Diverticular Disease
Many of us haven't even heard of it, but an estimated 30-50 percent of Americans over theage of 60 have Diverticular Disease.
Facts about Diverticular Disease
To understand Diverticular Disease, 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 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.
Diverticular Disease occurs when small pouches, known as diverticula, form in the walls of the large intestine or colon. It is believed that diverticula form when pressure inside the colon builds and makes the wall bulge in spots where it's naturally weak.
One of the causes of this pressure can be related to constipation. Normally your colon muscles move in waves, expanding and contracting as they move waste through your system. When the waste material is hard and dry, the muscles may have to squeeze harder, with more force.
There are many causes of constipation including medications, lack of exercise, stress, and inadequate intake of fluid and fiber. An adequate intake of fiber helps keep the stool soft and add bulk, so it takes less pressure to move through the colon.
Diverticular Disease and your Digestive System
To better understand the causes of Diverticular Disease, let's take a quick tour of your digestive system.
The digestive process begins in your mouth. Your teeth break up the food into small pieces and your saliva mixes with the food, allowing it to pass through the esophagus into the stomach. Using muscular contractions, the esophagus sends food from the mouth to the stomach.
Like a giant processing center, the stomach churns the food into smaller pieces, preparing it to travel on to the lower part of the digestive tract.
After leaving the stomach, the food passes into the small intestine, where the food's nutrients are further broken down and absorbed into the bloodstream. By the time food passes through all 21 feet of the small intestine and reaches the colon, only water and waste products remain.
Now the colon begins the process of removing waste from the body.
Here's how doctors think Diverticular Disease develops:
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A series of circular bands of muscle surround the colon. If two or more of these bands begin to contract at the same time, the colon cannot operate properly.
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What happens is that the contents of one section of the colon-gas, liquid, and waste material-cannot move on to the next section, as they should. So the trapped waste products press against the colon's wall, which is particularly dangerous for any weak spots.
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Through these weak spots, small sacs, or diverticula, bulge out of the intestinal wall in much the same way that a bicycle's inner tube can bulge out through a soft spot in the tire.
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No one knows why the muscle contractions of the circular bands become strong enough to set this process in motion. But what is known is that it takes years for Diverticular Disease to develop.
Divertlcular Disease Checklist
Diverticulosis
- Usually, no symptoms
- Occasionally, mild pain or cramping, more commonly on the left side
- Disturbed bowel habits, occasional constipation, rarely diarrhea
Diverticulitis
- Pain, severe at times
- Fever
- Nausea
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.
Diverticulitis
However, if the pouches become infected and inflamed, abdominal pain, fever, and nausea may result. This condition is called Diverticulitis. It is estimated that as many as one in five people who have diverticula may develop the complication of Diverticulitis.
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 Diverticular Disease
If you have Diverticular Disease, there's a good chance you don't know it. Usually, the small pouches (diverticula) that form in the wall of the colon do not cause any problems and can only be detected if you have an X-ray. Doctors are unsure of all the reasons for Diverticular Disease. But they think that the walls of the colon weaken during the normal aging process.
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.
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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
You feel some of the symptoms of Diverticular Disease. What do you do?
First, see your physician. He or she will ask about your bowel habits and history. The medical history is the physician's most important tool in diagnosing Diverticulitis.
The doctor also will perform a physical examination, which may include a close look at the rectum and the lower part of the colon. 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 with fiberoptic lenses, the doctor can examine the entire colon.. These exams view the colon from inside and provide additional information about the problem.
Treatment
In cases of Diverticulitis, antibiotics usually clear up the infected diverticula within a few days. While the colon is healing, the doctor may keep you on a low residue diet for a period of time.
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.
Managing Diverticular Disease
There are several ways to more Diverticular Disease. The following tips will help keep your colon functioning normally:
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Eliminate foods and other substances that may be irritating to the colon.
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Maintain an ideal weight.
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Eat a diet that includes high-fiber foods.
Adding Fiber To Your, Diet
If you have Diverticulosis which includes symptoms of occasional constipation, it's important to include high-fiber foods in your diet. Although fiber does not contain vitamins, minerals, or nutrients, it serves a vital function. Fiber itself adds bulk to keep other foods moving along the digestive tract, and it holds water which, in turn, softens the stool for easy elimination.
Fiber comes in two different forms:
soluble and insoluble. While they work differently, both are needed for proper bowel function. All fiber sources contain both kinds of fiber in varying amounts.
How can you get enough fiber in your diet?
The secret is to eat a well-balanced diet that includes a variety of high-fiber foods.
You don't have to totally rearrange your diet to accommodate more fiber. One way to start is to substitute high-fiber foods for low-fiber ones. Switch your bakery habits from white bread and rolls to whole-grain breads. Try brown instead of white rice. Eat whole grain cereal. And most easily of all, add fruits and vegetables to your diet.
Questions About Fiber:
Q: How much fiber do I need each day?
A: Nutrition experts suggest 20 to 35 grams a day, which is equivalent to 10 or more apples, oranges, or pears.
Q: What is the most effective way to add fiber to the diet?
A: By replacing high-fat, low-fiber foods with high-fiber ones. You can do this by eating wholegrain bread instead of white bread, eating vegetables such as broccoli with your dinner, and eating fruits unpeeled instead of peeled.
Q: At what rate should I add fiber to my diet?
A: In the beginning, go slowly. Too much too soon can cause gas and abdominal pain. It can take several weeks to add the recommended amount of bulk to the diet. While you're working on it, drink plenty of fluids.
Your general rule of thumb should be at least one serving of whole grain in every meal. Try this sample menu:
Breakfast - Cereal and / or toast. Make sure the first name on your cereals and breads is Whole Grain. Add banana slices to cereal.
Lunch - Sandwich on whole-grain bread. Carrot sticks.
Snack - Apple or raisins. Skip the candy bar, or at least cut back.
Dinner - Broiled chicken and steamed broccoli. Wheat rolls. Salad.
Fiber adds bulk to keep other Foods moving along.
Also, increase your intake of vegetables and fruit. You should be getting three servings of each every day. Try a sliced banana on your cereal, substitute carrot sticks for chips as a lunch side, and crunch on a salad for dinner. Wherever possible, eat the peels (you're off the hook with bananas and oranges).
There are possible downsides to increasing fiber. Some high-fiber foods, like beans, can produce excessive gas or bloating. Take in too much fiber too soon and you could suffer from bloating or abdominal cramps.
Remember, whenever you change your diet, for whatever reason, do it gradually. Let your body adjust. And check in with your doctor if you experience any discomfort.
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.