What are the primary factors contributing to diverticulosis and diverticulitis. How can diverticulitis be diagnosed and treated effectively. What dietary modifications can help manage diverticular disease.

Understanding Diverticulosis and Diverticulitis: Key Factors and Prevalence

Diverticulosis and diverticulitis are common digestive conditions that affect a significant portion of the population, particularly as people age. These conditions involve the formation of small pouches (diverticula) in the colon wall, which can become inflamed or infected.

The prevalence of diverticulosis increases with age:

• Approximately 10% of people over 40 develop diverticulosis
• At least 50% of people over 60 are affected
• 10-25% of those with diverticulosis will develop diverticulitis

Primary Factors Contributing to Diverticular Disease

Several factors contribute to the development of diverticulosis and diverticulitis:

1. Aging
2. Heredity
3. Diet low in fiber and high in refined foods
4. Constipation and straining during bowel movements

Is there a connection between low-fiber diets and diverticular disease. Some researchers believe that a lack of fiber in the diet leads to increased bowel wall strain when moving stool through the colon. This increased pressure can create weak points in the colon wall, potentially leading to the formation of diverticular pouches.

Symptoms and Complications of Diverticulitis

Diverticulitis occurs when the diverticular pouches become inflamed or infected. Common symptoms include:

• Abdominal pain, typically on the lower left side
• Fever
• Nausea
• Vomiting
• Changes in bowel habits

Can diverticulitis lead to serious complications. In some cases, diverticulitis can result in complications such as abscesses, perforations, or fistulas. These complications may require immediate medical attention and, in severe cases, surgical intervention.

Diagnostic Approaches for Diverticular Disease

If you suspect you have diverticulosis or diverticulitis, it’s crucial to consult a healthcare professional. Doctors employ various diagnostic tools to confirm these conditions:

• CT scan with contrast imaging
• X-rays processed and viewed on a computer
• Colonoscopy (in non-acute cases)

Why is a colonoscopy not recommended during acute diverticulitis. During an acute case of diverticulitis, a colonoscopy can potentially injure the intestine. In such situations, doctors typically rely on CT scans to confirm the diagnosis and assess the severity of the condition.

Treatment Options for Diverticulosis and Diverticulitis

The treatment approach for diverticular disease depends on the severity of the condition and whether it’s diverticulosis or diverticulitis.

Managing Diverticulosis

For mild cases of diverticulosis, doctors often recommend:

• High-fiber diet
• Regular bowel movements
• Adequate hydration

Treating Mild Diverticulitis

Mild cases of diverticulitis may be managed with:

• Bed rest
• Stool softeners
• Liquid diet
• Antibiotics
• Antispasmodic drugs

Managing Severe Diverticulitis

More severe cases of diverticulitis often require hospitalization and may involve:

• Intravenous antibiotics
• Intravenous feeding
• Drainage of infected abscesses
• Temporary colostomy in some cases

When is surgery considered for diverticulitis. Surgery may be recommended for patients who experience multiple acute attacks of diverticulitis or when intravenous therapy fails to effectively treat an acute attack. The affected section of the intestine may be removed when the patient is symptom-free.

Dietary Recommendations for Diverticular Disease Management

Diet plays a crucial role in managing diverticular disease. Here are some dietary recommendations:

• Drink at least eight 8-ounce glasses of water daily
• Consume prunes or prune juice as natural laxatives if constipated
• Follow a low-fat diet
• During acute attacks, stick to clear liquids or broths
• In periods of remission, incorporate high-fiber foods like cooked vegetables, cooked fruits, and apples
• Consider including probiotics, such as those found in yogurt

How does a high-fiber diet help in managing diverticular disease. A high-fiber diet can help prevent constipation, reduce pressure in the colon, and decrease the risk of diverticulitis flare-ups. It’s important to increase fiber intake gradually to avoid digestive discomfort.

Preventing Diverticulitis Flare-Ups: Lifestyle Modifications

While diverticula cannot be removed without surgery, there are several lifestyle modifications that can help prevent diverticulitis flare-ups:

• Maintain a high-fiber diet
• Stay well-hydrated
• Exercise regularly
• Avoid straining during bowel movements
• Quit smoking
• Maintain a healthy weight

Can stress management help prevent diverticulitis flare-ups. While the direct link between stress and diverticulitis is not fully established, managing stress through relaxation techniques, meditation, or yoga may contribute to overall digestive health and potentially reduce the risk of flare-ups.

Long-Term Outlook and Prognosis for Diverticular Disease

The long-term outlook for individuals with diverticular disease is generally positive, especially with proper management and treatment. Most people with diverticulosis never develop diverticulitis, and those who do often respond well to treatment.

For those who experience recurrent episodes of diverticulitis or complications:

• Regular follow-ups with a gastroenterologist may be necessary
• Surgical intervention might be considered to prevent future episodes
• Lifestyle and dietary modifications can significantly improve quality of life

What is the recurrence rate of diverticulitis after an initial episode. Studies suggest that approximately 20-30% of patients who have had an episode of diverticulitis will experience a recurrence. However, this risk can be reduced through proper management and lifestyle changes.

Recent Advances in Diverticular Disease Research and Treatment

Ongoing research continues to enhance our understanding of diverticular disease and improve treatment options. Some recent developments include:

• Investigations into the role of gut microbiome in diverticular disease
• Studies on the effectiveness of probiotics in preventing diverticulitis
• Research on minimally invasive surgical techniques for complicated cases
• Exploration of new medications to manage symptoms and prevent recurrence

How might understanding the gut microbiome impact diverticular disease treatment. Emerging research suggests that alterations in the gut microbiome may play a role in the development and progression of diverticular disease. This knowledge could lead to new therapeutic approaches, such as targeted probiotic treatments or fecal microbiota transplantation.

In conclusion, diverticular disease is a common condition that can be effectively managed through a combination of medical interventions, dietary modifications, and lifestyle changes. While it can lead to serious complications if left untreated, prompt diagnosis and appropriate treatment typically result in positive outcomes. As research continues to advance our understanding of this condition, we can expect even more effective prevention and treatment strategies in the future.

How To Treat It & Recovery Time

What Are the Causes of Diverticulosis and Diverticulitis?

Aging and heredity are primary factors in the development of diverticulosis and diverticulitis, but diet also plays a role. Eating a diet low in fiber and high in refined foods may increase the risk. Indeed, in Western societies, an estimated 10% of people over 40 eventually develop diverticulosis; the figure reaches at least 50% in people over 60. Diverticulitis will occur in about 10%-25% of those with diverticulosis.

Though it hasn’t been proven, some researchers think that if you are often constipated and usually strain when you have a bowel movement, you may create enough pressure in the intestinal walls to weaken them and begin the development of diverticular pouches. Another school of thought is that not enough fiber in the diet is responsible. The lack of fiber leads to increased bowel wall strain to move stool through the colon. That then causes increased local pressures that lead to the formation of pouches at weak points in the colon wall. The increased pressure along with undigested food caught in these pouches can erode the diverticular wall, causing inflammation and possible bacterial infection, which can result in diverticulitis.

Continued

How Are Diverticulosis and Diverticulitis Diagnosed?

If you think you have either diverticulosis or diverticulitis, talk to your doctor. Your doctor can perform tests to diagnose the conditions including:

• A series of contrast images from a CT scan or from X-rays that then are processed and viewed on a computer to see the intestines and surrounding tissue and bones
• Colonoscopy, a test in which a flexible lighted tube is used to examine the inside of the intestines

If you have an acute case of diverticulitis, a colonoscopy can injure your intestine. Instead, your doctor may recommend only a CT scan, which can help confirm the diagnosis of diverticulitis.

What Are the Treatments for Diverticulosis and Diverticulitis?

Once you develop diverticula, they are there to stay unless you have them surgically removed, which is not usually done. You can minimize the chances of developing an infection by modifying your diet. If you have a mild case of diverticulosis, your doctor may have you eat a high-fiber diet to make sure the bowels move regularly and to reduce the odds of getting diverticulitis.

Continued

If you develop diverticulitis you need to see a doctor to make sure you recover completely and to avoid possible life-threatening complications. Diverticulitis is treated using diet modifications, antibiotics, and possibly surgery.

Mild diverticulitis infection may be treated with bed rest, stool softeners, a liquid diet, antibiotics to fight the infection, and possibly antispasmodic drugs.

However, if you have had a perforation or develop a more severe infection, you will probably be hospitalized so you can receive intravenous (through a vein) antibiotics. You may also be fed intravenously to give the colon time to recuperate. In addition, your doctor may want to drain infected abscesses and give the intestinal tract a rest by performing a temporary colostomy. A colostomy creates an opening (called a stoma) so your intestine will empty into a bag that is attached to the front of the abdomen. Depending on the success of recovery, this procedure may be reversed during a second operation.

If you have several attacks of acute diverticulitis, your doctor may want to remove the affected section of the intestine when you are free of symptoms. You may also need surgery if intravenous therapy does not effectively treat an acute attack of diverticulitis. Whatever the treatment, the chances for a full recovery are very good if you receive prompt medical attention.

Continued

You should drink at least eight 8-ounce glasses of water daily to prevent constipation. If you do become constipated, prunes or prune juice may serve as natural laxatives. Follow a low-fat diet; fat slows down the passage of food through the intestine.

During acute attacks of diverticulitis, stick to clear liquids or broths while diverticula are inflamed and sensitive.

