Diverticular disease refers to conditions that affect small pockets or pouches known as “diverticula,” which are found in your digestive tract.
These bulges or pockets develop in the lining of the colon or large intestine and typically occur when the inner layer of the digestive tract pushes through weak spots in the outer layer.
Basically, the presence of diverticula in one’s intestine is what then leads to common diverticular diseases like diverticulosis and diverticulitis.
What are the Types of Diverticular Diseases?
Diverticular diseases are far more prevalent amongst people ages 40 and above, and the term describes two conditions that involve the development of small sacs within the colon wall – diverticulosis and diverticulitis.
On the one hand, diverticulosis is simply the presence of diverticula in the lining of the intestine, which is normal but may cause an uncomfortable symptom like a stomach ache.
On the other hand, diverticulitis occurs when these pouches or bulges become inflamed and infected, which can lead to severe abdominal pain, nausea, fever, and bowel changes.
What are the Causes of Diverticular Diseases?
As we mentioned above, small bulges in the large intestine (diverticula) are the primary causes of diverticular diseases.
If any of these diverticula get inflamed or infected, it may develop into diverticulosis. Currently, there are no exact reasons for diverticula development, but the most commonly speculated reason, according to physicians, is a lack of fiber in one’s diet.
Some other factors that usually increase one’s risk of developing diverticular disease include the following:
- Age: The incidence of diverticulitis increases with age. More than half of all adults over 80 have the condition, even though only a few are unaware that they have diverticulosis.
- Genetic factors: Although some experts are not totally convinced that genes play a role in the development of diverticulosis, some studies have shown proof that certain genes do, in fact, play a part in the development of diverticulosis.
- Fiber: For many years, it has been said that a low fiber diet could lead to diverticulitis. This is because compared to a diet low in fiber, a fiber-rich diet makes your stools softer, which means your large intestine has to exert less pressure when moving them out of your body.
- Medications: Some studies have found links between diverticular disease and other medications, including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), opiates, and steroids.
- Bacteria: Your colon can also become infected if bacteria or stool accumulate in the pouch. This will lead to an increase in harmful bacteria in the colon and a decrease in healthy bacteria.
- Obesity: Being seriously overweight increases your likelihood of developing diverticulitis.
- Smoking: People who smoke cigarettes are more likely to develop Diverticular diseases than nonsmokers.
- Lack of exercise: Vigorous exercise can lower your risk of diverticulitis.
What are the Symptoms of Diverticulosis?
Although diverticulosis is very common among older people, most people living with the disease do not show any symptoms, and chances are they will not be aware of their condition until they undergo screening.
In the United States, diverticulosis affects more than 30% of adults aged 50 to 59 and more than 70% of those aged 80 and older.
The following are some symptoms of diverticulosis a patient may experience:
- Mild abdominal cramps
- Constipation
- Blood in the feces
- Bloating
- Tenderness over the affected area
- Flatulence
- Anemia due to repeated bleeding
Additionally, it’s important to remember that experiencing one or all of these symptoms does not mean you have diverticulosis.
These symptoms are common signs of many other gastrointestinal disorders such as irritable bowel, inflammatory bowel disease, appendicitis, gallstones, and stomach ulcers.
How is Diverticulosis Diagnosed and Treated?
Since most people do not necessarily present symptoms of diverticulosis, it may not be easy to find except during evaluation for another condition. To be sure, your doctor may request your medical history, do a physical exam or perform tests like a CT scan, a colonoscopy, or a blood sample.
If the test shows signs of diverticula, your doctor will suggest some treatment options you can follow to minimize the pain and prevent them from infection or inflammation.
The main goal of diverticulosis treatment is to alleviate symptoms as quickly as possible, so your doctor may recommend the following:
- Switching to a diet rich in fiber (green vegetables, oat bran, and fiber supplements such as psyllium) in order to improve bowel habits and mild symptoms.
- Over-the-counter painkillers like paracetamol to help relieve your symptoms.
- Using laxatives to treat and reduce constipation
- Surgery to remove seriously affected bowel segments when symptoms are disabling.
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What are the Symptoms of Diverticulitis?
The major difference is that the pain associated with diverticulitis is persistent and severe rather than intermittent.
This infection and inflammation of your diverticula can occur suddenly and without warning but is most likely to occur if you have previously experienced some symptoms of diverticulosis.
That said, some symptoms of a diverticula inflammation may include:
- Diarrhea and/or constipation
- Painful cramps or tenderness in your lower abdomen
- Chills or fever; you may develop a temperature (fever) of about 38C (100.4F) or above
- A general feeling of being tired and unwell
- Feeling sick and/or vomiting
- Rectal bleeding: One in twenty cases of diverticular disease is associated with heavy or constant rectal bleeding. In this case, the diverticula can weaken the blood vessels in your large intestine (colon), making them vulnerable to damage. Although bleeding is usually painless, excessive blood loss may require a blood transfusion.
