Diverticulitis
Diverticulitis is the inflammation of the diverticula, small pouches found in the inner lining of the intestinal tract. Diverticulosis, the condition that causes the pouches to form, is common in people age 40 and older. Nearly half the people in the United States develop diverticulosis by the age of 60. Diverticula, which are multiple small pouches, can occur anywhere along the digestive tract, but are most commonly found in the lower portion of the large intestine, the sigmoid colon. Most often, these pouches are not troublesome, but when they become infected and inflamed, the resulting condition is known as diverticulitis.
Causes of Diverticulitis
While diverticulosis is extremely common, certain factors can make individuals more prone to developing the inflammatory condition. These factors include:
- Aging
- Obesity
- Diet low in fiber and high in animal fat
- Smoking
- Lack of exercise
- Medications such as steroids, opiates and NSAIDs
- Chronic constipation
Diverticula, which are typically the size of marbles, develop in weak spots along the intestinal tract. When stool or bacteria become lodged in a pocket, the inflammation or infection of diverticulitis can occur. If there is a serious tear or an intestinal perforation, emergency surgery is necessary.
Symptoms of Diverticulitis
The symptoms of diverticulitis can be alarming, similar to those of appendicitis. Severe abdominal pain, usually focused on the lower left abdomen is usually the presenting symptom. Other symptoms may include:
- Fever and chills
- Abdominal tenderness, bloating, or cramping
- Constipation or diarrhea
- Nausea or vomiting
- Diverticular bleeding
Patients with diverticulitis may have a large amount of red or maroon blood in their stool and may feel weak, dizzy, or light-headed.
Diagnosis of Diverticulitis
Diverticulitis is usually diagnosed during a flare-up of symptoms. Because the symptoms of diverticulitis are often similar to those of other intestinal disorders, one or more of the following tests may be performed to make a definitive diagnosis.
- Blood or urine test
- CT scan
- Abdominal ultrasound
- Digital rectal examination
- Liver function test
- Fecal analysis
- Colonoscopy or sigmoidoscopy
A physical examination of the abdomen is also a necessary part of the diagnostic procedure. For women, depending on symptoms, a pelvic examination to rule out other disorders may be necessary.
Treatment of Diverticulitis
Treatment of diverticulitis depends somewhat on the particular patient's symptoms and on their severity. An episode may be treated at home with rest, dietary changes, and administration of oral antibiotics and over-the-counter pain relievers. More extreme cases may require hospitalization, during which intravenous antibiotics are administered and the patient's digestive tract is allowed to rest. If there is an abscess present, a tube is inserted to drain the infected matter.
When surgery is required to treat diverticulitis, it is usually because there has been a complication, such as a fistula, the patient has a compromised immune system, or the patient has had many acute episodes of the disorder. If surgery is necessary, it may be performed as a primary bowel resection, a laparoscopic procedure, or, in more serious cases, as a bowel resection with a temporary colostomy.
Although diverticulitis is not usually life-threatening, it is important that it be treated effectively because serious complications, such as peritonitis or an intestinal obstruction, can occur. Once recovered from an acute attack, most patients can keep the condition under control by eating a high-fiber diet, taking fiber supplements, and taking probiotics. In some cases, patients will have to remain on a continuous or cyclical course of anti-inflammatory medication, such as Asacol, or even to take antibiotics periodically, in order to keep symptoms in check.