CONDITIONS
Diverticulitis
What is diverticulitis?
Diverticulitis is a condition characterized by inflammation or infection of small pouches (called diverticula) that can develop in the walls of the colon, particularly in the sigmoid colon, which is the lower part of the large intestine. These pouches form when weak spots in the colon’s muscular walls bulge outward, referred to as diverticulosis.
When these pouches become inflamed or infected, it leads to diverticulitis. The exact cause of diverticulitis is not fully understood. Still, it is believed to involve a combination of factors, including a low-fiber diet, lack of exercise, obesity, smoking, and genetic predisposition.
What increases the risk of diverticulitis?
Several factors can increase the risk of diverticulitis. These include:
- Age over 40 years
- Obesity
- Lack of exercise
- Smoking
- Eating a lot of fat and red meat
- Eating low-fiber diet
- Certain medicines like steroids, opioids, and nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen.
What are the types of diverticulitis?
There are four types:
Acute/Chronic
Acute: Diverticulitis typically starts as an acute issue, appearing suddenly and resolving quickly with treatment.
Chronic: Some individuals experience recurring episodes of diverticulitis, while others may develop chronic symptoms that persist over time. In chronic diverticulitis, inflammation, and infection may go down but never clear up completely. Various theories exist regarding the reasons behind this occurrence, such as incomplete healing of an acute episode or a connection to another chronic condition in the colon.
Uncomplicated/ Complicated
Uncomplicated: This is the most common type of diverticulitis. It can be easily treated with the appropriate medical care.
Complicated: Diverticulitis can become complex when the inflammation leads to additional complications. For instance, intense acute inflammation could result in the rupture of a diverticulum. Long-term inflammation may lead to scarring.
What are the symptoms of diverticulitis?
Possible symptoms can include:
- Severe abdominal pain, usually in the left lower part of the abdomen
- A distended abdomen or a colon that can be felt by hand.
- Fever
- Nausea and vomiting.
- Rectal bleeding.
- Constipation or, in rare cases, diarrhoea.
How is diverticulitis diagnosed?
The diagnosis of diverticulitis is based on medical history and a physical examination. Additionally, tests may be conducted to rule out other potential causes of the condition, such as blood tests, urine tests, and a CT scan of the abdomen.
- Blood, urine, and stool tests to check for infection
- CT scan of the abdomen to look for inflamed or infected diverticula
- A colonoscopy may also be necessary to examine the entire large intestine by inserting a tube through the anus, rectum, colon, and other parts of the large intestine. This procedure aims to assess diverticula and identify any other underlying factors contributing to the symptoms.
What is the treatment for diverticulitis?
The treatment for diverticulitis depends on the severity of the condition.
If the diverticulitis is mild and there are signs of infection, such as fever or elevated white blood cell count, the doctor is likely to recommend
- Antibiotics to treat the infections.
- A liquid diet gives the digestive system a chance to rest and heal. As symptoms improve, an individual can gradually transition to a low-fiber or high-fiber diet, depending on the doctor’s recommendations.
For severe diverticulitis, the individual may need hospitalization. Treatment includes bowel rest (nothing by mouth) and intravenous antibiotics
Surgery is typically necessary for the treatment of diverticulitis in the following situations:
- The presence of complications such as a bowel abscess, fistula, obstruction, or a puncture in the bowel wall.
- Multiple episodes of uncomplicated diverticulitis.
- A weakened immune system.
Two main types of surgical procedures can be performed:
- Primary bowel resection: In this procedure, the surgeon removes the diseased segments of the intestine and then reconnects the healthy segments through an anastomosis. This allows for normal bowel movements. Depending on the level of inflammation, the surgery may be performed as an open procedure or a minimally invasive laparoscopic procedure.
- Bowel resection with colostomy: If the inflammation is severe and it is not possible to rejoin the colon and rectum, a colostomy is performed. This involves creating an opening (stoma) in the abdominal wall connected to the colon’s healthy part. Waste passes through the stoma into a bag. Once the inflammation has subsided, the colostomy can be reversed, and the bowel can be reconnected.
Can diverticulitis be prevented?
According to studies, adopting certain lifestyle choices can decrease the chances of developing diverticulitis. These choices include:
- Consuming a diet that is high in fiber and low in red meat
- Regularly participating in physical activity
- Not smoking, or quitting smoking
Maintaining a healthy weight
In summary, diverticulitis is a condition characterized by the inflammation or infection of small pouches called diverticula that form along the walls of the colon (large intestine). These pouches typically develop when weak spots in the colon’s muscular wall give way under pressure. Diverticulitis can range from mild to severe and may lead to complications if left untreated. Symptoms of diverticulitis can vary but often include abdominal pain (usually on the left side), fever, nausea, vomiting, constipation, or diarrhoea. In severe cases, complications such as abscesses, perforation of the colon, or fistulas (abnormal connections between organs) may occur. Treatment for diverticulitis depends on the severity of symptoms. Mild cases of infection may be managed with rest, dietary changes, and antibiotics. Severe cases or complications may require hospitalization, intravenous antibiotics, and, in some cases, surgery to remove the affected portion of the colon. People who have experienced diverticulitis may benefit from long-term lifestyle changes to prevent recurrence. This includes maintaining a high-fiber diet, staying hydrated, exercising regularly, and avoiding smoking.
References
- Cleveland Clinic. Diverticulitis. Available from: https://my.clevelandclinic.org/health/diseases/10352-diverticulitis. Accessed on May 14th, 2024.
- Available from: https://www.webmd.com/digestive-disorders/understanding-diverticulitis-basics. Accessed on May 14th, 2024.
- Mayo Clinic. Diverticulitis. Available from: https://www.mayoclinic.org/diseases-conditions/diverticulitis/diagnosis-treatment/drc-20371764. Accessed on May 14th, 2024.
- National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Diverticular Disease. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/treatment. Accessed on May 14th, 2024.
