In 1985, on April 21 (the same date as Tiradentes’ death), Tancredo Neves, the president who never took office, died of complications from a disease called diverticulitis.
Who lived this moment, remembers that the great communication vehicles had to make enormous reports explaining what was the diverticulitis and the generalized infection that took the life of the then president.
It is not just to refresh the memory of those who lived at the time or to present the disease to the youngest that we need to talk about diverticulitis. It is a condition that can have serious complications and lead to death, as was the case with Tancredo Neves.
Contents
What is diverticulitis?
Diverticulitis is the infection of the diverticulum, an intestinal condition called diverticular disease or diverticulosis .
Diverticula are pockets that form in the intestine (small or large). It is as if a part of the intestine grew outwards, forming a kind of balloon, which can be small or even reach considerable sizes, such as 10cm, 15cm.
Approximately 30% of people over 50 years of age develop diverticulosis, with that number reaching 70% among patients in their 80s and 90s.
When diverticula become inflamed, symptoms such as pain in the abdomen, nausea, vomiting, fever , constipation or diarrhea may appear. If not treated properly, it can cause bleeding, perforation of the intestine and widespread infection.
But to fully understand what diverticulitis is, we need to know more about diverticulum and what diverticular disease is.
It can be found in the ICD-10 through the code K57.
Diverticular disease
Diverticular disease occurs when small balloon-shaped bags appear, the famous diverticula , usually in the large intestine – but they can happen more rarely in the esophagus and stomach.
When it occurs in the intestine, this condition is called diverticulosis , and it usually develops during middle age. When you reach 50 years old, the intestinal wall starts to become more fragile and ends up giving way, causing diverticula to usually appear.
They do not usually cause many problems and are formed due to the natural weakening of the intestinal tissues due to age, genetic predisposition and diets lacking fiber.
Contrary to what many believe, there is no scientific evidence that seeds or other foods induce the formation of diverticula or even stop in the diverticula causing inflammation.
However, patients who have already been diagnosed with diverticula along the intestine are predisposed to diverticulitis and should seek a special diet, rich in fiber, but always with the consultation and endorsement of a nutritionist, as they can get worse in cases of diverticulitis or lower gastrointestinal bleeding.
Types
Diverticulitis can be divided according to the size and incidence of diverticula in the intestine – hypertonic and hypotonic diverticulitis – and the severity of the infection – acute and severe diverticulitis .
Understand the difference:
Classification according to size and incidence
One of the classifications of diverticulitis is due to the size of the diverticula and their incidence in the intestine, that is, the number of diverticula. Check out:
Hypertonic diverticulitis
The diverticula are very small and present on the left side (descending colon). They affect younger people, especially those between 40 and 60 years old, bringing about a strong symptomatic manifestation and, as a complication, perforation of the intestine.
Among the symptoms, patients experience constipation and evacuate into separate, hard pieces;
Hypotonic diverticulitis
It is characterized by large diverticula, in large quantities and present in most segments of the large intestine. The type is more common in elderly patients and, in general, is asymptomatic.
Intestinal function is normal or has constipation, with bleeding as a common complication.
Classification according to severity
Diverticulitis can also be classified according to the severity of symptoms and the possibility of complications. Understand:
- Acute diverticulitis : also called uncomplicated diverticulitis, this variation affects about 70% to 80% of patients with diverticulosis, causing mild symptoms, such as pain, nausea, constipation or diarrhea;
- Severe diverticulitis: usually comes with high fever, severe abdominal pain and the patient’s inability to eat. In such cases, hospitalization is common, as complications such as fistulas (perforations in the intestine) may develop.
What causes diverticulitis?
The diverticula arise due to the pressure of the fecal bolus on the intestinal wall. Over time, the tissue of this organ is thirsty, causing the formation of pouches.
It is speculated that one of the factors for the development of diverticulitis is a diet rich in animal fat and low in fiber, which would increase the pressure inside the intestine. In addition, as the age passes, the walls of the organ become less flexible, favoring the appearance of diverticula.
Diverticulitis, on the other hand, happens when feces enter the diverticulum causing inflammation. If left untreated, it can easily become an infection and lead to all the common complications of the disease due to the proliferation of bacteria.
