Diverticulitis

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

Causes

The reason pouches form in the colon wall is not clear. Doctors believe it happens when food moves too slowly through the bowel and pressure in the colon increases. Undigested food or stool trapped in one of the pouches 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

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

Symptoms

Diverticulitis symptoms 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 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 fluid into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal spots in your colon
Flexible Sigmoidoscopy - a thin, lighted tube inserted into the rectum to examine the rectum and the lower colon
Colonoscopy - a thin, lighted tube inserted through the rectum and into the colon to examine the 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 muscle spasms and cramping help to control the discomfort.
Fluids
For mild inflammation, you can drink clear liquids for the first two to three days, while you rest in bed. For a more serious case, you will be admitted to the hospital, where fluids are given intravenously. You may need to have fluid removed from your stomach through a tube inserted down your throat.
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)
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

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.