During periods of remission, it may help to make the following foods, which are high in fiber, part of your diet: cooked vegetables, cooked fruits, and apples. Probiotics, found in yogurt, may also be helpful.

Diverticulitis symptoms need a second look

To Your Health

Published 6:03 p.m. ET Aug. 4, 2015

Dear Dr. Roach: I am a 67-year-old woman. For the past year, at least twice a month for three or four days, I am sick with nausea, diarrhea, chills and feverishness, lower-left abdominal discomfort and no appetite. During those days, if I do have any intake, it is liquids. I take Compazine and Imodium as needed. Prilosec is my only other GI-related medicine; I take 40 milligrams, twice a day. My doctor increased the Prilosec two months ago in hopes that this thing would go away, but it has not. I had a colonoscopy done, which showed a couple of benign polyps and diverticulosis. I have been on the Prilosec for GERD for several years. I have not had X-rays or a CT scan. My gallbladder and my appendix have been removed. I stopped taking the Prilosec to see if that helps. Any thoughts?

C.L.

Dear C.L.: You are describing the classic presentation of acute diverticulitis. The diverticulosis seen on your colonoscopy revealed the presence of diverticula, saclike protrusions of the wall of the colon — mostly the sigmoid colon, which is in the lower left of the abdomen. Nausea and vomiting are common symptoms, in addition to fever and chills. Diarrhea is present in about a third of people.

I have to say that I am surprised you haven’t had a CT scan or some other diagnostic test, such as an ultrasound, a contrast enema or an MRI. These are very good for confirming the diagnosis. Since I certainly can’t be sure that you have had recurrent diverticulitis, a CT scan in particular can show other possible etiologies of your symptoms.

Sometimes we physicians get “stuck” on a particular diagnosis (error analysis has come to medicine, and I am concerned that your doctor has what is called an anchoring heuristic error). Omeprazole (Prilosec) is a good treatment for GERD, and it is part of the treatment for stomach ulcers. However, a year is way too long to have had these symptoms without a proper evaluation, and it is past time to get another opinion. A careful history and physical exam during the time you have symptoms is one place to start, and imaging tests might be appropriate afterward.

If this is diverticulitis, antibiotics are the usual treatment for an acute case. With as many recurrences as you seem to be having, it is worthwhile to consider surgical treatment to remove the diseased portion of your colon.

Dear Dr. Roach: I have heard of people whose hair turned white overnight due to some traumatic event. Is there any truth to that?

H.M.

Dear H.M.: The sudden change of hair color is called canities subita. There was a review of literature published in 2013 with 44 well-documented cases of sudden color change, 21 of which were associated with an episode of emotional stress. Think Sir Thomas More or Marie Antoinette before their respective executions. However, while true, rapid, color change is certainly documented, it is exceedingly rare.

What probably is more common is the sudden loss of pigmented hair in someone who already has some gray hair. Sudden loss of pigmented hair, in a condition called alopecia areata diffusa, can lead to an apparent color change. Hair lost during chemotherapy or radiation sometimes can come back with a different color or texture.

Email questions to [email protected].

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Diverticular Disease | Gastrointestinal Society

Click here to download a PDF of this information.

Diverticular disease and diverticulosis are interchangeable terms meaning the presence of diverticula in the large intestine (colon). Diverticula are small sac-like out-pouchings of the colon lining that balloon through the outer colon wall, occurring most frequently in the lower section of the colon (sigmoid), which is located on the left side of the pelvis.

Diverticular disease occurs in about 5% of the Western adult population who are younger than forty years of age, but it rises sharply to occur in at least 50% of those who are older than sixty years of age. It’s a disease most prevalent in the elderly; 65% of those who are older than eighty-five years of age have diverticulosis.

The number of diverticula in the gut can vary from a single occurrence (diverticulum) to hundreds. Generally, diverticula increase in number and in size over time. They are characteristically 0.5-1 cm (0.2-0.4″) in diameter but can exceed 2 cm (0.8″). Although rare, physicians have reported some extreme cases of large diverticula, spanning up to 25 cm (10″).

There is a wide geographic variability of diverticular disease and a striking correlation with an urban diet, which suggests a dietary factor as its root. However, the exact cause of this disease remains unknown. One theory is that diverticula occur when pressure, such as that caused by straining during constipation, builds up inside the colon and makes the intestinal wall balloon out in spots where the wall is weak. These weak spots are the sites between the muscle bundles, which run both lengthwise and circularly throughout the colon. In addition, the bowel tends to become irritable and spastic when there is inadequate bulk passing through and it must contract more intensely to pass contents along.

In about 10-25% of diverticular disease patients, the diverticula become inflamed (diverticulitis).

Symptoms of Diverticular Disease

Please pay close attention to the use of the similar but distinctly different definitions: the condition of diverticular disease (diverticulosis) and inflammation of the diverticula (diverticulitis).

Diverticulosis is often present without any symptoms. Many symptoms are similar to those of irritable bowel syndrome (IBS) and often include changing bowel activities such as constipation, diarrhea, or alternating between the two extreme stool consistencies.

Diverticulitis (flare-up) occurs when the diverticula become inflamed and/or infected. There might be an increase in diarrhea, cramping, and bowel irritability, and symptoms can include intense pain, abdominal cramping, bleeding, bloating, and fever. The pain and tenderness is often in the left lower portion of the abdomen.

Rarely, fistulae, bowel obstruction, and lower intestinal hemorrhage occur, or a diverticulum can perforate, causing a local abscess with a marked increase in the degree and nature of the pain. Additional symptoms are likely to include fever, nausea, and vomiting. Sometimes these complications require urgent surgery.

Diagnosing Diverticular Disease

The presence of colonic diverticula is challenging to diagnose as most patients are asymptomatic and the nonspecific symptoms overlap considerably with those of IBS. Your symptom history and a careful physical examination can reveal important clues to your physician. It is easier to diagnose this condition during a flare-up, as this typically presents with a fever, more tenderness over the abdomen, and more severe symptoms.

Blood tests may reveal the degree of inflammation present and a number of other tests can help pinpoint a diagnosis. X-rays can be helpful to observe the shape and function of the colon. For this test, you undergo a barium-containing enema, which shows up as bright white on X-rays, providing a contrasting picture of the contours of the bowel. Another method is by colonoscopy examination, during which a physician inserts an instrument called a colonoscope via the anus to view the inside of the colon. The scope is made of a hollow, flexible tube with a tiny light and video camera.

Colonoscopies usually require conscious sedation; however, since most diverticula form in the sigmoid colon, your physician might suggest a flexible sigmoidoscopy examination instead. This is a less invasive procedure during which the physician looks at only the lower portion of the bowel, and sedation is not typically required. During periods of flare-up, the bowel might be too tender to perform these investigations and the risk of bowel perforation might be too high, so a physician might choose a computed tomography (CT) scan or an even less invasive procedure known as virtual colonoscopy (VC) during diverticulitis. All imaging tests for the colon require some advance bowel preparation.

Your physician will also consider other conditions that could be causing your symptoms and will eliminate these as possibilities before confirming a diverticular disease diagnosis.

Management of Diverticulosis

Recommendations for the ongoing dietary management of diverticular disease include consuming well-balanced meals and snacks, and ensuring high-fibre content and adequate fluid intake, as outlined in Canada’s Food Guide. Fibre and fluid help soften stool, allowing it to move more quickly and easily through the colon, thereby avoiding excessive pressure against the colon wall.

Aim for 20-35 g of fibre daily, consumed evenly throughout the day. To help monitor your fibre intake, check the nutrient content on the labels of packaged foods. In the Nutrition Facts table, you will find fibre listed in grams (g) and the percentage (%) of the recommended Daily Value (DV) per serving. When the content has less than 5%, the product has a low-fibre content; when the content has 15% or greater, the product has a high-fibre content.

Make gradual changes while increasing fibre intake, as this approach will help avoid bloating, gas, and general abdominal discomfort that can occur as your body adapts to the dietary modifications. Be sure to increase the amount of liquid you drink, especially when increasing fibre.

There is no evidence that excluding whole pieces of fibre from the diet, such as nuts, corn, and seeds, will benefit the disease course, so there is no reason to avoid your favourite high-fibre foods, even if they contain small seeds. Ask us for information regarding a high-fibre diet or consult a registered dietitian in your area, or check our website.

Antispasmodic medication may provide bowel symptom relief; however, this could be treating co-existing irritable bowel syndrome rather than the diverticular disease itself.

Management of Diverticulitis

When a flare-up (diverticulitis) occurs, your physician will most likely recommend an immediate transition to a restricted-fibre or fluid diet and physical rest, and is likely to prescribe antibiotics, possibly antispasmodics, and pain medications. In severe cases, your physician might recommend hospital admission for intravenous feeding so that your bowel may rest for a few days.

Diverticulitis may respond to medical management, but if episodes become frequent, then surgical resection of the affected area might be necessary. Only about 1% of those with diverticular disease require surgery. In many cases, the surgeon can remove the damaged portion of the bowel (colectomy) and connect the remaining ends together. If this is not safe or possible, the surgeon may bring the end of the colon to a new surgical opening through the abdominal wall (colostomy). The patient then wears a removable appliance to collect the bowel contents. A colostomy might be required temporarily or permanently, depending upon the particular circumstances.

