Digestive Health

By Dr Saravana K.

Diverticulosis is the formation of numerous tiny pockets, or diverticula, in the lining of the bowel. It is formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid and while straining during a bowel movement. They are most common in the lower portion of the large intestine. Complications with diverticulosis include:

Bleeding which occurs with chronic injury to the small blood vessels that are adjacent to the diverticula. Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This occurs when outpouchings become blocked with waste, allowing bacteria to build up, causing infection.

The occurrence of diverticulosis increases with age. Usually diverticulosis does not cause any troublesome symptoms. Good bowel hygiene is most important to prevent diverticular disease or reduce the complications from it. This means having regular bowel movements and avoiding constipation and straining. Eating appropriate amounts of the right types of fibre are important to maintain good bowel hygiene. Drinking plenty of water and exercising regularly are also important.

What are the symptoms of diverticulitis?

  • Painful cramps or tenderness in the lower abdomen
  • Chills or fever

How is diverticulitis diagnosed?

Tests may include X-rays, CT scanning, ultrasound testing, a sigmoidoscopy, colonoscopy, barium enema, and blood tests to look for signs of infection or the extent of bleeding.

In people with rapid, heavy rectal bleeding, the doctor may perform a procedure called angiography to locate the source of the bleed. During this test, doctors inject the patient’s arteries with a harmless dye that will allow the doctor to view the source of the bleeding.

How is diverticulitis treated?

Diverticulitis sometimes resolves without medical treatment, but it frequently requires antibiotics. Sometimes the infection is so severe that it is necessary to be admitted to a hospital for intravenous antibiotics and other supportive care. Rarely, a surgeon may need to remove the affected part of the bowel.

During the active stage of the infection, many experts recommended eating a low-fibre diet and drinking plenty of water. A month or so after the infection resolves, fibre should be back on the menu.

Emergency treatment, including surgery, may be needed when the antibiotics do not work, and in cases of a large abscess, perforation, peritonitis, or continued rectal bleeding.

What complications are associated with diverticulitis?

Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity, causing the following problems:

  • Peritonitis (a painful infection of the abdominal cavity)
  • Abscesses (“walled off” infections in the abdomen)
  • Obstruction (blockages of the intestine)

If an abscess is present, the doctor will need to drain the fluid by inserting a needle into the infected area. Sometimes surgery is needed to clean the abscess and remove part of the colon. If the infection spreads into the abdominal cavity (peritonitis), surgery is needed to clean the cavity and remove the damaged part of the colon. Without proper treatment, peritonitis can be fatal.

Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A complete blockage requires emergency surgery, although a partial blockage does not.

Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. The most common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.

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