What is diverticulosis and diverticulitis?
Diverticula are small, bulging pouches that form in the lining of the large gut in some individuals. The presence of diverticula is known as diverticulosis. They are usually seen in people over the age of 40 years and are mostly harmless.
The condition when one or more diverticula become inflamed or infected due to the accumulation of waste products and bacteria is called diverticulitis. Diverticulitis can cause fever, severe abdominal pain, nausea, and change in bowel habits. Diverticulitis may be mild and treated conservatively with diet, medication, and rest. Severe and recurrent diverticulitis would require surgery.
What are the signs and symptoms?
In many cases, diverticulosis is asymptomatic. The condition may go undiagnosed till a routine colonoscopy is done. However, in a few individuals, diverticulitis causes symptoms - referred to as a diverticulitis attack or flare-up. One may have multiple, recurring episodes of flare-ups. The symptoms usually occur suddenly and may persist for days.
The most common signs and symptoms of a diverticulitis attack include:
What are the causes?
Diverticulitis occurs when one or more diverticula become inflamed or infected due to the accumulation of waste products and bacteria. Diverticulitis occurs due to the presence of diverticulosis.
Certain factors that may increase the risk of diverticulosis and diverticulitis, such as:
- Genetics: Genetics may play an important role. Having family members who have diverticulitis increases the risk of getting the condition.
- Age: The risk of getting diverticulitis increases with age, usually over the age of 40 years.
- Smoking: Nicotine and other chemicals in cigarettes and tobacco products can weaken the lining of the colon, causing diverticulosis and in-turn, diverticulitis.
- Dehydration: Dehydration affects digestion causing accumulation of waste products and harmful bacteria in the colon.
- Medications: Some medications, such as long-term pain killers or steroids, can cause weakening or irritation of the colon.
- Sedentary lifestyle: Regular exercise may decrease the risk of diverticulitis.
- Obesity: Being overweight causes increased pressure on the colon, increasing the risk of diverticulosis and diverticulitis.
- Constipation: Chronic straining while passing stools increases the pressure on the wall of the colon.
How is diverticulitis treated?
Diverticulosis usually does not require treatment, but regular follow-up and lifestyle modifications may be advised.
Diverticulitis requires treatment and the treatment options depend on the severity of the signs and symptoms.
Mild or uncomplicated diverticulitis:
If the symptoms are mild, diverticulitis may be treated conservatively on an out-patient basis, at home. Treatment may include:
- Antibiotics to treat the infection
- A liquid diet until the symptoms improve, after which solid food can be slowly included in the diet.
- Plenty of rest
Severe or complicated diverticulitis:
A severe attack of diverticulitis may even require hospitalization. Treatment may include:
- Intravenous (IV) antibiotics
- Pain killers
- Drainage of abscess if one has formed
- Liquid diet
Surgery may be indicated in the following cases:
- Complications, such as abscess, fistula or bowel obstruction, or perforation of the bowel wall.
- Multiple, recurring episodes of uncomplicated diverticulitis.
- A weak immune system due to other conditions like HIV or diabetes.
There are two main types of surgery:
- Primary bowel resection: Diseased segments of the intestine are removed (resection) and the ends of the healthy segments are reconnected (anastomosis). This is also called bowel resection and anastomosis. It may be performed as an open surgery or a minimally invasive (laparoscopic) procedure.
- Bowel resection with colostomy: If the inflammation is severe, it may not be possible to reconnect the colon and rectum. In such cases, a colostomy may be performed. A colostomy is an opening (stoma) made in the abdominal wall, which is connected to the healthy part of the colon. Bowel waste (stools) passes through the opening and into the bag (colostomy bag). Once the inflammation resolves, the colostomy may be reversed, and the healthy segments of the bowel may be reconnected.
The following lifestyle modifications may help prevent diverticulitis or further attacks by promoting healthy bowel function:
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