Diverticular Disease Outlook

Once a diverticulum forms, it does not go away on its own. The best preventative measure to avoid diverticular disease would seem to be a well-balanced, high-fibre diet beginning as early on in life as possible. There are many other health benefits associated with this diet. By also drinking adequate fluids, and staying physically active, you might be able to prevent further diverticula from forming and avoid unpleasant flare-ups. Many individuals are able to live symptom-free with diverticular disease by making these lifestyle changes. Medical and surgical treatments are available for those whose disease is persistent and unresponsive to these modifications.

Want to learn more about diverticular disease?

We have several related articles that may be helpful:

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Is diverticular disease making you housebound? « My Diverticulitis

THE PROBLEM

DD affects people in many different ways, some have few or no symptoms and their lifestyle is unaffected. Others are simply too ill to even think about leaving their home. These extremes can be a permanent or temporary situation for many sufferers. Older, retired people with DD sometimes have a different problem. An organiser of outings for an over-60s club said that people with DD could not go on their trips because they dare not go away from a toilet. That was 3 decades ago and not much has changed since then. Some coaches now have on-board toilets but public transport and car journeys also present problems. Apprehension and nervousness before a holiday, meal or outing, even a pleasurable one, sends their guts into overdrive. There is no mention of this problem in medical or self-help books or websites. It is not a topic of conversation even with close relatives and comedian’s jokes do not help.

This is a ‘flight or fight’ reaction of the sympathetic nervous system which empties the bowel and bladder. This is also experienced by actors, singers, sportsmen and women etc. but with performers, when the bowel has emptied and work begins, things can settle down. A bowel with DD which is damaged in structure and nerve control does not always produce a normal reaction. A second factor can be the major movements of the bowels which usually take place on rising/breakfast, so that early morning is a common time for bowel evacuation. A high-fibre diet often recommended for people with DD means that the bowel is relatively full. A combination of these factors can produce quite distressing results and avoiding the trigger situation is a natural reaction

HELPFUL TIPS

When this problem was raised in a former patient support group there were several helpful suggestions based on member’s experience. Giving in to the situation can lead to a downward spiral resulting in becoming housebound and loss of social activities. Looking back, contributors thought they worried far too much and this made the problem worse. Making outings less of an ‘event’ and more frequent can send the spiral upwards. Realising what was happening and knowing the location of toilets often helped. Other tips were…..

• Allow sufficient time for the bowel to be emptied before setting out, once empty it will settle down
• Avoid constipation so that there are less faeces to evacuate
• Have a low fibre diet for a few days beforehand for the same reason
• Get up early for a few days beforehand
• Make appointments for afternoons if possible

CAN DRUGS BE USED TO EASE THE PROBLEM ?

Some sufferers reported short term tranquilisers or herbal remedies had helped. Antidiarrhoea drugs are the most obvious and easily purchased solution, but their use is not clear-cut. The BNF (British National Formulary, an official guide to drug use) says that antimotility drugs (codeine, diphenoxylate, loperamide) are contraindicated for DD because they could exacerbate symptoms. On the other hand, if the problem is called “IBS” rather than “DD” then loperamide can be used to relieve diarrhoea. (An anomaly of dual diagnosis!)  Advertising promotes the immediate beneficial effects of loperamide but not that bowel movements can be prevented for several more days. Your doctor or pharmacist should advise on a personal basis whether antidiarrhoeal drugs are suitable.

WHAT DOES THIS TELL US ABOUT DD?

There is another way of looking at this problem. Some apprehension, bustle and early rising are clearly a good laxative which is unrelated to diet, food supplements or fibre levels. Perhaps this observation might be used to good effect. Not defaecating in the morning is a risk factor for constipation in DD patients (1).

Are retirement and/or no longer going out to work early in the morning behind the housebound problem? This change in lifestyle when age is also slowing down bowel function would tend to produce constipation. Is this the time when symptomless diverticulosis changes to symptomatic diverticular disease and medical help? A support group survey showed that diagnosis of DD occurred at retirement ages (Fig 1). This is the same as in the 1970s in Belfast (2). The diverticula had formed before retirement age. Exactly the same data is presented in Fig. 2 in the cumulative form which is often found in DD research statistics. This gives the impression that DD incidence continues to increase with age rather than that people with DD get older.

Diagnosis as a result of diverticulitis can occur any time when diverticula are present. Reports are increasing of cases quite early in life – in 20s and 30s age groups. This shows that diverticula can be formed at a young age and not neccesarily as a result of a lifetime of low-fibre diet or only related to old age. There may be different time scales for cause, formation of diverticula, infections and functional symptoms of DD.

REFERENCES

(1)   Osipenko MF & Bikbulatova EA   Colon diverticula: origin, prevalence, clinical maefestations.  Ter Arkh 2007, 79, 26. (PMID 17460964)

(2)   Parks TG    Natural history of diverticular disease of the colon.   Clinics in Gastroenterology. 1975, 4, 53.

© Mary Griffiths 2010

NOTE This article appeared in the Journal of the Bladder and Bowel Foundation, Issue no. 5, Summer 2010, and is also available in the professional resources section of their website

Tags: ageing, Diagnosis, Drugs, Statistics, Symptoms

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Managing Both IBS and Diverticulosis

Has your doctor diagnosed you with having diverticulosis alongside your irritable bowel syndrome (IBS)? Do you wonder if there is a relationship between the two? And do you find it challenging to figure out what to eat so as not to make the symptoms worse of either of the two health problems? Let’s take a look at any possible overlap and then discuss what you can do to take care of yourself when you have both.

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What Is Diverticulosis?

Diverticulosis is a health condition in which tiny pockets (sacs) are present in the lining of the large intestine. These sacs are known as diverticula, and they push outward on the wall of the colon. They are most likely to be found in the sigmoid colon, which is the lowest part of the large intestine.

Diverticulosis is one of the three conditions classified as a diverticular disease—the other two being diverticulitis, in which the pockets or sacs known as diverticula become infected or inflamed, and diverticular bleeding, in which the diverticula start to bleed. 

Symptoms 

For many people, diverticulosis causes no symptoms. In others, the presence of these sacs may contribute to constipation, diarrhea, abdominal pain and bloating. All symptoms of IBS as well.

The symptoms of diverticulitis can be more severe. Pain can range from mild to severe, and come on quickly or gradually worsen. Pain may wax and wane. Other symptoms of diverticulitis include:

• Abdominal pain and cramping
• Abrupt change in bowel habit, i.e. constipation or diarrhea
• Chills
• Fever
• Lower abdomen tenderness, particularly on the left side
• Vomiting

A dangerous risk with untreated diverticulitis is that of bowel perforation—a potentially life-threatening condition that will require surgery.

Diverticular bleeding is typically evidenced by a sudden large amount of bright red to dark maroon blood in the stool. Bleeding usually stops on its own, but if you experience any bleeding in your stool or from your rectum, you must see a physician to accurately evaluate what caused the bleeding. 

Overlap Between IBS and Diverticulosis

In case you were wondering if you were imagining things that your two health problems may be connected, you might be pleased to know that the thought has occurred to researchers as well. Let’s take a look at a couple of key studies and their results:

One 2013 study followed a large group of subjects who were diagnosed as having diverticulitis, with no previous history of a functional gastrointestinal disorder (FGDs) such as IBS or a psychiatric illness, at a Veterans Administration hospital, over a period of approximately six years. They found that these individuals were at an almost five percent greater risk for developing IBS, and at approximately twice the risk for developing a different FGD or a mood disorder. These results have led this group of researchers to propose the notion of “post-diverticulitis IBS” (PDV-IBS), a label that would be applied to individuals who experience chronic IBS digestive symptoms following an episode of diverticulitis. Please keep in mind that this is just one study—much more work would have to be conducted before any official classification is made of a new sub-type of IBS.

A different study published in 2010 used a questionnaire approach to determine if there is a relationship between having diverticular disease and IBS. The results indicated that having IBS raised a person’s risk for diverticulosis, but did not necessarily raise one’s risk for experiencing diverticulitis. This increased risk for diverticulosis was even more prominent for individuals with IBS who were older than 65. Interestingly, regardless of age, the increased risk for diverticulosis was more likely to be seen in individuals who were diagnosed with diarrhea-predominant IBS (IBS-D) or alternating type IBS (IBS-A).

Another large study was conducted in Japan in 2014. The researchers highlight that there is a primary difference as to where diverticular disease presents itself when comparing individuals from the West (Europe and the United States) versus those from Asia. Apparently, in the West, diverticular disease is more likely to show up in the distal colon—the descending colon on the left side and the sigmoid colon. In contrast, in Asia, diverticular disease is more likely to show up on the right side of the colon. Why is this important? According to the researchers, these differences are important as left-sided diverticulitis tends to be more severe, while right-sided diverticular disease leaves one at an increased risk for bleeding.

In this Japanese study, results indicated that participants who showed signs of diverticular disease on either the left side or on both sides, of the colon, were more likely to have IBS while participants who had right-side diverticular disease did not show this higher risk.

What to Do If You Have Both

It can seem very challenging to figure out what to do if you have both health problems. Luckily, some of the same treatment recommendations for IBS apply to diverticular disease:

• Increase Your Fiber Intake: This may be in the form of eating a high-fiber diet or taking a fiber supplement. 
• Take Probiotics: Research is not conclusive, but there is some indication that probiotics can help to prevent diverticulitis in individuals who have diverticulosis, according to a 2013 study. You can find probiotics in supplement form or in fermented foods.

