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Diverticulitis

Definition:
Diverticulitis is inflammation or infection in a pouch that forms in the wall of the large intestine (colon). The pouch is called a diverticulum (multiple pouches are called diverticula). The presence of pouches without inflammation is called diverticulosis.

Causes:
The reason(s) why pouches form in the colon wall is not clear. Doctors believe when food moves too slowly through the bowel, a constant pressure is built up. This pressure increase then pushes along the colonic side walls resulting in pouch formations. Digested food or stool becomes trapped in one of the pouches and leads to inflammation and infection.

The following may contribute to diverticulitis:

  • Low-fiber diet – fiber softens stools and makes them pass through the bowel more easily
  • Increased pressure in the bowel from straining to pass a hard stool
  • Defects in the colon wall
  • Chronic constipation
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.
  • Eating a low-fiber diet
  • Age: 50 or older
  • Previous episodes of diverticulitis
  • High meat or protein diet
  • Chronic constipation
Symptoms:
Diverticulitis symptoms can come on suddenly. They vary in intensity depending on the severity of the infection.

Symptoms include:

  • Abdominal pain
  • Tenderness, usually in the left lower abdomen
  • Swollen and hard abdomen
  • Fever
  • Chills
  • Poor appetite
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Both diarrhea and constipation
  • Cramping
  • Rectal bleeding
Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical and rectal exam. Early diagnosis is important, because the pouch can break, releasing stool into the abdomen. This is a surgical medical emergency.

Tests may include:

  • Analysis of a stool sample to look for blood
  • Blood tests to look for signs of infection, inflammation, and bleeding
  • X-rays to look for a rupture
  • CT scan or ultrasound to locate and determine the size of the inflamed pouch

Once the inflammation subsides, other tests may be performed, including:

Barium Enema - injection of a dye into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal pouches in your colon

Flexible Sigmoidoscopy - a thin, lighted camera is inserted into the rectum to examine the rectum and the lower colon

Colonoscopy - a thin, lighted camera is inserted through the rectum and into the colon to examine the entire lining of the colon

Treatment:
The goals of immediate treatment are to:
  • Resolve the infection and inflammation
  • Rest the bowel
  • Prevent complications

Treatments include:

Medications
Antibiotics and other microbe-fighting drugs are given to eliminate the infection. Pain medications and drugs to decrease the abdominal pain. Generally once the antibiotics start to work, the pain will subside.

Fluids
For mild inflammation, you can drink clear liquids for the first two to three days. For a more severe case, you will be admitted to the hospital, where fluids are given intravenously. Antibiotics will be administered to you via and intravenous line. If you have nausea and vomiting, a plastic tube may be inserted through your nose into your stomach. This will help with the vomiting and make you feel comfortable.

Preventive Care
Changes in your diet can help prevent future attacks of diverticulitis.
  • Increase the amount of fiber you eat, by eating more fruits, vegetables and whole grains.
  • Supplement your diet with a fiber product, as recommended by your doctor.
  • Avoid laxatives, enemas, and narcotic medications that can lead to constipation.
  • Avoid the following foods if your doctor recommends it:
    • Nuts
    • Corn
    • Seeds
    • Other foods that could get trapped in a pouch
Surgery
Surgery to remove the section of the bowel with pouches may be recommended if:
  • You have had multiple attacks during a two-year period
  • A pouch breaks and the contents spread into the abdominal cavity (will require cleaning out the abdominal cavity, as well)
  • When surgery is done on an elective basis, the surgeon will remove part of the disease bowel and hook the normal bowel together.

Surgery is also used to treat complications of diverticulitis, such as:

  • Abscess – occurs if the infected pouch fills with pus
  • Blocked bowel – scar tissue that forms and blocks movement of stool through the intestine
  • Fistula – occurs if the infection spreads and colon tissue attaches to another organ such as the bladder or the uterus/vagina
  • When surgery is done on an emergency basis, the surgeon will remove the disease bowel but will not hook the two ends of the bowel together. This is because of the serious infection. You will most likely end up with a piece of bowel coming out to your abdomen (colostomy). After a period of 6-12 weeks, the surgeon will go back and hook the bowel back together.
Prevention:
The following recommendations may help prevent diverticulitis by improving the movement of stool through the bowel and decreasing constipation:
  • Eat a balanced, high-fiber diet with plenty of fruits, vegetables and whole grains.
  • Drink eight 8-ounce glasses of water each day.
  • Exercise regularly.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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