Risk factors
There are several risk factors that can increase the chances of developing diverticulitis. Are they:
Obesity
Overweight and obesity are risk factors for the development of diverticulitis as the digestive system of obese patients is not regulated, which consequently leads to a higher incidence of diverticulosis (formation of diverticula), an essential factor for the development of diverticulitis.
In addition, in people with obesity, there is a greater accumulation of fat in the vessels that penetrate the intestinal wall. As fatty formations exert pressure on the intestinal wall, this may be one of the reasons for the formation of diverticula.
Sedentary lifestyle
People who do not exercise are more likely to develop diverticulitis, because the lack of physical exercise decreases intestinal transit time. This makes the stool more time putting pressure on the intestine, which can lead to the appearance of diverticula.
Smoking
Another risk factor for the onset of diverticulitis is smoking . When you smoke, the whole organism is compromised and, due to the action of nicotine and other substances in the digestive system, there are greater risks for the formation of diverticula.
Bad eating habits
Not eating properly, preferring foods that can increase intestinal pressure, such as animal fat, and leaving aside the fibers contained in fruits and vegetables makes the formation of diverticula more easily, which increases the chances of developing diverticulitis .
Aging
As time goes on, the intestine walls naturally lose the elasticity they had in the past. For that reason, people over 50 are more at risk for diverticulitis, making the formation of diverticula more likely.
Symptoms
Diverticulitis can happen in episodes, which means that the patient can suffer from it more than once in his life. According to a study by the University of Helsinki in Finland, approximately 39% of people who have had one episode of diverticulitis will have another one in the future.
That same study also showed that the first episode is usually the worst in terms of symptoms, especially as the patient is not sure what is affecting him.
Another explanation for this phenomenon is that the diverticulum heals after the first episode, which helps to prevent future inflammation and perforation. So, especially in mild cases, the chances of the disease coming back are lower.
However, while for some diverticulitis is just a one-off episode, for others the problem can become chronic. In such cases, surgery may also be necessary, in which a part of the intestine is removed.
The pain and tenderness in the abdomen can be constant and persist for several days. Usually, they occur on the left side of the abdomen, but they can also happen on the right side, especially in people of Asian descent.
In addition to the discomfort and discomfort in the region, other symptoms include:
- Swelling;
- Nausea;
- Vomiting;
- Cold;
- Diarrhea (less common);
- Fever;
- Urgency to urinate;
- Having to go to the bathroom more often to urinate;
- Burning when urinating;
- Bloody stools.
How is the diagnosis made?
There are several other conditions that can cause symptoms very similar to those of diverticulitis, so when you go to the doctor looking for a diagnosis, he may pass you a series of tests to eliminate other possible causes.
The doctor responsible for making the diagnosis and monitoring of diverticulitis is the gastroenterologist, digestive tract surgeon or coloproctologist . At the appointment, he will ask you about the symptoms, your medical history and what medications you use. A physical examination will also be done to check the sensitivity of the abdomen.
Still, how to diagnose diverticulitis only through physical evaluation is not possible, the doctor will order some tests, among them:
Digital rectal examination
The digital rectal exam is done to check the health of the final portion of the intestine. In it, the doctor inserts a finger into the anal cavity and searches, through touch, for changes in the region.
This test is surrounded by several taboos on the part of men, but it is one of the most practical ways to identify serious problems, such as prostate cancer , and it must be done at least once a year by men, usually over 40 years old.
Learn more: What is digital rectal examination? How is done?
Bloodtests
Blood tests, such as blood count and CRP (Reactive Protein C), try to rule out the possibility of inflammation, anemia and kidney or liver problems.
When there is inflammation or infection, the tests are usually elevated.
Image tests
Abdominal ultrasound and computed tomography are usually the exams chosen so that the doctor can analyze the gastrointestinal structures and check for the presence of diverticula, obstructions or dilations of the intestine.
Also included in this category are simple X-ray examinations of the abdomen (for cases where there is perforation) and magnetic resonance imaging.
Urine tests
It is important to do urine tests to rule out the possibility of infection by some other agent.
The test is simple, being done with the collection of the first urine of the day. Then, the sample is sent to the laboratory.
Stool test
The stool test is done to check whether or not gastrointestinal infections are present, such as infection by Clostridium difficile , responsible for colitis , for example.