There are some lifestyle recommendations for reducing problems from diverticular disease. Although these factors are not necessarily associated with IBS, making these changes will help to improve your overall and digestive health:

1. If you are a smoker, take steps to stop.
2. Be sure to exercise regularly.
3. Maintain a healthy weight.
4. Keep alcohol use to a minimum.
5. Keep your use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) to a minimum.

Diverticulitis – Diagnosis and treatment

Diagnosis

Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms.

Your doctor will start with a physical examination, which will include checking your abdomen for tenderness. Women generally have a pelvic examination as well to rule out pelvic disease.

After that, the following tests are likely:

• Blood and urine tests, to check for signs of infection.
• A pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain.
• A liver enzyme test, to rule out liver-related causes of abdominal pain.
• A stool test, to rule out infection in people who have diarrhea.
• A CT scan, which can identify inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment.

Treatment

Treatment depends on the severity of your signs and symptoms.

Uncomplicated diverticulitis

If your symptoms are mild, you may be treated at home. Your doctor is likely to recommend:

• Antibiotics to treat infection, although new guidelines state that in very mild cases, they may not be needed.
• A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet.

This treatment is successful in most people with uncomplicated diverticulitis.

Complicated diverticulitis

If you have a severe attack or have other health problems, you’ll likely need to be hospitalized. Treatment generally involves:

• Intravenous antibiotics
• Insertion of a tube to drain an abdominal abscess, if one has formed

Surgery

You’ll likely need surgery to treat diverticulitis if:

• You have a complication, such as a bowel abscess, fistula or obstruction, or a puncture (perforation) in the bowel wall
• You have had multiple episodes of uncomplicated diverticulitis
• You have a weakened immune system

There are two main types of surgery:

• Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure.
• Bowel resection with colostomy. If you have so much inflammation that it’s not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.

Follow-up care

Your doctor may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven’t had the test in the previous year. There doesn’t appear to be a direct link between diverticular disease and colon or rectal cancer. But colonoscopy — which is risky during a diverticulitis attack — can exclude colon cancer as a cause of your symptoms.

After successful treatment, your doctor may recommend surgery to prevent future episodes of diverticulitis. The decision on surgery is an individual one and is often based on the frequency of attacks and whether complications have occurred.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

Some experts suspect that people who develop diverticulitis may not have enough good bacteria in their colons. Probiotics — foods or supplements that contain beneficial bacteria — are sometimes suggested as a way to prevent diverticulitis. But that advice hasn’t been scientifically validated.

Preparing for your appointment

You may be referred to a doctor who specializes in disorders of the digestive system (gastroenterologist).

What you can do

• Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Make a list of all your medications, vitamins and supplements.
• Write down your key medical information, including other conditions.
• Write down key personal information, including any recent changes or stressors in your life.
• Ask a relative or friend to accompany you, to help you remember what the doctor says.
• Write down questions to ask your doctor.

Questions to ask your doctor

• What’s the most likely cause of my symptoms?
• What kinds of tests do I need? Do these tests require any special preparation?
• What treatments are available?
• Will the diverticulitis come back?
• Should I remove or add any foods in my diet?
• I have other health conditions. How can I best manage these conditions together?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:

• When did you first begin experiencing symptoms, and how severe are they?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve or worsen your symptoms?
• Have you had a fever?
• What medications and pain relievers do you take?
• Have you had any pain with urination?
• Have you ever had a screening test for colon cancer (colonoscopy)?

Diverticulosis | Michigan Medicine

Topic Overview

What is diverticulosis?

Diverticulosis
is a condition that develops when pouches (diverticula) form in the wall of the colon (large intestine). These pouches are usually very small (5 to 10 millimeters) in diameter but can be larger.

In diverticulosis, the pouches in the colon wall do not cause symptoms. Diverticulosis may not be discovered unless symptoms occur, such as in painful diverticular disease or in diverticulitis. As many as 80 out of 100 people who have diverticulosis never get diverticulitis.^{footnote 1} In many cases, diverticulosis is discovered only when tests are done to find the cause of a different medical problem or during a screening exam.

What causes diverticulosis?

The reason pouches (diverticula) form in the colon wall is not completely understood. Doctors think diverticula form when high pressure inside the colon pushes against weak spots in the colon wall.

Normally, a diet with adequate fiber (also called roughage) produces stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool. A low-fiber diet also can increase the time stool remains in the bowel, adding to the high pressure.

Pouches may form when the high pressure pushes against weak spots in the colon where blood vessels pass through the muscle layer of the bowel wall to supply blood to the inner wall.

What are the symptoms?

Most people don’t have symptoms. You may have had diverticulosis for years by the time symptoms occur (if they do). Over time, some people get an infection in the pouches (diverticulitis). For more information, see the topic Diverticulitis.

Your doctor may use the term painful diverticular disease. It’s likely that painful diverticular disease is caused by irritable bowel syndrome (IBS). Symptoms include diarrhea and cramping abdominal (belly) pain, with no fever or other sign of an infection. For information on the symptoms of IBS, see the topic Irritable Bowel Syndrome (IBS).

How is diverticulosis diagnosed?

In many cases, diverticulosis is discovered only when tests, such as a barium enema X-ray or a colonoscopy, are done to find the cause of a different medical problem or during a screening exam.

How is it treated?

The best way to treat diverticulosis is to avoid constipation. Here are some ideas:

• Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
• Drink plenty of fluids, enough so that your urine is light yellow or clear like water.
• Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It’s fine to be active in blocks of 10 minutes or more throughout your day and week.
• Take a fiber supplement, such as Citrucel or Metamucil, every day if needed. Read and follow all instructions on the label.
• Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and do not strain when you are having a bowel movement.

This treatment may help reduce the formation of new pouches (diverticula) and lower the risk for diverticulitis.

Can diverticulosis be prevented?

Eating a high-fiber diet, getting plenty of fluids, and exercising regularly may help prevent diverticulosis.

90,000 Diverticular disease, colon diverticulosis

Diverticular disease – a disease characterized by clinical manifestations of varying severity due to the presence of diverticulum or diverticulosis, including inflammation (diverticulitis) and its complications (peridiverticulitis, abscess, perforation, fistula, peritonitis), as well as bleeding.

Diverticular disease predominantly affects the sigmoid colon, then the descending colon, less often the right half of the transverse colon, and rarely the right colon.

Etiology

Until now, it is not known which of the factors is more important for the development of diverticula: anatomical defect of the intestinal wall or the action of forces in the intestinal cavity.

Found that the basal intracavitary pressure in patients with diverticular disease and in healthy individuals is the same. However, the segment of the intestine affected by diverticula contracts more strongly in response to food intake or pharmacological stimuli.

Another important etiological factor may be the weakness of the intestinal wall.The tone of the muscles of the large intestine gradually decreases with age, which, apparently, explains the predominant lesion of the elderly.

Thus, diverticular disease can be explained by a periodic significant increase in intracavitary pressure, affecting the wall of the colon weakened by age-related changes.

Classification

This disease is classified as follows:

1. Diverticular disease without clinical manifestations .
2. Diverticular disease with clinical manifestations . This form is characterized by a complex of symptoms, including abdominal pain and various bowel dysfunctions.
3. Diverticular disease with a complicated course :
   1. diverticulitis;
   2. perforation;
   3. bleeding;
   4. intestinal obstruction;
   5. internal or external intestinal fistulas.

Symptoms, clinical picture of diverticulosis and diagnosis of the disease

Diverticulosis of the colon may not appear for a long time, and it is discovered by chance when examining patients.

The main symptoms of clinically uncomplicated colon diverticulosis are abdominal pain and bowel dysfunction. Abdominal pains are varied in nature – from mild tingling to severe colic. Most often they are localized in the lower abdomen, especially in the left iliac region or above the pubis, that is, in the area of ​​the sigmoid colon. In some patients, these pains are varied not only in nature, but also in localization, and therefore the doctor does not always associate them with a disease of the colon.In a number of patients, pain is caused by food intake, which is explained by the influence of the gastrocolic reflex.

Intestinal dysfunction manifests itself more often in the form of constipation, and prolonged absence of stool significantly increases the pain syndrome. Diarrhea is sometimes noted, which, however, is not permanent. Often, patients complain of unstable stools; sometimes the symptoms described are combined with nausea or vomiting.

Complications of diverticulosis are usually quite pronounced. Diverticulitis is most often observed – in about 1/3 of patients with diverticular disease of the colon.The main signs of diverticulitis are abdominal pain, fever, and leukocytosis. The appearance of the last two signs against the background of the existing clinically expressed or asymptomatic diverticulosis makes it possible to distinguish the onset of inflammation from functional pain.

With the spread of the inflammatory process in the form of paracolitis, along with the listed symptoms, the formation of an infiltrate is noted, the size of which ranges from insignificant, hardly detectable by palpation, to extensive foci occupying the entire left half of the abdomen.The progression of the inflammatory process can lead to abscess formation with the threat of an abscess breakthrough into the abdominal cavity. The abatement of inflammation does not always lead to a complete resorption of the infiltrate, and then induration of the mesentery or surrounding tissues simulates a tumor in the abdominal cavity.

The sigmoid colon or other parts of the colon, as a result of repeated attacks of diverticulitis, paracolitis, or the formation of an abscess, may be fused with adjacent organs. In this case, the abscess can open into the bladder, urethra, vagina, or small intestine with the formation of fistulas.

