What is diverticulitis?
Diverticula are small, bulging pouches that form in the lining of the digestive system in some people. They are usually formed in the lower part of the large intestine. The presence of diverticula is known as diverticulosis. They are usually seen in people over the age of 40 and rarely cause issues. When one diverticulum or diverticula becomes inflamed or infected due to the accumulation of waste products and bacteria, the condition is called diverticulitis. Diverticulitis can cause issues characterized by fever, severe abdominal pain, nausea and change in bowel habits. Diverticulitis may be mild and treated conservatively with diet, medication and rest. It may be severe and recurring requiring surgery.
What are the symptoms of a diverticulitis flare-up?
In many cases, diverticulosis does not cause any troublesome symptoms. The condition may go undiagnosed until a routine colonoscopy is done. When diverticulosis causes symptoms, it is called a diverticulitis attack or flare-up. One may have multiple, recurring episodes of flare-ups. The symptoms usually occur suddenly and may persist for days.
The most common signs and symptoms of a diverticulitis flare-up include
What causes diverticulitis?
Some possible causes of and risk factors for diverticulitis are as follows
- Genetics: Genetics may play an important role. Having family members who have diverticulitis increases the risk of this condition.
- Age: The risk of diverticulitis increases with age, usually over the age of 40.
- Smoking: Nicotine and other chemicals in cigarettes and tobacco products can weaken the lining of the colon causing diverticulosis and, in-turn, diverticulitis.
- Dehydration: Dehydration affects digestion, leading to the accumulation of waste products and harmful bacteria in the colon.
- Medications: Some medications, such as long-term painkillers or steroids, can cause weakening or irritation of the colon.
- Sedentary lifestyle: Regular exercise may reduce the risk of diverticulitis.
- Obesity: Being overweight exerts increased pressure on the colon, increasing the risk of diverticulosis and diverticulitis.
- Constipation: Chronic straining while passing stools increases the pressure on the wall of the colon.
What are the complications of diverticulitis?
Although complications are not common, around 25% of people with acute diverticulitis tend to develop complications, which may include
- Abscess: Infection and accumulation of pus in the outpouching.
- Scarring: Inflammation in the area of swelling may heal with scarring, causing obstruction of the bowel.
- Fistula: An abnormal connection between the bowel and another part is called a fistula. A fistula may also form between two parts of a bowel.
- Peritonitis: Peritonitis may occur if the diverticular pouch gets infected, swollen and ruptured, causing the intestinal contents to spill into the abdominal cavity. This is a medical emergency and requires immediate attention.
Can diverticulitis be treated?
Treatment depends on the severity of the signs and symptoms.
Mild or uncomplicated diverticulitis: If the symptoms are mild, diverticulitis may be treated conservatively on an outpatient basis at home. Treatment may include
- Antibiotics to treat infection
- Painkillers for swelling and pain
- A liquid diet until the symptoms improve after which solid food can be slowly included in the diet
- Plenty of rest
Severe or complicated diverticulitis: A severe attack of diverticulitis may even require hospitalization. Treatment may include
- Intravenous (IV) antibiotics
- Drainage of an abscess, if it forms
- Liquid diet
Surgery: Surgery may be indicated in the following cases
- Having complications such as abscess, fistula or bowel obstruction or perforation of the bowel wall
- Having multiple, recurring episodes of uncomplicated diverticulitis
- Having a weak immune system due to other conditions such as human immunodeficiency virus (HIV) or diabetes
There are two types of surgery
- Primary bowel resection: Diseased segments of the intestine are removed (resection) and the ends of the healthy segments are reconnected (anastomosis). This is also called bowel resection and anastomosis. It may be performed as an open surgery or a laparoscopic (minimally invasive) procedure.
- Bowel resection with colostomy: If the inflammation is severe, it may not be possible to reconnect the colon and rectum. In such cases, a colostomy may be performed. Colostomy is making a stoma (an opening) in the abdominal wall. This opening is connected to the healthy part of the colon. The stoma is connected to a bag. Stools (bowel waste) pass through the opening and into the colostomy bag. Once the inflammation resolves, the colostomy may be reversed and the healthy segments of the bowel may be reconnected.
Can diverticulitis be prevented?
The following practices may help diverticulitis by promoting healthy bowel function
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