Pelvic examination
In the common pelvic exam, the gynecologist will evaluate the entire genital region of the woman, first looking at the outside. Then, he makes use of a speculum (gynecological metal instrument) to be able to better visualize the internal parts of the vagina.
Then he will insert one or two fingers into the vagina to assess the condition of the tubes, ovaries and uterus. In the case of diverticulitis, the doctor also inserts the finger into the patient’s anus to check the integrity of the final portion of the intestine.
Along with this procedure, a pregnancy test is also recommended to rule out the possibility of pregnancy.
Colonoscopy
A colonoscopy uses a tube with a camera is inserted into the anus of the sedated patient. Diverticulosis is often discovered through this examination, which may already serve as an alert for the patient to take more care with food.
Enema opaco
This examination is done by inserting contrast in the intestine. Then, the patient is submitted to X-ray. Through the generated images, it is possible to see if there is the formation of diverticula and inflammation.
Differential diagnosis
It is important to make the differential diagnosis for other diseases, as soon as diverticulitis can present very mild symptoms and that, at times, can be confused. Among the suspicions that the doctor may have are:
- Carcinoma intestinal;
- Appendicitis;
- Ischemic colitis;
- Irritable bowel syndrome;
- Pelvic inflammatory disease;
- Colorectal cancer;
- Gastroenteritis;
- Intestinal constipation;
- Torsion of a cyst in the left ovary.
Is there a cure?
Yea! But it is important to emphasize that it is the diverticulitis (inflammation of the diverticula) that has a cure, and not diverticulosis (formation of diverticula in the intestine). The latter, although not curable, can be controlled.
Usually, the cure is through the use of antibiotic medications and temporary and permanent changes in the diet so that the intestines recover well.
What is the treatment?
The treatment for diverticulitis depends on the intensity of the symptoms, the presence or absence of complications, such as perforations, and whether it is the first crisis or if there have been previous ones. Understand:
Antibiotics
Drug treatment is done primarily with antibiotics, as it is intended to prevent the inflammation and possible infection of the diverticulum from becoming complicated, causing a generalized infection.
The doctor may even prescribe some medications to relieve the pain that the patient is feeling.
Liquid diet
For a few days, especially during the start of treatment, the doctor may prescribe a liquid diet, so that the intestines rest and recover better.
Low fiber diet
As your symptoms improve, your doctor may recommend that you eat a low-fiber diet to recover your gastrointestinal system. It may seem counterintuitive, but it turns out that fibers can help the diverticulum to retain feces, so for a few days it is best to avoid them and then reinsert them into the diet.
Follow-up
It is recommended that all patients undergo a medical follow-up with a colonoscopy after 6 or 8 weeks. This follow-up is necessary to confirm that the episode of diverticulitis was not related to other problems.
Surgery
In the latter case, there is the possibility of surgery to remove the portion of the intestine that has the inflamed diverticulum. Unlike in the past, surgery today practically leaves no scars, as it is done through laparoscopy, a process performed through small holes, which make it less invasive.
Still, it is an invasive procedure and should be done only in chronic cases or when there was a complication such as perforation of the intestinal wall, which causes feces to spread to other parts of the body.
Check now some reasons for the doctor to consider surgery as a therapeutic measure:
- When you have had 3 or more bouts of diverticulitis, or when a bout occurs in someone under 50, as the risks of serious complications are greater;
- When there is a narrowing of the lower part of the large intestine due to the formation of scars, as they can cause serious complications;
- When there is a sensitive and persistent mass in the abdomen, it can be cancer;
- When endoscopy or radiography shows changes in the lower part of the large intestine, it may be cancer;
- When there is pain when urinating or presence of air in the urine, as this may be indicative of the formation of a fistula (opening) between the intestine and the bladder;
- When there is sudden abdominal pain in people taking corticosteroids, as the large intestine may have ruptured within the abdominal cavity.
Medicines
The main form of treatment for diverticulitis is through the use of antibiotics. Treatment with these drugs should be continued for a period of 7 to 10 days, with the improvement of symptoms occurring between 2 and 3 days after the start of treatment.
The main antibiotics used to treat diverticulitis are:
- Amoxicillin ;
- Rifaximina;
- Clavulanic acid ;
- Sulfametoxazol + Trimetoprima;
- Metronidazole .