Diverticulum perforation occurs in both clinically expressed and asymptomatic colon diverticulosis. Perforation into the free abdominal cavity leads to the development of rapidly progressive peritonitis, the clinical manifestations of which do not differ from those in other forms of acute inflammation of the peritoneum. Intestinal obstruction in colon diverticulosis is obstructive in nature with all the manifestations inherent in this form. One of the common reasons for the development of obstruction in diverticulosis is the formation of the so-called pseudotumor.

Intestinal bleeding, although it does not usually have a profuse character, is nevertheless often so pronounced that it quickly attracts the attention of both the patient himself and the doctors.

Significant difficulties arise in determining the source of bleeding. Bleeding from the diverticulum is also observed in the asymptomatic course of the disease, which creates even greater diagnostic difficulties. Along with obvious bleeding, its latent forms can also be observed, manifested only by anemia.The symptoms of the listed complications, although quite striking, are not specific. In this regard, it is sometimes very difficult to determine the causes of their occurrence, and for this a comprehensive examination is used.

Clinical manifestations of colon diverticulosis and its complications cannot serve as a basis for establishing an accurate diagnosis of the disease. Diagnosis and differential diagnosis of colon diverticulosis is based on the analysis of clinical manifestations of the disease and the results of mandatory X-ray and endoscopic studies of the colon.

Conservative treatment of diverticular disease

Currently, the following principles of treatment of this disease have been formulated:

1. Asymptomatic colon diverticulosis, discovered incidentally, does not require special treatment. A diet rich in plant fiber, bran is prescribed.
2. for diverticulosis with severe clinical manifestations, a set of therapeutic measures is used:
   1. a balanced diet containing a large amount of vegetable fiber, and with persistent constipation and fluid;
   2. vitamins;
   3. drugs that normalize bowel function;
   4. with a pronounced spastic component, antispasmodics or calcium channel blockers (Decitel) are prescribed, which act selectively on the intestinal wall.For pain syndrome, analgesics are prescribed, morphine preparations are contraindicated for these purposes, since they increase intraintestinal pressure;
   5. in the presence of diverticulitis phenomena require the appointment of antibiotics;
   6. antidiarrheal agents can be used for diarrhea;
   7. in the presence of enzymatic insufficiency of the pancreas, enzymatic preparations are prescribed;
   8. when dysbiosis is detected, it is advisable to use bacterial drugs (colibacterin, bifidumbacterin, bificol).

Surgical treatment

There are the following indications for surgical treatment of diverticular disease:

Emergency:

• perforation of the diverticulum;
• intestinal obstruction;
• profuse bleeding.

Planned:

• formation of a chronic infiltrate simulating a malignant tumor;

90,029 internal and external fistulas;

• clinically pronounced diverticular disease, refractory to complex conservative treatment.

Diverticulitis

Diverticulitis

DIVERTICULOSIS, DIVERTICULAR DISEASE, DIVERTICULITIS

What is Diverticulitis?

Diverticulitis is an infection or inflammation of the saccular protrusions of the intestine that can form in your intestines. These sacs are called diverticula.

Diverticula can appear anywhere in your intestines. If you have them, it is called diverticulosis.If they become infected or inflamed, you have diverticulitis.

Sometimes diverticulitis is mild. But it can also be severe, with a massive infection or perforation (your doctor will call it a rupture) of the intestine.

Diverticulitis Treatment

If your diverticulitis is mild, your doctor will suggest rest and a liquid diet until the inflammation in your gut subsides. They may also give you antibiotics to treat the infection.

In more severe cases, you may have to stay in the hospital and take intravenous antibiotics.

If an abscess develops, the surgeon will drain it.

The most common type of surgery for all forms of diverticular disease is resection of the sigmoid colon (sigmoidectomy). The sigmoid colon is the section of the large intestine that runs directly in front of the rectum, at the end of the intestine.This is the area where the stress of bowel movement exerts the greatest pressure on the intestinal wall, so this is where the most diverticula form. The operation involves removing the sigmoid colon as well as a small section of the rectum. Since diverticula can occur in other parts of the intestine, it is usually not possible to remove all of them. After the affected area of ​​the intestine is removed, the ends are sewn back together again.

In most cases, this is a minimally invasive procedure that is performed by inserting instruments through small incisions in the abdominal wall (laparoscopy).But this can also be done by making a larger incision (open surgery). Our clinic has extensive experience in both open and laparoscopic colon interventions, but it should be noted that minimally invasive technologies are preferred.

Complicated diverticulitis can lead to peritonitis (inflammation of the lining of the abdomen).

The pus can then spread into the abdominal cavity and even cause blood poisoning. This is a medical emergency requiring urgent surgery.But this surgery usually does not involve removing any portions of the intestine first. Instead, the abdomen is flushed and an artificial opening is made or an unnatural anus (colostomy) is formed. This is because the inflammation must completely disappear before the sigmoid colon is resected. After a few months, resection of the sigmoid colon with closure of the colostomy can be performed.

If you have a ruptured bowel or peritonitis, you will need surgery.It is very important that in emergency operations, resection of the affected intestine may result in the removal of a colostomy – an unnatural anus on the anterior abdominal wall.

That is why your doctor can offer you a planned laparoscopic bowel resection, which will be completed without removing the unnatural anus.

Our clinic has extensive experience in performing laparoscopic colorectal interventions.

Decision-making

Until a few decades ago, people with diverticular disease were almost always advised to undergo surgery.Currently, clinical guidelines urge doctors to do this only if absolutely necessary. It is a good idea to try other options such as medication and dietary changes. The decision about whether to have surgery or not will mainly depend on the symptoms in daily life. Only certain groups of people should consider the risk of complications associated with diverticulitis when making this decision. Other medical conditions, a person’s age and life circumstances also play an important role.

Sometimes different doctors give different advice. Find out in detail as much as possible about the pros and cons of treatment options, and get a second opinion. All of these can help you make a decision.

Find out more at the consultation of Professor V.A. Kashchenko

90,000 symptoms and treatments in adults 9,0001

Diverticular disease is an acquired disease of the large intestine that usually manifests itself after 40 years. Its course is asymptomatic, so you need to know what colon diverticulosis is, symptoms and treatment in adults.

Symptoms and clinical manifestations of the disease

Diverticula are called blindly ending protrusions of the wall of a hollow or tubular organ. Their presence is denoted by the term diverticulosis. According to the code MKB10:

• K57 – complications and acquired forms of the disease,
• Q43.8 – congenital diverticulosis.

The disease can occur not only in the gastrointestinal tract. Diverticulosis of the intestinal wall develops as a result of its vascular changes and the formation of areas with high intraluminal pressure due to impaired peristalsis.

The symptomatology of the disease does not actually appear, the detection occurs as a result of examinations pursuing other goals, which complicates the treatment. But diverticulitis has symptoms, although not pronounced.

What is a diverticulum

Pain syndrome with diverticulosis

Painful sensations in the initial stage of the disease are practically not perceptible and are perceived as gastrointestinal dysfunction or ischemic colitis. A person with diverticulosis may feel slight colic, flatulence, or a feeling of fullness in the abdomen.

• can be sharp and cutting or lingering and aching,
• Soreness is stronger on the left, but may be active in the middle of the abdomen or below.

• anus,
• buttock zones,
• waist,
• sacrum,
• groin.

• fever,
• tachycardia,
• leukocytosis,
• phenomena similar to peritonitis.

Anatomical structure and localization of diverticulosis

Stool disorder with diverticulosis

Stagnation of feces resulting from diverticulosis causes concomitant manifestations:

• false urge to empty the bowels,
• constipation of a chronic nature or alternating with diarrhea,
• mucous discharge from the anus, flatulence, stench,
• after the completion of stool, the feeling remains that the rectum is still full.

Prolonged stagnation of feces leads to irreversible changes in the intestinal walls.

Blood impurities in feces

Examination of the patient’s feces shows that they have a spherical shape surrounded by mucus with an admixture of blood.

High temperature

The development of the disease leads to the accumulation of bacteria in the stagnant feces. Acute phlegmonous diverticulosis leads to an increase in body temperature. Against the background of a high temperature, severe pain appears. Normalization of the patient’s condition is carried out by taking medications.

Pain as one of the main symptoms of diverticulosis

Nausea, vomiting, loss of appetite with diverticulosis

Prolonged stagnation of feces leads to an exacerbation of diverticulosis, the result of which is a complete disruption of the gastrointestinal tract and digestion.In the acute form of the disease, patients complain of lack of appetite, vomiting after eating.

Causes of the disease

The main reason for the transition of the disease into a chronic form is asymptomatic.

Only 1/5 of patients complain of abdominal pain in the intestines with diverticulosis.

Foods poor in fiber

Consumption of dietary fiber less than 30 g / day makes it difficult to move the food masses through the gastrointestinal tract, which reduces the saturation period.Toxic substances and bile acids are not excreted from the body, food processing slows down and the production of digestive juices is not stimulated.

Inflammatory processes

The reason provoking the development of chronic diverticulosis can be not only age, non-compliance with diet, lack of physical activity. Inflammation leads to gastrointestinal disruption and diverticulosis.

Age Range

The risk of diverticulum development increases in proportion to the person’s age.

Patients with diverticulosis at the age of less than 30 years are 20 times less than those who applied for help at retirement age. In women, the disease manifests itself after the onset of menopause, while in men, earlier manifestations are characteristic.

