doctor suspects you may have diverticulitis, your doctor may use your medical history, a physical exam, and tests to diagnose these conditions.

Doctors may also diagnose diverticulosis if they notice pouches in the colon wall while performing tests, such as routine x-rays or colonoscopy, for other reasons.

Your doctor may use the following tests to help diagnose diverticulosis and diverticulitis:

Blood test

A health care professional may take a blood sample from you and send the sample to a lab to test for inflammation or anemia.

CT scan

A computerized tomography (CT) scanuses a combination of x-rays and computer technology to create images of your gastrointestinal (GI) tract.

An x-ray technician performs the procedure in an outpatient center or a hospital. A radiologist reads and reports on the images. You don’t need anesthesiafor this procedure.

For a CT scan, a health care professional may give you a solution to drink and an injection of a special dye, called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. A CT scan of your colon is the most common test doctors use to diagnose diverticulosis and diverticulitis.

Lower GI series

A lower GI series, also called a barium enema, is a procedure in which a doctor uses x-rays and a chalky liquid called bariumto view your large intestine. The barium will make your large intestine more visible on an x-ray.

An x-ray technician and a radiologist perform a lower GI series at a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You don’t need anesthesia for this procedure.

For the procedure, you’ll be asked to lie on a table while the radiologist inserts a flexible tube into your anus and fills your large intestine with barium. You will need to hold still in various positions while the radiologist and technician take x-ray images and possibly an x-ray video, called fluoroscopy. If pouches are present in your colon, they will appear on the x-ray.

Colonoscopy

Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon.

A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You will receive sedatives, anesthesia, or pain medicine during the procedure.

During a colonoscopy, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and into your colon. Doctors may use colonoscopy to confirm a diagnosis of diverticulosis or diverticulitis and rule out other conditions, such as cancer.

Treatments of Diverticulitis

The goal of treating diverticulosis is to prevent the pouches from causing symptoms or problems. Your doctor may recommend the following treatments.

High-fiber diet

Although a high-fiber diet may not prevent diverticulosis, it may help prevent symptoms or problems in people who already have diverticulosis. A doctor may suggest that you increase fiber in your diet slowly to reduce your chances of having gasand pain in your abdomen. Learn more about foods that are high in fiber.

Fiber supplements

Your doctor may suggest you take a fiber product such as methylcellulose (Citrucel) or psyllium (Metamucil) one to three times a day. These products are available as powders, pills, or wafers and provide 0.5 to 3.5 grams of fiber per dose. You should take fiber products with at least 8 ounces of water.

Medicines

Some studies suggest that mesalazinetaken every day or in cycles may help reduce symptoms that may occur with diverticulosis, such as pain in your abdomen or bloating. Studies suggest that the antibiotic rifaximin (Xifaxan) may also help with diverticulosis symptoms.

Probiotics

Some studies show that probiotics may help with diverticulosis symptoms and may help prevent diverticulitis. However, researchers are still studying this subject. Probiotics are live bacteria like those that occur normally in your stomachand intestines. You can find probiotics in dietary supplements—in capsule, tablet, and powder form—and in some foods, such as yogurt.

For safety reasons, talk with your doctor before using probiotics or any complementary or alternative.

To help prevent diverticulitis:

  • Eat a high-fiber diet that is low in fat and red meat.
  • Drink plenty of water.
  • Exercise regularly.

Surgery is often not needed to treat diverculitis.Complications, such as peritonitis, abscess, or fistula may require surgery, either immediately or on an elective basis. In most cases, the decision to perform elective surgery is taken when the risks of the surgery are smaller than the ones resulting from complications of the condition.

Elective surgery may be performed at least six weeks after recovery from acute diverticulitis.

Emergency surgery is necessary for people whose intestine has ruptured; intestinal rupture most always results in infection of the abdominal cavity.During emergency diverticulitis surgery, the ruptured section is removed and a colostomy or ileostomy is performed. This means that the surgeon will create an opening between the large intestine and the surface of the skin. The colostomy is closed in about 10 or 12 weeks in a subsequent surgery in which the cut ends of the intestine are rejoined.

Diverticulitis surgery can be done in two ways: through a primary bowel resectionor through a bowel resection with colostomy. Both bowel resections may be done in the traditional way or by laparoscopic surgery.

The traditional bowel resection is made using an open surgical approach, called colectomy. During a colectomy, the patient is placed under general anesthesia. A surgeon performing a colectomy will make a lower midline incision in the abdomen or a lateral lower transverse incision. The diseased section of the large intestine is removed and then the two healthy ends are sewn or stapled back together. A colostomy may be performed when the bowel has to be relieved of its normal digestive work as it heals. A colostomy implies creating a temporary opening of the colon on the skin surface and the end of the colon is passed through the abdominal wall and a removable bag is attached to it. The waste will be collected in the bag.

However, most surgeons prefer performing the bowel resection laparoscopically, mainly because the postoperative pain is reduced and the patient’s recovery is faster. The laparoscopic surgery is a minimally invasive procedure in which three to four smaller incisions are made in the abdomen or navel.

All colon surgery involves only three maneuvers that may vary in complexity depending on the region of the bowel and the nature of the disease. The maneuvers are the retraction of the colon, the division of the attachments to the colon and the dissection of the mesentery.After the resection of the colon, the surgeon normally divides the attachments to the liver and the small intestine. After the mesenteric vessels are dissected, the colon is divided with special surgical staplers that close off the bowel while cutting between the staple lines.

When excessive inflammation of the colon renders primary bowel resection too risky, bowel resection with colostomy remains an option. Also known as the Hartmann’s operation, this is a more complicated surgery typically reserved for life-threatening cases. The bowel resection with colostomy implies a temporary colostomy, which is followed by a second operation to reverse the colostomy. The surgeon makes an opening in the abdominal wall (a colostomy) which helps clear the infection and inflammation. The colon is brought through the opening and all waste is collected in an external bag.

The colostomy is usually temporary, but it may be permanent, depending on the severity of the case. Most of the time, several months later after the inflammation has healed, the patient undergoes another major surgery, during which the surgeon rejoins the colon and rectum and reverses the colostomy.

Medicines

Some studies suggest that mesalazinetaken every day or in cycles may help reduce symptoms that may occur with diverticulosis, such as pain in your abdomen or bloating. Studies suggest that the antibiotic rifaximin (Xifaxan) may also help with diverticulosis symptoms.

Probiotics

Some studies show that probiotics may help with diverticulosis symptoms and may help prevent diverticulitis. However, researchers are still studying this subject. Probiotics are live bacteria like those that occur normally in your stomachand intestines. You can find probiotics in dietary supplements—in capsule, tablet, and powder form—and in some foods, such as yogurt.

For safety reasons, talk with your doctor before using probiotics or any complementary or alternative

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