Diverticular Disease

By Dr Harold Gunatillake - Health Writer

Many people have finger-like pouches projecting outside the bowel, mostly found in the lower part of the large bowel, sigmoid colon.

These are bulges between the long muscle layers of the bowel, may be areas that have less resistance and weaker than the muscle covered areas. Chronic constipation with long sitting and straining at defecation may be a factor causing the condition. Those who are on low fibre diet as meat eaters may cause diverticular disease. The condition is more common among the Caucasians, whilst rare among the Asians who eat high fibre diets.

Fibre is the part of fruits, vegetables, and grains that the body cannot digest. Some fibre, called soluble fibre, dissolves easily in water. It takes on a soft, jelly-like texture in the intestines. Insoluble fibre passes almost unchanged through the intestines. Both kinds of fibre help prevent constipation by making stools soft and easy to pass.
Lack of exercise is also associated diverticular disease.

On colonoscopy the doctor could see the tiny openings of these pouches and one could count them.

The condition of having diverticula is called diverticulosis; the condition becomes more common as people age.

The inner lining of these pouches can get inflamed like the inflammation of the appendix (appendicitis). Then, we call the condition diverticulitis.

Symptoms: The symptoms are similar to irritable bowel syndrome: abdominal discomfort, bloating and constipation. One may have in addition, nausea and vomiting and change of bowel habits.

Diverticulitis is unnoticeable for quite a while before symptoms and complications start appearing. Most people may live with it, without knowing a whole life time. Diverticular appear in most people after the age of 40. When they get inflamed as in appendicitis, it is referred to as diverticulitis.

In the past barium enema x-ray investigation diagnosed the condition. Today a quick CT scan or MRI scan reveals more detains and can be performed without bowel preparation.
Bleeding: Rectal bleeding from diverticula is a rare complication. Doctors believe the bleeding is caused by a small blood vessel in a diverticulum that weakens and then bursts. When diverticula bleed, blood may appear in the toilet or in the stool. Bleeding can be severe, but it may stop by itself and not require treatment. A person who has bleeding from the rectum—even a small amount—should see a doctor right away. Often, colonoscopy is used to identify the site of bleeding and stop the bleeding. Sometimes the doctor injects dye into an artery—a procedure called angiography—to identify and treat diverticular bleeding. If the bleeding does not stop, surgery may be necessary to remove the involved portion of the colon.

Diverticulitis may lead to abscess formations, or even perforate leading to peritonitis. A few days with antibiotics will subside the abscesses. Perforation is an emergency and may have to be operated and the segment removed.

Treatment:
Increasing the amount of fibre in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fibre keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends consuming 20 to 35 grams of fibre each day. The table “What foods have fibre?” shows the amount of fibre in some foods that a person can easily add to the diet.

The doctor may also recommend taking a fibre product such as methylcellulose (Citrucel) or psyllium (Metamucil) one to three times a day. These products are available in powder, pills, or wafers, and provide 2 to 3.5 grams of fibre per dose. Fibre products should be taken with at least 8 ounces of water.

Avoidance of nuts, popcorn, and sunflower, pumpkin, and sesame seeds has been recommended by physicians out of fear that food particles could enter, block, or irritate the diverticula. However, no scientific data support this treatment measure. Eating a high-fibre diet is the only requirement highly emphasized across the medical literature. Eliminating specific foods is not necessary. The seeds in tomatoes, zucchini, cucumbers, strawberries, and raspberries, as well as poppy seeds, are generally considered harmless. People differ in the amounts and types of foods they can eat. Decisions about diet should be made based on what works best for each person. Keeping a food diary may help identify what foods may cause symptoms.

If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, some pain medications actually cause constipation.
It is a nuisance disease and you need to be careful in diet, take medication for constipation and discomfort, and regular colonoscopy check-ups. These diverticular do not turn cancerous.

When surgery is required, there are two main types of surgery:

  1. Resection of the large bowel of the disease area and re anastomosing of the cut ends
  2. Bowel resection with colostomy is done, if you have much inflammation that it’s not possible to re-join your colon and rectum. An opening called stoma in your abdominal wall is connected to the healthy part of your colon. Waste passes through this opening into a bag, until such time the inflammation subsides, when the diseases portion is resected, colostomy opening closed and the gut is re anastomosed end to end.

This is a brief account of the management of diverticular disease.

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