Hereditary predisposition to diverticulosis

Genetically transmitted weakness of the connective tissue, changes in the vascular nature in the intestinal walls, chronic diseases, discoordination of motility and dystrophic changes in the muscular wall of the colon – all this leads to the development of diverticulosis.

Infection with worms

Worms and parasitic worms, once in the gastrointestinal tract, begin to actively reproduce. The laying of eggs on the walls, the release of toxins leads to a weakening of the intestines, a violation of the acid-base balance, infection and the development of the disease.

Parasites can cause diverticulosis

Diagnosis of the disease

In the first place when diagnosing a disease is the questioning of the patient. Complaints of spastic pain, stool retention and increased body temperature during intense pain indicate the need for a deeper examination.

The most informative method for detecting the disease was recognized as irrigoscopy – examination of the large intestine using a barium enema. On examination:

• draws attention to the contour of the descending and sigmoid colon,
• reveals a displacement of the colon,
• intestinal fixation caused by paraintestinal inflammation.

Radiology (computed tomography) shows fistulous passages and narrowing of the lumen in the intestine when there is an infiltrate.

To find out how badly the intestine is affected, to determine the presence of diverticula and the condition of the mucous membrane, you can use a colonoscopy.

Colonoscopy apparatus

In the acute course of the disease without treatment, the blood test may show:

• ESR increase,
• leukocytosis,
• left shift of the formula,
• toxic granularity of neutrophils.

Experts define the disease by palpation of the abdomen at moments of exacerbation.Irritation of the peritoneum in certain anatomical zones indicates perforation of the diverticulum and its breakthrough into the abdominal cavity.

Complications of the disease

An inflammatory process left without treatment can result not only in prolonged hospitalization, but also cause surgical intervention.

A disease that has turned into a chronic form causes certain types of complications.

Intestinal obstruction

Peculiarities of diverticulosis treatment

The main goal in the treatment of diverticulosis is to eliminate the cause of inflammation, relieve pain, prevent recurrence of the disease and eliminate infection in order to avoid complications. The classification of diverticulosis, which gives an assessment of the patient’s condition, allows you to choose the right methods for treating the intestines.

• diverticulitis,
• peri-intestinal infiltrate,
• perforation of the diverticulum,
• rectal fistula,
• intestinal bleeding.

Drug treatment of disease

In case of exacerbation of diverticulosis, urgent hospitalization is required, since drugs are administered intravenously to accelerate the action.In an abscess, drainage tubes are placed to prevent peritonitis.

• normalization of intestinal microflora,
• Basic Dietary Fiber Therapy,
• restoration of intestinal motility,
• drug treatment of complications.

Sulfasalazine

Means for regulating stool in case of diverticulosis

Patients with diverticulosis of pre-retirement and retirement age are prescribed treatment with herbal preparations, combining them with diet therapy and drinking plenty of fluids. Middle-aged people undergo a course of systemic treatment to restore bowel function.

Rifaximin is given to patients with diarrhea.The antibiotic slows down and stops the growth of pathogenic bacteria in diverticulosis, but at the same time causes:

• pain in muscles, stomach,
• dizziness and nausea,
• malaise and fatigue.

For the treatment of prolonged constipation, laxatives with an oil or vegetable base are used.

What diet should be followed for intestinal diverticulosis?

Slag-free diet therapy is required for gastrointestinal disorders.In moments of exacerbation of the disease, restriction of fiber intake is required.

Folk remedies

The use of medicinal plants for diseases, the production of infusions and decoctions from them, homeopathy is welcomed by orthodox medicine.

Herbal treatment at home

Disease prevention

To eliminate the risk of diverticulosis and minimize the likelihood of recurrence of the disease, you need to monitor the daily diet, including foods rich in fiber and fiber. It should be borne in mind that abuse of the latter can lead to flatulence, diarrhea and bloating.

Physical activity, proper nutrition, maintaining normal weight are the main methods of combating intestinal diverticulosis.

The intensity of the load depends on the preparedness of the person and the state of his health. People with chronic illnesses should engage in restorative sports without resorting to intense training.

• What is diverticulosis, how the disease develops and the basics of its treatment can be found in the video:
• About proper nutrition for diverticulosis for the treatment and maintenance of intestinal health can be found in the video:

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Diverticular bowel disease

Published on 01.05.2020 Comments: 3 Read: 8 min Views:

Diverticula are sacs formed by a fold of the mucous membrane of the intestinal wall.

They protrude from the inside of the intestines through the muscles surrounding the intestines and can sometimes trap feces moving through the intestines. Intestinal diverticula are extremely common and usually harmless. They often appear in bunches. The diameter of each is usually less than 2 cm.

They tend to appear after age 40 and are more common in older people.Studies show that they are present in 75% of people over 80.

In a somewhat simplified way, distinguish three forms of the disease :

• Diverticulosis is a condition of having one or more diverticula. There are usually no symptoms or problems associated with this condition.

• Diverticular disease – bulges cause discomfort or complications. They can cause intermittent or permanent discomfort. This is called chronic diverticular colon disease.

• Diverticulitis – the bulges are inflamed. It is usually treatable but can have serious consequences if the inflammation spreads.

Causes

Diverticula occur in places where the intestinal musculature is weaker. The most common diverticulosis is the sigmoid colon (sections of the colon about 40-45 centimeters long). In this S-shaped region in front of the rectum, the pressure of the stool against the intestinal wall is highest.

This pressure pushes the intestinal mucosa through the weakest points of the intestinal wall, resulting in the formation of diverticula.The weakest spots are the areas around the blood vessels that pass through the inside of the colon wall.

Risk factors for the development of diverticula:

• hereditary predisposition
• weak connective tissue
• sluggish intestinal motility
• low fiber diet
• Frequent constipation
• Frequent consumption of red meat
• overweight
• smoking
• lack of physical activity

Intestinal diverticulosis – symptoms

Many people have diverticulosis without knowing it.Most diverticula do not cause discomfort. This disease can be expressed by pain in the left lower abdomen, less often in the right. Bloating, constipation, or diarrhea may also be present. Symptoms often subside temporarily, but may be permanent. They are often stronger after a meal and weaker after a bowel movement.

But in most cases, diverticulosis is invisible if there are no complications. Most people live with it all their lives and do not even know about its existence.

Complications of diverticulosis

Bleeding and inflammation are two possible complications of diverticulosis.

Bleeding with intestinal diverticulosis can occur if feces are retained in diverticula. The intestine draws fluid out of the feces before expelling them. If they remain there for a long time, they become dry and hard. This can destroy nearby blood vessels. This process is usually painless.

Bleeding with diverticulitis is quite profuse. A feature of bleeding with diverticula is bright red blood. If heavy bleeding continues, this is an emergency and requires immediate hospital treatment.

Another potential problem caused by diverticula is inflammation, in other words, diverticulitis. Unlike bleeding diverticula, inflamed and infected diverticula can become extremely painful. The sudden pain is especially severe in the lower left abdomen, as most diverticula occur in the left intestine. The pain may be accompanied by a fever.

Other signs of acute diverticulitis include constipation, diarrhea, bloating and nausea, and sometimes seizures.Vomiting is rare.

Diverticulitis can range from mild discomfort to a dangerous condition if inflammation spreads to the intestinal wall, surrounding area, or adjacent organs. Clumps of pus (abscesses) and fistulas may form.

A rare but serious complication is the formation of a hole in the intestinal wall (intestinal perforation). If the contents of the intestines escape into the abdominal cavity, it can lead to life-threatening peritonitis.

This usually manifests itself in the form of severe abdominal pain, hard abdominal wall, fever, nausea, palpitations and general weakness.It is important to quickly recognize the signs of peritonitis and seek medical attention.

Untreated, peritonitis causes death within hours.

The vast majority of people with diverticulosis never experience bleeding, let alone fistulas or peritonitis.

In some people, diverticula become inflamed again and again after successful treatment, and recurrent exacerbation of diverticulitis occurs. Then they talk about chronically recurrent diverticulitis .

As a result, cicatricial stenosis can form in the intestines, making it difficult for stool to pass. In extreme cases, intestinal obstruction can result. The risk of complications is highest with first diverticulitis.

With recurrent inflammation, the risk is significantly reduced.

Good to know: Diverticula do not cause colon cancer. This is due to intestinal polyps. The link between diverticulitis and cancer is not scientifically proven.

Often, doctors diagnose diverticulosis if another disease is suspected. For example, diverticula are often found during routine colonoscopy.

If you go to a doctor with complaints, he will ask you about pre-existing diseases and medication, physically examines the abdominal cavity.

Depending on the nature of the symptoms, blood and urine tests, as well as body temperature and usually ultrasound, may be done.

If the diagnosis is still unclear, computed tomography and possibly colonoscopy may be required.

• Video of colonoscopy in patient with diverticulitis:
• Evaluation should also rule out other medical conditions, as the symptoms of diverticular disease are similar, for example, to appendicitis or irritable bowel syndrome.

In acute diverticulitis, colonoscopy is too risky, as this procedure artificially inflates the intestines with air.However, it is often recommended to have an examination 4-6 weeks after healing. This is done to check if the symptoms were caused by polyps, colon cancer, or other medical conditions.

CT is most commonly used to confirm diverticulitis. Diverticula are clearly visible with this examination method.