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Living together
Living with diverticulitis, especially if it is chronic, can be a very thankless process. Not only because of the inescapable pains of the crises, but also because, once the diverticulosis is diagnosed, it is necessary to make some life changes.
Although for some people these changes may be radical, difficult to make or even unwanted, in the end they contribute to the health of the individual with diverticulosis in the same way that they would contribute to the health of a person who does not have the problem.
So, look on the bright side: although you have a problem like diverticulosis, now you have no excuse, you are bound to lead a healthier life!
Treatment for the condition can be relatively simple, depending on the severity of the infection and inflammation, so living with the disease requires some behavioral changes, such as eating more fiber, improving nutrition and practicing physical activity.
Allied to this, it is very important to maintain medical attendance, carry out the exams periodically, as one must try as hard as possible to avoid a second crisis.
Prognosis
The prognosis of diverticulitis varies widely according to the degrees of infection and inflammation caused by the disease.
In cases where it was severe and there was perforation of the intestine, for example, the prognosis is not good, as the patient is at risk of generalized infection.
In cases where it is chronic, the prognosis is also poor, as it may be necessary for the patient to have surgery to remove the part of the intestine that presents the inflamed diverticula, which makes it often necessary even one colostomy (externalization of the intestine).
Despite this, when the cases are not so severe, the prognosis is good and, with treatment, the patient heals from the inflammation and / or infection, although he has to adopt a series of behavioral changes to prevent the disease from manifesting itself again.
Complications
If left untreated, diverticulitis can bring some complications to the body, such as:
Bleeding
Bleeding can happen inside the intestine even if there is no inflammation of the diverticulum itself. This process is called diverticular bleeding and can be identified by the presence of blood in the stool .
To treat this problem, it is usually necessary to have a colonoscopy to determine the bleeding site. In cases where bleeding is high, angiography (radiographic examination of blood vessels) and even surgery may be necessary.
Fistulas
Fistulas happen when there is communication between the intestine and other organs in the body due to inflammation and the appearance of wounds in the intestine wall, usually causing severe abdominal pain and the presence of feces in the urine.
The treatment of this complication will depend on the size and location of the fistula. It is done by the coloproctologist and it may be necessary to perform surgeries.
Bowel obstruction
Intestinal obstruction is a serious complication of diverticulitis. In it, the intense inflammation in the intestine prevents the passage of fluids and feces through the organ, which causes bloating, abdominal cramps and vomiting.
In such cases, it is necessary to perform surgery to correct or remove the inflamed part of the intestine.
Perforation of the intestinal wall
Perforation occurs when a crisis of diverticulitis has not been treated or has not been treated correctly. It causes intense abdominal inflammation and there may be contamination of other parts of the body by the stool, which can lead to severe infections.
In such cases, surgery is also performed to correct or remove the inflamed area of the intestine.
Generalized infection
Generalized infection is the most serious complication of diverticulitis. It was this complication, more specifically, that led Tancredo Neves to his death.
When there is contamination of the body by feces, it may be that many of the bacteria naturally present in the intestine, where they can stay without causing major problems, spread to the rest of the body, causing severe symptoms.
In such cases, especially if the infection has spread to multiple organs, treatment becomes more difficult as it can be difficult to control. It can happen that several organs stop working, the known multiple organ failure, which can lead the patient to death.
Prevention
Patients who have diverticulitis must also have diverticulosis. Therefore, to prevent diverticulitis, it is necessary to treat diverticulosis well, for example, through behavioral changes, to prevent any inflammation of these parts of the intestine from occurring. Understand:
Adopt a high fiber diet
The ideal is to consume between 25g and 35g of fibers per day. They are found naturally in a number of foods and facilitate the passage of feces, as they increase their volume. When the stool is not bulky enough, the intestine needs to push harder to push it out.
Prizes for hydration
It is very important to stay properly hydrated, as this has a direct impact on the proper functioning of the intestine. Water helps feces to move more easily through the intestine and prevent the formation of new diverticula.
It is generally recommended to drink approximately 2 liters of water per day and, for the patient with diverticulosis, this is no different.
Practice physical exercises
Exercising frequently and regularly helps to maintain more efficient bowel movements, which makes you less prone to constipation, which can lead to diverticulitis.
