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To understand diverticulosis, it is helpful to know about the
anatomy and function of the intestine. The small intestine is the
long, thin segment of bowel that begins at the stomach and ends
at the large intestine or colon. The colon starts in the right
lower abdomen and forms a large question mark across the entire
abdomen ending in the rectum. Just above the rectum is the
sigmoid (S-shaped) part of the colon. Liquid stool enters the
right colon and, as it moves through the colon, is dehydrated so
that a formed stool eventually enters the rectum.
The Sigmoid Colon
The sigmoid colon has the specialized job of contracting
vigorously to maintain a high pressure. This action regulates the
movement of stool into the rectum. And since the sigmoid is a
high pressure part of the colon, it is here that most diverticuli
occur.
Diverticulosis
Diverticulosis means that there are pockets or projections
extending out from the colon. These occur very gradually over a
long period of time. They occur at weak points in the bowel
wall.
The pockets develop because of the pressure exerted within by
the contracting colon. As noted earlier, since the sigmoid colon
has the highest pressure in the colon, it is here that most
diverticuli occur. Because of these balloon-like projections, the
sigmoid often becomes thickened and narrowed. When this happens,
significant changes in the bowel function can occur, such as
discomfort, diarrhea, and/or constipation.
Who Gets Diverticulosis?
Since it takes so long to develop, diverticulosis usually
appears later in life. However, it is not uncommon to see this
occur in people who are in their 30s. Eventually the colon,
especially the sigmoid colon, becomes studded with these pockets.
The disorder is mostly one of Western society. It is uncommon in
rural Africa and India. The diet in these areas consists of
unprocessed foods and grains with a very high fiber content. So,
increased fiber ingestion may have great benefit.
Symptoms of Diverticulosis
As diverticuli form, few symptoms are noticeable, except
perhaps for intermittent spastic discomfort in the left lower
abdomen. Usually, there are no symptoms at all.
When diverticulosis is far advanced, the lower colon may
become very fixed, distorted, and even narrowed. When this
occurs, there may be thin or pellet-shaped stools, constipation,
and an occasional rush of diarrhea. The problem then becomes a
mechanical or structural one, and treatment is more
difficult.
Complications of Diverticulosis
It is, perhaps, remarkable that so few people have
complications of diverticulosis when compared with the number of
people who have the condition. Still, complications do occur and
they can be serious. Diverticulitis is the most common.
Diverticulitis
Like a balloon, as a diverticulum expands, it develops a thin
wall compared with the rest of the colon. The colon is home to
many beneficial bacteria-helpful as long as they stay in the
colon. However, these bacteria can seep through the thin wall of
diverticuli and cause infection. This infection around
diverticuli is called diverticulitis. It can be mild with only
slight discomfort in the left lower abdomen. Or it can be quite
extreme with severe tenderness and fever. Treatment is usually
needed for diverticulitis. It requires antibiotics and resting of
the bowel by avoiding food or, at times, even liquids. For severe
cases, the patient must be hospitalized.
Bleeding
At times, bleeding can occur from a ruptured blood vessel in
diverticuli. This may produce a gush of blood from the rectum or,
occasionally, black stools when the bleeding is from a
diverticulum in the right colon.
Perforation
This complication is the most uncommon but the most serious.
Bacteria escape into the abdomen where peritonitis, or an
abscess, can develop. Abdominal surgery usually is required to
correct this problem.
Diagnosis of Diverticulitis
The medical history is the physician's most important tool
in diagnosing diverticulitis. The physical exam may find
tenderness present in the left lower abdomen. A barium enema
x-ray usually is required to determine the extent of the
disorder. Flexible sigmoidoscopy and colonoscopy are exams
performed through the rectum with a lighted, flexible endoscope.
These exams view the colon from inside and provide additional
information about the problem.
Treatment of Diverticulosis
Diverticulosis may be preventable. As noted, fiber, bran and
roughage should be an important part of the diet. Certain types
of fiber, such as wheat bran retain large quantities of water.
This, in turn, provides a bulkier stool. This type of large, soft
stool may help decrease the pressure in the bowel over time.
Bulking agents are available in drug stores and can be effective.
The generic names for some of these products are psyllium and
methycellulose.
Bran and fiber can be found in very palatable forms in many
cereals, breads and other foods. Generally, a daily intake of 20
to 30 grams is recommended, beginning at a young age.
It is known that emotional stress can increase spasms of the
colon and, perhaps, result in the formation of diverticuli.
Stress should be controlled and treated if necessary. Also,
medications can be used to decrease spasm in the colon.
Surgery may be needed to remove the diseased portion of the
colon when diverticulitis occurs at an early age or when there
are recurrent episodes. When surgery is done in a non- emergency
situation, a colostomy is usually not needed.
Summary
Diverticulosis is a disorder that may be preventable if
treated early in life. At any stage, there is usually effective
therapy available. Diverticulitis, a complication of
diverticulosis, can be readily diagnosed by the physician and
effective therapy is available. Working with the physician,
prevention and treatment programs can be structured to obtain the
best results for the patient.
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