Diverticulitis
Diverticulitis
affects nearly half the Americans older than age 60, which have
small, bulging pouches (diverticula) in their digestive tracts, a
condition known as diverticulosis. Although diverticula can form anywhere,
including in your esophagus, stomach and small intestine, most occur in
your large intestine — especially on the left side of the colon just
above the rectum. Because these pouches seldom cause any problems, you may
never know you have them.
Sometimes, however, one or more pouches in the colon may
become inflamed or infected, causing severe abdominal pain, fever, nausea
and a marked change in your bowel habits. When diverticula become
infected, the condition is called diverticulitis. Mild cases of
diverticulitis can be treated with rest, changes in your diet and
antibiotics. But serious cases may require surgery to remove the diseased
portion of your colon. Occasionally, you may develop complications that
require emergency surgery.
Fortunately, only 15 percent to 20 percent of people
with diverticulosis ever develop diverticulitis. Best of all, you can help
prevent both types of diverticular disease by including more high-fiber
foods in your diet.
Signs
and Symptoms of Diverticulitis
Diverticulitis can feel like appendicitis, except you'll
generally have pain in the lower-left side of your abdomen, instead of the
lower-right side. The pain is usually severe and comes on suddenly, but
sometimes you may have mild pain that becomes worse over several days and
fluctuates in intensity. You may also have abdominal tenderness, fever,
nausea, and constipation or diarrhea.
Less common signs and symptoms of diverticulitis may
include:
Causes
of Diverticulitis
Diverticula usually develop when naturally weak places
in your colon give way under pressure. This causes marble-sized pouches to
protrude through the colon wall. Pouches are most common in your sigmoid
and descending colon — the lower portions of your large intestine just
above your rectum — and often occur as a result of straining during
bowel movements over a number of years. The pouches are small at first but
become larger with time.
Sometimes a bit of stool may become lodged in one of the
pouches, leading to infection. A small tear or perforation can also
develop in an infected pouch, which in turn can cause an infection within
your abdomen (peritonitis). If the infection is limited to an area around
the wall of your colon where the diverticula are inflamed, you may develop
a localized collection of pus known as an abscess.
Prevention
of Diverticulitis
The following measures can help prevent or slow the progression of
diverticular disease:
- Eating more fiber.
High-fiber foods, such as fresh fruits and vegetables and whole
grains, soften waste material and help it pass more quickly through
your colon. This reduces pressure inside your digestive tract. Aim for
25 to 30 grams of fiber each day. Try to substitute fruits, vegetables
and grain products for foods high in fat. Be sure to add fiber
gradually to avoid bloating, abdominal discomfort and gas. If you have
a hard time consuming 25 to 30 grams of fiber every day, consider
using a fiber supplement such as psyllium (Metamucil, Fiberall) or
methylcellulose (Citrucel).
- Drinking plenty of
fluids.
Fiber works by absorbing water and increasing the soft, bulky waste in
your colon. But if you don't drink enough liquid to replace what's
absorbed, fiber can be constipating. Try to drink at least eight
8-ounce glasses of water or other beverages that don't contain
caffeine or alcohol every day.
- Responding to bowel
urges.
When you need to use the bathroom, don't delay. Delaying bowel
movements leads to harder stools that require more force to pass and
increased pressure within your colon.
- Exercising regularly.
Exercise promotes normal bowel function and reduces pressure inside
your colon. Try to exercise at least 30 minutes on most days.
Treatments
In general, your treatment depends on the severity of
your symptoms and whether this is your first attack of diverticulitis. If
your symptoms are mild, a liquid or low-fiber diet and antibiotics may be
all you need. But if you're at risk of complications or have recurrent
attacks of diverticulitis, you may need more advanced care.
Home care
If your condition calls for home treatment, expect to remain quiet for
a few days. You'll also temporarily need to avoid all whole grains, fruits
and vegetables, so your colon can rest and heal. Once your symptoms
improve, often in two to four days, you can gradually start increasing the
amount of high-fiber foods in your diet.
In addition, your doctor will likely prescribe
antibiotics to help kill the bacteria causing your infection. Even if you
start feeling better, be sure to finish your entire course of medication.
Stopping too soon could cause your infection to come back. It also helps
create strains of bacteria that are resistant to antibiotics. If you have
moderate or severe pain, your doctor may recommend an over-the-counter
pain reliever such as acetaminophen (Tylenol, others) or a prescription
pain medication, although these medications tend to be constipating and
may aggravate the problem.
Hospitalization
About half the people with diverticulitis require hospitalization and
many need intravenous antibiotics. You're more likely to be hospitalized
if you have vomiting, a fever above 100 F, a high white blood cell count
or are at risk of complications such as a bowel obstruction or
peritonitis. You're also likely to need additional care if you are older,
have another disease or have a weakened immune system.
Diverticulitis
Surgery
If you have recurring diverticulitis, your doctor may recommend
surgery to remove the diseased part of your colon. There are two types of
surgery:
- Primary bowel
resection.
This is the standard surgery for people with diverticulitis. Your
surgeon will remove the diseased part of your intestine and then
reconnect the healthy segments of your colon (anastomosis). This
allows you to have normal bowel movements. Depending on the amount of
inflammation, you may have open (traditional) or laparoscopic surgery.
In open surgery, your surgeon makes one long incision in your abdomen,
while laparoscopic surgery is performed through three or four tiny
incisions. You'll heal faster and recover more quickly with
laparoscopic surgery. Unfortunately, it may not be an option if you
are very overweight or have extensive inflammation.
- Bowel resection with
colostomy.
This surgery may be necessary if you have so much inflammation in your
colon that it's not possible to rejoin your colon and rectum. During a
colostomy, your surgeon makes an opening (stoma) in your abdominal wall.
The unaffected part of your colon is then connected to the stoma, and
waste passes through the opening into a bag. A colostomy may be
temporary or permanent. Several months later — once the inflammation has
healed — your surgeon may be able to perform a second operation to
reconnect your colon and rectum.
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