1. We can say that computed tomography in this case is the most informative method.
2. This is what the colon diverticula look like on CT:

• A less accurate method for diagnosing diverticulosis is an irrigoscopy.
• This is what diverticula look like with irrigoscopy:

Colon diverticula that do not cause discomfort do not need treatment.

People with severe diverticulitis are treated in a hospital. They are fed intravenously to keep their gastrointestinal tract empty and given intravenous antibiotics.

Mild bowel diverticulitis can be treated at home with rest, a simple diet, and antibiotics. Bleeding from the diverticulum may stop after taking medications such as Vasopressin.

Occasionally, a doctor can stop the bleeding during a colonoscopy.

If bleeding does not stop, segmental resection may be required, which is a surgical procedure to remove part of an organ (in this case, part of the intestine).

In many cases, surgery can be performed laparoscopically.

Diverticulitis usually responds well to treatment and then heals within a few weeks. However, about 20% of those affected get recurrent diverticulitis at least once in subsequent years.

If acute diverticulitis persists or persistent symptoms persist, the affected portion of the colon may be surgically removed. Due to the presence of risks, the procedure must be carefully weighed. However, with severe complications such as peritonitis, it is necessary to act quickly.

What should not be eaten with intestinal diverticulosis?

Refined foods, canned food, sausages, fatty, fried, smoked foods are banned. You can not drink alcohol, strong coffee, fast food.We’ll have to forget about hot spices, onions and garlic.

Prevention

Constipation with diverticulosis is the main cause of complications. Establishing regular, soft stools is essential to prevent diverticulitis.

To prevent or slow down the development of diverticulitis, follow these guidelines:

1. Increase the amount of fiber in your diet. 2. Drink plenty of water.

3. Go in for sports.

Let’s dwell on each of the points in more detail.

Intestinal diverticulosis – diet and nutrition

1. The main method of preventing constipation is diet and nutrition.
2. The diet should be built on those foods that are easy to digest, improve peristalsis, form soft and voluminous feces.

First of all, these are fruits and vegetables: apricots, plums, apples, figs, cabbage, beets, carrots. Side dishes for main courses should be prepared either from stewed vegetables or from boiled cereals.Meat, poultry or fish dishes should preferably be steamed or boiled; it is better to refuse a fragrant crispy crust.

The diet for diverticulosis should be high in fiber. This ensures that the stool is not too hard. Dietary fiber is found in whole grains, vegetables, legumes, and fruits.

• Nutrition for intestinal diverticulosis should include fermented milk products, which not only facilitate digestion due to their acidic environment, but also normalize the intestinal microflora, making the body healthy and reducing the negative effects of constipation.
• It is very good to make one meal (better dinner) only from laxative products: eat beet salad, a slice of bread with bran dried in a toaster and drink dried apricot or prune compote.
• Preparations based on bran or plantain seeds are sometimes prescribed, such as “Mucofalk”, “Fitomucil Norm”.

Until recently, in case of intestinal diverticulosis, it was recommended to exclude certain foods from the diet, especially seeds, nuts, cereals, corn and popcorn.Small residues of these products were thought to get stuck in the diverticulum and contribute to inflammation. However, studies have not confirmed this.

Drinking mode

In a healthy person, as a rule, bowel movements occur in the morning, immediately after sleep. With a tendency to constipation, the digestive tract can “start” only after breakfast, so breakfast should never be neglected.

At breakfast, you can eat foods that are digested the longest, since being active during the day and long awake time will ensure their successful breakdown and absorption.

The drinking regime should also be adapted to the needs of digestion. If you increase your intake of fiber-rich foods, you should also increase your water intake.

No other drink can replace regular, clean water. Mineral water for constipation should be consumed only on the recommendation of a gastroenterologist. Compotes, tea and juices are best drunk at room temperature or a little warmer, without added sugar.

Both food and water should be consumed evenly throughout the day, reducing portions in the evening.

Movement

For the effective work of the muscles, including the muscles of the intestines, a regular load is needed, which will ensure the pushing of the food lump through the intestines.

Subject to the diet and diet, this lump will be soft, voluminous, and will form at a certain time, “training” the intestinal muscles and facilitating its emptying.

You should also exercise your abdominal muscles by doing simple exercises every day.Regular, but not excessive load on the abdominal muscles activates blood circulation, reduces spasms of smooth muscles, and ensures the natural movement of the food bolus.

1. Any physical activity will be useful – yoga, cycling and hiking, swimming, active games in the fresh air, breathing exercises.
2. The implementation of these simple recommendations will improve both the health of the digestive system and overall well-being, and will allow you to maintain youth, activity and beauty.

Diverticulosis – symptoms, treatment, causes of the disease, first signs

Nutrition for this disease is aimed at eliminating constipation-causing foods from the diet: grains, pumpkin and sunflower seeds, seeds.

Fruits and vegetables recommended by dietitians;

The use of leguminous crops is strictly individual, because they can be good for one person and bad for another. If, when taking beans or peas, the patient does not have unpleasant sensations in the abdomen, then the use of these products is suitable for him.Low and medium fat dairy products allowed, except milk:

When cooking vegetable soups and other vegetables, skin and seeds are removed from products containing them.

After cooking, it is recommended to grind all this in a blender for better passage through the intestines.

In case of symptomatic diverticulosis, fatty, high-calorie foods are prohibited. The best option is lean, simple food that is easy to digest.

The condition of diverticulosis will remain with a person for life, it is almost impossible to cure the disease until the end, but it is really possible to prevent complications and their consequences.

Therefore, the patient must choose a varied diet of correct nutrition, which will become a permanent eating habit for him.

Prognosis of the disease

Will be beneficial with proper active treatment and prevention of complications. In addition, moderate physical activity is required, long walks in the fresh air, special gymnastics, and swimming. The patient must adhere to the correct diet and selection of healthy foods. With all this, the chances of successful treatment increase.

If the consequences of complications appear (abscesses, signs of “acute abdomen”), the prognosis will be doubtful, as well as in other diseases of the abdominal cavity with an inflammatory process.

As for the treatment with folk remedies, they will not give the same effect as when combined with traditional medicine. The main thing is to notice unsuccessful symptoms in time and take measures to treat the disease.

Medicines

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• Of the main groups of drugs used to treat bowel disease such as diverticulosis, antibiotics are in the first place and are prescribed during an exacerbation.
• Also used in treatment are myotropic antispasmodics, calcium channel blockers, anticholinergics, osmotic laxatives, dietary fiber supplements, enzyme preparations, adsorbents, simethicone and probiotics.

Of the group of antibiotics, broad-spectrum drugs are most often prescribed.In this case, II-III generation cephalosporins (Cefotaxime, Ceftazidime), protected penicillins (Amoxiclav, Augmentin), monobactams, metronidazole, rifaximin (Alpha-normix), aminoglycosides (Gentamicin), Sulfasalazine are suitable.

With diverticulosis, the intake of this group of funds must strictly correspond to the prescribed scheme. Otherwise, it is likely that the therapy will be ineffective with the subsequent emergence of antibiotic resistance.

Side effects include the possible development of intestinal disorders such as diarrhea and dysbiosis, as well as allergic reactions.Therefore, this group of medicines should be prescribed according to strict indications after consultation with a specialist.

There are several groups of drugs of choice to relieve pain syndrome: antispasmodics, calcium channel blockers and anticholinergics. It is known that the main cause of abdominal pain is the spasm of the walls of the hollow organ. This fully explains the need for the appointment of the listed funds, since they help to relax the smooth muscles of the intestine.

Among antispasmodics, No-shpa, Papaverin, Drotaverin are widely used.Mebeverin is referred to calcium channel blockers, and hyoscine butyl bromide and Platyphyllin are quite effective anticholinergic antagonists.

Among their side effects, the development of hypotension and heart palpitations is likely. Allergic reactions cannot be ruled out. The drugs are not recommended for use in severe renal, hepatic or heart failure. With concomitant stomach pathology, it is more convenient to use these medicines in such a dosage form as suppositories.

In diverticulosis, the appointment of laxatives is justified in order to prevent fecal retention, as this contributes to an increase in intraintestinal pressure and exacerbation of the symptoms of the disease.It is more preferable to take osmotic agents, the action of which occurs directly in the intestinal lumen.

For these cases, lactulose preparations (Normase, Duphalac) are ideal. Its reception excludes increased peristalsis and does not cause an exacerbation of pain in the abdomen. It is also the most studied probiotic.

The drug is contraindicated in intestinal obstruction, is used with caution in diabetics.

Other effective laxatives for diverticulosis are Macrogol, sorbitol and magnesium sulfate.

The next group – preparations based on dietary fiber (Mucofalk). They have scientifically proven efficacy and are recognized as the only group of drugs as a basic therapy, even with an asymptomatic course of the disease.

Prescribed to accelerate the passage of intestinal contents, reducing the likelihood of complications of diverticulosis. In addition, they have an anti-inflammatory effect and stimulate the development of their own intestinal microbiota, eliminating the manifestations of diarrhea.As an additional effect, their hypocholesterol effect was revealed.

Enzyme preparations (Creon, Penzital) improve digestion and, accordingly, the absorption of nutrients, which reduces the symptoms of intestinal dyspepsia in the form of bloating and abdominal discomfort.