If you notice that you are experiencing symptoms of diverticulitis, it is crucial that you see your doctor at once.
Your doctor will first want to know your medical history (such as bowel habits, symptoms, diet, and current medications). Then they will perform a physical exam, possibly including an abdominal exam. They may also order one or more diagnostic tests such as blood tests and CT scanning if needed.
How Can You Treat Diverticulitis?
If you have a mild case of diverticulitis, your doctor will prescribe antibiotics and may also prescribe some paracetamol for pain relief. Although you may feel better once you start taking medications, it is still important to finish your antibiotic course.
Besides this, your doctor may also recommend sticking to a fluid-only diet for several days until your symptoms improve. This is usually because trying to digest solid foods may only worsen your symptoms. If you begin to feel a lot better after 2-3 days, you can gradually introduce solid foods into your diet.
A low-fiber diet is recommended for the 3 to 4 days of recovery until you return to the preventative high-fiber diet. This is to reduce the number of feces (poo) your large bowel has to deal with while it is inflamed.
If you have more severe diverticulitis, you may need to go to the hospital, particularly if:
- Your pain cannot be reduced using paracetamol
- You are unable to drink enough fluids to keep yourself hydrated
- You are unable to take antibiotics by mouth
- Your general state of health is poor
- You have a weakened immune system
- Your GP suspects complications
- Your symptoms fail to improve after two days of treatment at home
If you are admitted to the hospital for treatment, you are likely to receive injections of antibiotics and be kept hydrated and nourished using an intravenous drip (a tube directly connected to your vein).
Most people start to show signs of improvement within 2 to 3 days. In some cases, your doctor may recommend the long-term use of mild antibiotics; this usually helps with preventing further attacks.
Getting Surgery for Diverticular Disease
In the past, doctors have recommended surgery as a preventative measure for people who had two episodes of diverticulitis as a precaution to prevent complications. This is no longer the case, as studies have found that in most cases, the risks of serious complications from surgery usually outweigh the benefits.
In very rare cases, a severe episode of diverticulitis can only be treated with emergency surgery. This is when a hole (perforation) has developed in the bowel. This is uncommon but causes very severe abdominal pain that requires an emergency trip to the hospital.
However, there are exceptions to this, such as:
- If you have a history of serious complications arising from diverticulitis
- If you have symptoms of the diverticular disease from a young age (the longer you live with diverticular disease, the greater your chances of having a serious complication)
- If you have a weakened immune system or are more vulnerable to infections
If you’re considering surgery, be sure to discuss the benefits and risks carefully with the doctor in charge of your care.
Living With Diverticular Disease
To help prevent recurring flare-ups, which happen in one-third of patients with uncomplicated diverticulitis, you may want to discuss some lifestyle adjustments you can make with your doctor.
Here are some questions you should ask your doctor:
- What lifestyle changes can I make to prevent the diverticular disease from getting worse?
- Is diverticular disease a sign of colon cancer or another health condition?
- Does having diverticular disease put me at an increased risk of colorectal cancer?
- Are there medicines that treat diverticular disease?
- Will I need surgery to treat diverticular disease? Are there other options?
In the past, doctors thought people with diverticulosis should avoid certain food, but recent research now suggests these foods aren’t harmful and won’t cause diverticulitis flare-ups.
Nonetheless, if you feel certain foods are worsening your symptoms, stop eating them and talk to your doctor. Additionally, you should also:
- Avoid smoking
- Eat less red meat
- Drink plenty of water (half your body weight in water)
- If obese, lose weight
- Consume a high fiber diet, i.e., at least 14 grams of fiber per 1,000 calories consumed
- Consider taking a fiber supplement (such as psyllium) alongside your regular meals
- Exercise regularly to encourage bowel function and peristalsis.
How to Build a Fiber-Rich Diet
Getting enough fiber is important to prevent recurring flare-ups. It is also beneficial to your health in the following ways:
- Relieves constipation
- Improves digestion
- Bulks up your stool
- Reduces cholesterol and glucose levels by slowing digestion.
- Helps with blood sugar control
- Assists in weight loss
- Reduces the risk of certain cancers
So, to boost your fiber intake, you will need to stick to foods like grains, fresh fruits, and vegetables and cut back on refined foods. Examples of food rich in fiber are:
- Whole-wheat flour
- Nuts,
- Potatoes
- Oats
- Beans,
- Apples
- Citrus
- Carrots
- Peas
- Broccoli
- Avocado
- Brussel sprouts
- Whole-wheat pasta
- Lima beans
- Raspberries
- Blackberries
- Pear
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