DIVERTICULAR
DISEASE
It may be more than what you ate.
Abdominal pain is a common complaint seen in Emergency
Departments on a daily basis, but is a concern that can be easily
addressed by a health care provider through a simple evaluation
to determine the specific cause.
Many causes resulting in abdominal pain include a simple upset
stomach, heartburn, appendicitis, bowel obstruction, kidney stone,
urinary tract infection, ovarian cyst or diverticular disease.
If the more serious concern of diverticular disease is diagnosed,
then treatment should begin. Let's look a little more closely
at this fairly common problem and treatment options.
What is diverticular disease? Diverticula
are little pouches in the large intestine that develop over years.
These little pouches
are actual herniations of weakened bowel that push from the inside
of the intestine outward. The inside of the large intestine or
colon should look nice and smooth. With diverticula, the colon
looks like a cobble stone road with the pouches extending into
the wall of the muscular intestine.
When a person has several diverticula, then the diagnosis of diverticulosis
is made. When stool and food particles get caught in these pouches,
they become inflamed and infected. This is called diverticultitis.
The older you become, the greater chance is that you may develop
diverticular disease.
How common is diverticulosis? This
is a very common cause of intestinal problems and the incidence
clearly increases with age. At age
65, about 50% of all Americans have diverticulosis. That incidence
will increase by 15% at age 85. It is a little more common in
women than men by about 10%. It is interesting to note that of
all people with diverticulosis, up to 25% will develop a case
of diverticulitis, that will require medical or surgical management.
What causes diverticulosis? In the
early 1900's, diverticular disease was first diagnosed in the
United States. The American
diet of processed foods that lack in fiber had lead to this progression.
Constipation is felt to be a leading irritant whereby the increased
pressure of stool in the colon leads a weakening of the wall of
the intestine. The weakening of the intestinal wall leads to the
development of diverticula.
What causes diverticulitis? A person who has
diverticulosis is at risk for developing inflammation and infection
of the little
pouches. These pouches retain bacteria, stool, and food leading
to an irritated condition that requires medical and sometimes
surgical management.
What are the symptoms of diverticulitis? Most
commonly, patients may present with vague complaints of abdominal
pain. The pain
is usually on the left side of the lower abdomen. It may be rather
sudden onset and nature. The pain will worsen over time and may
include nausea with vomiting. As the condition worsens, a person
may develop a fever and become very ill. Left untreated, the pouches
may become very inflamed and infected leading to rupture. This
is a very serious condition and at this point, intestinal contents
can spill inside the abdominal cavity, leading to a very serious
infection.
How is this diagnosed? Many people
know that they have diverticulosis, as it was incidentally diagnosed
on a screening colon exam. But,
sometimes the presentation of abdominal is the first hint of a
problem. The examining provider will get a history and perform
a physical examination. Blood tests may point to inflammation
or infection. The x-ray of choice is the CT Scan, which looks
at the structure of the intestine and whether an infection is
present. An abscess or collection of pus may be seen in the most
severe cases.
What is the treatment? Once the diagnosis
is made, changes in diet to avoid seeds and grains are recommended.
Bowel rest is
important. In patients that have a mild case, a two-week course
of oral antibiotics is recommended. In more serious cases, hospitalization
is necessary to provide intravenous antibiotics. The most serious
cases may require surgery to remove an abscess or a portion
of the damaged colon.
What else can I do? Prevention is key,
especially once the diagnosis of diverticulosis is made.
The avoidance of foods
with seeds,
grains, and vegetables difficult to digest is essential. It
is very important to seek medical attention when you develop
abdominal
pain, as diverticular disease is only one possible diagnosis
out of many others, some which can be life threatening.
