What Is Diverticulitis?
Diverticula may develop when pressure causes small pouches to protrude from the colon. While they rarely cause problems, they are most common after the age of 40, reports the Mayo Clinic. The presence of these pouches is called diverticulosis.
Diverticula are found in more than half of Americans older than 60. It is believed that people who eat low-fiber diets or diets containing mostly processed foods may be at greater risk. Because constipation and hard stools are more likely when people don’t eat enough fiber, straining to pass stools and putting pressure on the colon or intestines leads to the formation of these pouches.
Diverticulitis occurs when the pouches become inflamed or infected. Patients may experience abdominal pain, nausea, fever and bowel movement changes.
What Are the Symptoms?
Most people who have diverticulosis have no symptoms and don’t realize they have the condition, except perhaps for some bloating or cramping in the lower part of the abdomen. In rare cases, they may notice blood in the stool or on toilet paper.
People who develop diverticulitis, however, have more severe and sudden symptoms that become worse over a period of several days. Among the symptoms patients may experience:
● Pain or tenderness, either consistent or intermittent, most typically in the lower left quadrant of the abdomen, although it may occur on the right side
● Bloating or gas
● Fever or chills
● Nausea and vomiting
● Constipation or diarrhea
● A feeling of fullness, even without eating.
What Are My Risk Factors?
There are several factors that have been linked to an increased risk of developing diverticulitis. Among them:
● Age: Your chances of developing diverticulitis increases with age, and more than half of Americans over 60 have diverticulosis.
● Obesity: Being overweight increases your risk for developing diverticulitis, and being morbidly obese puts you at a greater risk of requiring more invasive treatment if you develop the condition.
● Smoking: Smokers are more likely than non-smokers to develop diverticulitis.
● Poor Physical Fitness/Lack Of Exercise: People who are more physically fit and who exercise regularly are at a lower risk of developing diverticulitis than those who have more sedentary lifestyles.
● Diet: Diets that are high in animal fat or processed foods and low in fiber may be a cause of diverticulitis.
● Medications: Mayo Clinic notes that several drugs have been linked to an increased risk of diverticulitis, including steroids, opiates and nonsteroidal anti-inflammatory drugs, including ibuprofen and naproxen.
Possible Complications
About 25 percent of people who develop this condition will develop complications, which range in severity and treatment. According to the National Institutes of Health (NIH), these complications may include:
● An abscess or pocket that fills with infected pus
● A perforation or hole in the lining of the colon
● A fistula or abnormal passageway that forms between sections of the colon or the bowel and the bladder
● A stricture, or narrowed area in the colon, as a result of scarring from the diverticulitis
Another severe complication, peritonitis, can occur if the infected pouch ruptures, causing the contents of the intestine to spill into the abdominal cavity. This life-threatening complication requires immediate medical care.
Diagnosis
Because most patients are unaware that they have developed diverticula, this condition is most often diagnosed during an attack. The symptoms of diverticulitis are somewhat general, so your doctor will have to perform a series of tests to rule out other potential conditions, starting with a physical exam. Women likely will undergo a pelvic exam to rule out pelvic disease.
Treatment
Mild cases of diverticulitis can be managed at home, using antibiotics to treat infection and over-the-counter (OTC) pain medications, such as acetaminophen, to manage pain. Your doctor likely will recommend a liquid diet for several days while your bowel heals, with solid foods gradually re-introduced as symptoms improve.
More serious cases or those with complications will likely require hospitalization for administration of intravenous (IV) antibiotics. If an abscess has formed, you may need to have a tube inserted to drain it.
In some particularly serious cases, surgery may be required, especially if a patient develops a complication, such as the ones outlined above, if the patient has a condition that compromises the immune system or has experienced multiple diverticulitis attacks.
A surgeon may recommend a primary bowel resection, in which the diseased portions of the intestine are removed and the healthy segments are reconnected, allowing the patient to maintain normal bowel movements. This procedure may be performed laparoscopically or as an open surgery.
In more serious cases, your doctor may have to perform a procedure called a bowel resection with colostomy. This more invasive procedure is performed when there is too much inflammation or damage to rejoin your colon and rectum successfully. When this situation occurs, you will have to have an opening, called a stoma, put in your abdominal wall, where the healthy section of your colon will connect to a colostomy bag to pass waste from the body. In some cases, this procedure may be reversed once inflammation eases.
While the symptoms and treatments for diverticulitis may be uncomfortable, it is a manageable condition when patients have a close relationship with their healthcare providers and maintain a healthy, vigilant lifestyle.