Diverticulosis (cont.)
How do diverticula form?
The muscular wall of the colon
grows thicker with age. Thickening of the colon wall may reflect
the
increasing pressures required by the colon to eliminate feces. A
diet low in
fiber can lead to small, hard stools which are difficult to pass.
Over time,
vigorous contractions in the colon push the inner intestinal
lining outwards
(herniates) through cracks in the muscle walls. These pouches or
sacs that
develop are called diverticula.
What are the symptoms of diverticular disease?
Most patients with diverticulosis have few or no symptoms. The
diverticulosis condition in these individuals is found
incidentally during
tests for other intestinal problems. Twenty percent of patients
with
diverticulosis will develop symptoms related to
diverticulosis.
The most common symptoms of diverticular disease include:
These symptoms
are related
to difficulty of passing stool along the left colon narrowed by
diverticular disease.
More serious complications include:
- diverticulitis,
- collection
of pus
(abscess) in the pelvis,
- colon obstruction,
- generalized
infection of the
abdominal cavity (bacterial peritonitis), and
- bleeding into the
colon.
A diverticulum can rupture, and the bacteria within the colon can spread into the tissues surrounding the colon causing diverticulitis. Constipation or diarrhea may also occur. A
collection
of pus can develop around the inflamed diverticulum, leading to
formation
of an abscess, usually in the pelvis. On rare occasions, the
inflamed
diverticula can erode into the urinary bladder, causing
bladder
infection
and passing of gas during urination. Inflammation in the colon
can also
lead to bowel obstruction. Infrequently, a diverticulum
ruptures freely
into the abdominal cavity causing a life threatening infection
called
peritonitis.
Diverticular bleeding occurs when the expanding diverticulum erodes into a blood
vessel at
the base of a diverticulum. Rectal passage of red, dark or
maroon-colored
blood and clots occur without any associated abdominal pain.
Rarely, blood
may be black from a diverticulum of the right
colon.
Bleeding may be continuous or intermittent, lasting several
days.
Patients
with active bleeding usually are hospitalized for monitoring.
Intravenous
fluids are given to support the blood pressure.
Blood
transfusions are
necessary for those with moderate to severe blood loss. In a
rare
individual with brisk and severe bleeding, the blood pressure can
drop,
causing dizziness, shock, and loss of consciousness. In most
patients,
bleeding stops spontaneously and they are sent home after
several days in
the hospital. Patients with persistent, severe bleeding require
surgical
removal of the bleeding diverticula.
Next: How is the diagnosis of diverticulitis made? »
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