Physical exercise helps to reduce the amount of time it takes for food to pass through the digestive system.
Take the test yourself: 30 minutes of exercise a day, 5 times a week. Your gut and your health will thank you.
Avoid straining when going to the bathroom
When constipation occurs, do not force the feces out, as they can get stuck in the diverticula, possibly leading to diverticulitis.
If constipation comes, the best thing to do is to make an appointment with your doctor to, if necessary, use laxatives that allow you to go to the bathroom without having to apply force.
Diet for diverticulitis
To prevent diverticulitis attacks from occurring again, it is important to pay particular attention to food.
Since inflammation tends to occur when feces accumulate in diverticula, it is essential to look for food in a way to have more consistent stools that are not lodged in these portions of the intestine.
Check now the foods that should be consumed and avoided by those who have diverticulosis and want to avoid bouts of diverticulitis in the future!
Foods that should be part of the dish
The best type of food that can be eaten by those who want to improve the fecal cake are those rich in fiber, as they increase the volume of the stool, making the intestine need less effort to eliminate it.
It is worth remembering that the ingestion of the foods mentioned below are to prevent diverticulitis and should not be consumed during a crisis without medical approval , as it may happen that excess fibers hinder the recovery of the condition, since the fecal cake produced is larger .
Now, some foods that you can add to your daily life to prevent diverticulitis:
- Lentils;
- Black and red beans;
- Oat;
- Money;
- Apple;
- Integral rice;
- Banana;
- Orange;
- Strawberry;
- Dry fig;
- Raisins;
- Whole grain bread;
- Almonds;
- Broccoli;
- Quinoa;
- Avocado;
- Artichoke;
- Flax seeds;
- Corn;
- Carrot.
Foods to Avoid
On the other hand, there are foods that should be avoided during crises , as they can worsen symptoms and worsen the situation. Are they:
- Popcorn;
- Dry fruits;
- Vegetable or fruit peels;
- Peas;
- Coco;
- Tomatoes;
- Strawberries;
- Pickles;
- Cucumber;
- Café;
- Tea;
- Alcoholic beverages;
- Beetroot;
- Bean;
- Carrot;
- Broccoli;
- Cauliflower;
- Pumpkin;
- Cabbage;
- Cabbage.
Important reminder!
Always consult a nutritionist before adopting dietary changes! This is the most qualified professional to understand the body of each patient and what type of diet to adopt. In the case of diseases that require the restriction or adoption of certain foods as part of the treatment, the nutritionist should be consulted.
Common questions
Who has diverticular disease can not eat anything that contains seeds?
Yes you can! There is no study that proves that the seeds interfere in the intestines of a person who has diverticula.
Who has diverticulitis needs to do colostomy (externalization of the intestine)?
Not necessarily . It will only be necessary to have a colostomy when serious complications, such as perforation of the intestine, happen. This procedure is performed so that the recovery of the infectious condition takes place in a more effective and safe way.
Can diverticulitis become cancer?
No . Neither diverticulitis nor diverticulosis turned out to be cancer . This confusion happens because many patients affected by diverticulitis are also affected by cancer of the intestine. However, the two diseases have no causal relationship between one and the other.
In fact, the conditions are related to the extent that both have two risk factors in common: they are more prevalent among people aged 50 and over and are especially common in those who have a low-fiber diet.
Therefore, despite having no causal relationship, both bowel cancer and diverticulosis (and, consequently, diverticulitis), can be prevented through good nutrition.
Who has had diverticulitis once are more likely to have it again?
This index varies. According to a Finnish study at the University of Helsinki, approximately 39% of patients who have already had diverticulitis are likely to experience another in the future. However, it is not possible to know until it happens.
Is diverticulitis more common in Westerners?
More or less . Diverticulitis, in fact, is more frequent in industrialized countries, especially because of eating habits, which do not take into account the amount of fibers necessary for the proper functioning of the intestine.
However, the disease occurs in Eastern people as well, although in these cases it is more frequent that it happens on the right side of the intestine.
Diverticulitis is an inflammation and / or infection of parts of the intestine of people who have diverticular disease. Therefore, it is very important to maintain a healthy diet rich in fiber, always worrying about the proper functioning of the intestine.
Find out more about how to improve your health and your gut in the Healthy Minute!
