Diverticulitis and diverticulosis: symptoms and therapy

Diverticulitis is a condition that occurs when one or more diverticula in the digestive system become inflamed or infected.


What are diverticula?

A diverticulum is a small structure shaped like a sac with a narrow neck that protrudes from the intestinal mucosa.

Diverticula can develop in any part of the intestine, but they are usually found in the sigmoid colon, which is the end of the colon (also called the large intestine).
As a rule, they develop in the section of the colon closest to the rectum and where the stools become firmer.
Therefore, the most affected area is the left side of the abdomen.
Over time, several diverticula can develop.

Diverticulosis occurs when at least two diverticula form in the wall of the colon.
Diverticulosis and diverticulitis together are called diverticular disease.

Diverticula are more common in the elderly. About half of all people over the age of 60 have diverticulosis.

Classification according to Hinchey

  • First stage: paracolic abscess
  • Second stage: spread of the abscess (pelvic area or retroperitoneum, i.e. behind the peritoneum)
  • Third stage: purulent peritonitis
  • Fourth stage: fecal peritonitis

Causes of diverticulitis

Diverticulosis is believed to be due to an increase in pressure on the inner wall of the intestine.
As the body ages, the outer layer of the intestinal wall thickens.
This causes a narrowing of the intestinal interior.
The stool moves more slowly through the large intestine, which increases the pressure.
Hard stools can be the result of a low-fiber diet or too long a “transport time” in the colon. These factors increase the pressure on the intestinal walls.
Frequent and repeated pressing during defecation increases the pressure and contributes to the formation of diverticula.
In Western industrialized countries, diverticulosis is largely caused by a low-fiber diet.
Fiber is found in fruits and vegetables, whole grains, and legumes (dried beans, peas, and lentils).
There are two types of fiber: soluble (it dissolves in water) and insoluble.
The soluble fiber forms a gelatinous and soft substance in the digestive tract.
The insoluble fiber passes through the digestive tract almost unchanged.
Both are necessary to keep the stool soft and allow smooth movement through the digestive tract, thus preventing constipation.

Symptoms of diverticulosis

The most common symptom of diverticulosis is intermittent pain in the lower abdomen (intestines), especially on the lower left side.
In the acute phase, the pain often increases when eating and shortly thereafter. Defecation and flatulence can relieve the pain.
Other symptoms of diverticulosis include:

  • altered bowel function, such as constipation, diarrhea, or episodes of constipation, which in turn are followed by diarrhea;
  • Fullness;
  • Bleeding from the rectum.

Symptoms of diverticulitis

The main symptom of diverticulitis is a constant and severe pain. The pain usually begins below the navel before moving to the lower left side of the abdomen.
In the Asian population, the pain can be located on the lower right side of the abdomen. The reason for this is that Asians tend to develop diverticula elsewhere in their colon. The reason is believed to be genetic (some genes discovered in Asian peoples can alter the natural course of diverticulitis).

In addition to severe stomach pain, other symptoms of diverticulitis include:

  • high fever, 38º or higher,
  • Indisposition
  • constipation (constipation),
  • hemorrhagic complication,
  • Anorexia
  • Bleeding from the rectum.

Diagnosis of diverticulitis

Since diverticulosis is often asymptomatic (without symptoms), it is usually discovered during the examination of other diseases, such as colorectal cancer (colon cancer).
As a rule, diverticulitis is diagnosed during an acute attack.

The examinations that confirm the diagnosis of diverticulitis include:

Medical history – including diet.

Physical examination – with rectal examination.

Colonoscopy – the colonoscopy is done through a thin, flexible tube that is inserted into the anus so that the doctor can look at the entire length of the colon.

Contrast enema – a special dye is injected into the intestine through the anus, after which an X-ray is taken.

CT – to visualize abscesses outside the inner wall of the intestine.

Blood test – to show signs of infection.

Stool examination – to detect the presence of occult blood in the stool or the presence of an infection that can cause the same symptoms as diverticulosis and diverticulitis.

Differential diagnosis

The doctor must exclude the following diseases:

  • Irritable bowel syndrome
  • Ulcerative colitis
  • Crohn’s disease

What are the complications of diverticulitis?

As a result of diverticulitis, serious complications can occur. Most complications are the result of injuries and perforations of the intestinal wall.
In this case, the intestinal contents (stool) can empty from the intestine into the surrounding abdominal cavity and cause the following problems:

  • Peritonitis (a dangerous infection of the abdominal cavity)
  • Abscesses (an infection in the abdomen)
  • Obstruction (intestinal obstruction)

If there is an abscess, treatment may be needed to drain the fluid by inserting a needle into the infected area.
Sometimes surgery is required to clean the abscess cavity and remove part of the colon.
If the infection has spread to the abdominal cavity (peritonitis), an urgent operation is required to clean the abdominal cavity and remove the damaged part of the colon.
Without appropriate therapy, peritonitis can be fatal.
The infection can lead to fibrosis in the colon and the fibrotic tissue can cause partial or total intestinal obstruction.
Partial intestinal obstruction does not need to be treated by emergency surgery.
However, an emergency operation is unavoidable in the case of a complete intestinal obstruction.

Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs or between an organ and the skin. Frequent fistula formation occurs between the bladder and the large intestine.
When this serious complication occurs, surgical intervention must be performed to remove the fistula and the affected area of the colon.

Therapy of diverticulosis

In the presence of diverticulosis, there is no way for the person concerned to prevent the formation of new diverticula.
Treatment revolves around the patient’s symptoms.
The gradual transition to a diet with soluble fiber (green vegetables, oat bran and fiber such as psyllium) usually leads to an improvement in well-being and symptoms.
Some foods can make symptoms worse or even trigger diverticulitis. One should avoid nuts and seeds; Some sufferers observe that the renunciation of legumes (for example, peas and beans) or sweet corn alleviates the symptoms.
It may be useful to take laxatives (laxatives) for a short period to treat and prevent constipation.
Rarely, surgery is performed to remove the affected area of the intestine. It is only recommended if the symptoms are unbearable.

Alternative medicine for diverticulitis

Some experts suggest that people with diverticulitis are deficient in “good” bacteria in their colon. Probiotics are foods or supplements that contain beneficial bacteria and help restore the body’s natural balance, which can help prevent diverticulitis. However, this has not yet been confirmed by clinical trials.
Probiotic supplements can be found in pharmacies in preparations with lactic acid bacteria.

What therapy helps with diverticulitis? Medication

1. For milder symptoms:
If diverticulitis develops, a course of treatment with broad-spectrum antibiotics against anaerobic and gram-negative bacteria is usually required, for example, Augmentan (amoxicillin and clavulanic acid) or a combination of ciprofloxacin and metronidazole (if there is an allergy to penicillin).
An antibiotic commonly prescribed by doctors is Xifaxan (Rifaximin).
Antibiotic treatment should last at least 7 days.
It is important to consume sufficient clear liquids such as tea, fruit juice (except orange juice) and water ice. The doctor may order a fasting cure until the symptoms have passed.
For a short period of time, strong painkillers may be required.
If the infection is not severe, the symptoms may pass under this treatment.
Once the symptoms have passed, you can eat normally again, but a high-fiber diet is preferable.

2. In case of severe or persistent symptoms:
If the symptoms are severe, hospitalization may be required.
The doctor may administer antibiotics and fluid directly through an infusion through the vein. An injection of painkillers may be required.

When do you need surgery for divericulitis?

Inpatient treatment may also be recommended if the symptoms are not very pronounced, but do not pass in about 48 hours under treatment with antibiotics.
Surgical intervention cannot cure diverticulitis, but it is performed due to the complications or to remove part of the colon (partial colostomy).
The damaged part of the colon can be removed laparoscopically.

When complications arise
As already indicated, some people with diverticulitis develop complications such as intestinal obstruction, fistula formation, abscesses and peritonitis.
Surgery is usually required to treat these rare but serious complications.
For example, surgery is sometimes required to drain an abscess or remove part of the infected intestine.

Treatment of bleeding diverticula
A large hemorrhage must be treated as soon as possible by a blood transfusion. Sometimes this is the case in people with diverticulitis.
However, the bleeding stops on its own in about 3 out of 4 cases.
Sometimes surgery is needed to stop the bleeding.

Natural remedies for diverticulitis

The home remedies are:

  • Increase the daily consumption of green vegetables. Introduce fiber gradually to avoid unpleasant symptoms such as excessive flatulence.
  • It is allowed to drink milk in moderation.
  • The use of additional dietary fibre supplements (such as Psyllium, Benefibra, BioColonic, Fibre up) is recommended.
  • Drink plenty of fluids to keep the stool soft so that it easily passes through the intestines.
  • Regular exercise to support muscle activity (peristalsis) and intestinal function.

What should you eat? Diet and nutrition for the prevention and treatment of diverticula

Foods to avoid

All hard and hard-to-digest foods, such as:

  • Soup cube
  • Meat and fish
  • Ham
  • Non-fermented soft cheese
  • Oil and butter, lard and bacon
  • Bread, pasta and rice in refined form
  • Desserts, except fruit ice cream
  • Strawberries, kiwi, raspberries, black berries
  • Sunflower seeds, pumpkin seeds, cuminosams, sesame seeds (kernels and seeds can be deposited in the diverticula)
  • Chocolate and fried or savoury foods

Limit or avoid drinks that irritate the intestines:

  • Wine
  • Beer
  • Spirits

Allowed foods:

  • Foods that contain a lot of filamentous fiber, such as sweet potatoes
  • Corn
  • Rice and other whole grains
  • Vegetables, artichokes and legumes to avoid
  • Pumpkin and zucchini
  • Ginger
  • Fruit, for example, bananas, except for the one that is included in the list of foods to avoid

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