Simethicone (Espumisan) and adsorbents (Smecta, Enterosgel, Polysorb) are prescribed for the same purpose as symptomatic therapy of flatulence. However, the latter can lead to constipation, therefore, are more preferable for diarrheal syndrome.The drugs are contraindicated for atony and intestinal obstruction, bleeding of the gastrointestinal tract, exacerbation of peptic ulcer disease and their intolerance.

Probitic drugs (Linex, Hilak-forte, Bifidumbacterin, etc.) are prescribed to restore the intestinal microflora, especially after a course of antibiotic therapy and with a tendency to constipation.

Treatment with folk remedies as an adjunct against the background of the main therapy also helps to reduce the symptoms of the disease with its stabilization in the remission stage.

In any case, therapy should be prescribed only by a doctor after preliminary consultation and a series of diagnostic procedures. Treatment is difficult. And although a cure for diverticulosis has not yet been created, the disease can be kept under control for a long time.

Folk remedies

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Improper diet for a long time will lead to bowel disease. Diverticulosis can be treated with folk remedies, combining with medications.In this case, do not forget to consult with your doctor. Traditional medicine will help the body to alleviate this ailment in simple and affordable ways.

Treatment of diverticulosis with oatmeal.

The benefits of oatmeal are known all over the world. In Scotland, they are the main dish. In Great Britain, they have been used for breakfast for centuries. Therefore, the British have the smallest percentage of diseases of the gastrointestinal tract. In Russia, they also resort to them when problems with the stomach or intestines arise.For diverticulosis, jelly made from oatmeal can help:

• Normalize stool;
• Tone the intestines;
• Reduces pain symptoms;
• Eliminate flatulence.

It is recommended to use it every morning with bread.

Alternative treatment of diverticulosis bran

Treatment of intestinal diverticulosis with folk remedies involves the use of bran. Bran itself is a valuable source of fiber and vitamins.Even the ancient healer Hippocrates used them to treat people suffering from pain in the intestines. Bran has the following properties:

• They cleanse the body well;
• Treat constipation;
• Relieve abdominal pain;
• Prevents exacerbation of the disease.

Treatment with herbal decoctions

Herbs are an effective treatment for diverticulosis. Herbal infusions are used for constipation, diarrhea, flatulence. They use carminative and anti-inflammatory herbs.We are:

• Chamomile;
• Sage;
• Lovage;
• Dill Seeds;
• Cinquefoil;
• Wormwood;
• Blueberries and others

With their regular use, you can achieve a positive result. But do not forget to consult a doctor.

Walnut treatment.

Walnut is considered to be the most unique remedy in the treatment of many diseases. It is called the tree of life, as it feeds, restores strength and can heal, including diverticulosis.

The patient’s daily diet is advised to include walnuts, pumpkin seeds, lentils. It is recommended to prepare a medicinal decoction based on dry red wine from the leaves of the walnut.

It will help improve metabolism and increase appetite, as well as reduce pain in the intestines.

Diverticulosis of the intestine folk remedies will not be able to cure, but they can reduce or remove painful symptoms.

The information is for reference only and is not a guide to action.Do not self-medicate. At the first symptoms of the disease, consult a doctor

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Disease diverticular intestine – a disease characterized by the formation of diverticula of the intestinal wall; development of diverticulosis (multiple diverticula) and diverticulitis is possible (see Diverticular disease ).

The incidence of diverticular disease of the colon reaches 20% in the population; with age, the frequency increases, reaching 40-50% among patients 60-80 years old. The predominant age of is 60–80 years. Rarely occurs before the age of 40.

Classification • Colon diverticula. More frequent damage to the left half of the large intestine is explained by its anatomical and functional features – a smaller diameter, a large number of bends, a denser consistency of the contents; the sigmoid colon has a reservoir function, so the pressure in it is higher. • Diverticula of the small intestine meet less often diverticula of the colon. Diverticula of the duodenum occur more often (see. Diverticula of the stomach and duodenum ), mainly its distal part. In 3% of cases, duodenal diverticula are combined with jejunal and ileal diverticula.

The etiology of is largely controversial, the onset of the disease is more likely due to a combination of factors, rather than the action of one of them. Hernia theory is one of the most common. The reason for the formation of protrusions is considered to be the weakness of the connective tissue frame of the intestinal wall, which develops as the body ages.Disturbance of intestinal motor function, also characteristic of an aging organism, leads to an increase in intraintestinal pressure and protrusion of the mucous membrane in places of least resistance. The highest intraintestinal pressure occurs in the narrowest part of the large intestine – the sigmoid. For this reason, diverticula are more likely to form there. The close location of blood vessels explains the tendency of diverticula to bleed • Vascular theory. The main reason for the appearance of diverticula is changes in the intestinal wall due to circulatory disorders • Theory of congenital predisposition • Mechanical, or pulsatile, theory.With increased activity of the smooth muscles of the intestinal wall, excessive segmentation of the intestine occurs, leading to an increase in intraintestinal pressure in certain areas. Under the influence of high pressure, the mucous membrane protrudes through the muscle.

Genetic aspects – see Diverticular disease .

Risk factors for the development of diverticular bowel disease • Age over 40 • A diet low in fiber.

Risk factors for diverticulitis • History of diverticulitis • Multiple colon diverticula.

Clinical picture • Diverticulosis without clinical manifestations • Diverticulosis with clinical manifestations is characterized by abdominal pain, bloating, unstable stools (alternation of constipation, diarrhea and normal stools) • Allocate uncomplicated and complicated diverticulosis characterized by vascular disease •• Clinical picture of uncomplicated diverticulosis , bloating, unstable stools (alternating constipation, diarrhea and normal stools) •• Complicated diverticulosis (see.Complications).

Concomitant pathology. Colitis, dysbiosis.

Age characteristics • Children. Diverticular disease occurs very rarely, more often complications of Meckel’s diverticulum are possible • Elderly. It occurs most often, diagnosis is difficult due to the large number of concomitant diseases.

Complications of diverticulosis

• Diverticulitis occurs in about 25% of patients with diverticulosis. Main signs •• Acute onset – pain and tension of the muscles of the anterior abdominal wall in the left lower quadrant of the abdomen •• With the progression of the disease – fever, chills •• Anorexia, nausea, vomiting •• Diarrhea or constipation •• Painful dense sedentary infiltration in the abdominal cavity (when the inflammatory process spreads from the diverticulum to the surrounding tissues) •• When the bladder is involved in the process – dysuria.

• Perforation •• When a diverticulum is perforated into the abdominal cavity, a clinic of diffuse peritonitis develops; The development of peritonitis may be associated not only with perforation of the diverticulum, but also with abscesses that occur in the thickness of the intestinal wall, with inflammation and swelling of the diverticulum neck with its blockage.

• Bleeding •• Occurs in 20-25% of cases, often the first and only manifestation of the disease •• Usually bleeding is associated with ulceration of the neck or wall of the diverticulum and the vessel passing there as a result of chronic inflammation or the formation of a pressure ulcer in the place of fecal stone •• Bleeding from non-inflamed diverticulum can occur in patients with essential arterial hypertension, atherosclerosis, heart disease, blood diseases, diabetes mellitus and with prolonged use of GC and sometimes death.

• Intestinal obstruction •• The cause of intestinal obstruction can be an inflammatory infiltrate compressing the intestine, adhesions leading to deformation of the intestine and its mesentery, in some cases – intussusception of a part of the intestine with diverticulum or spasm of smooth muscles •• Intestinal obstruction is more often in the nature of diverticulosis obstructive with all manifestations inherent in this form.

• Internal or, less often, external intestinal fistulas •• In men, sigmo-vesical fistulas develop more often, in women – sigmo-vaginal fistulas •• With the formation of internal fistulas, a complex system of fistulous passages may form, opening onto the skin of the anterior abdominal wall •• intestinal-urinary fistula – pneumaturia, fecaluria.

• Small bowel diverticula can lead to malabsorption syndrome due to overgrowth of bacterial flora.

Laboratory tests • With diverticulosis, the number of leukocytes in the peripheral blood usually remains within the normal range; with diverticulitis, a shift of the leukocyte formula to the left often occurs, an increase in ESR • With bleeding, IDA develops • In urine, leukocytes, erythrocytes, components of intestinal contents can be detected; with the formation of an intestinal-urinary fistula, bacteria specific to the intestine are found in the urine. • Data from a scatological study confirming the presence of inflammation: neutrophilic leukocytes, an admixture of a large number of macrophages in the mucus, desquamated epithelium.

Special examinations • Contrast X-ray examination. Traditional irrigography or colonoscopy is considered the most valuable diagnostic test for diverticulosis. In case of complicated diverticulosis in the first 1-2 weeks, the study is limited to only sigmoid and colonoscopy. If diverticulitis is suspected, a water-soluble radiopaque contrast agent (eg gastrographin) can be used • Colon diverticula can also be detected by oral contrast study 24–72 hours after ingestion of barium suspension • Plain X-ray of the abdominal organs in horizontal and vertical positions – with perforation diverticulum and peritonitis • Colonoscopy reveals the source of intestinal bleeding.Typical endoscopic signs of diverticulosis •• The presence of single or multiple orifices of diverticula (holes) in the intestinal wall •• Often a blood vessel is found near the orifice of the diverticulum •• In the area of ​​the diverticulum – increased tone and stiffness of the intestinal wall; when the diverticulum is close to the physiological sphincters, the latter are spasmodic, open with difficulty •• Sometimes you can observe the discharge of pus from the mouth of the diverticulum • CT is used in the acute stage of the disease to assess the state of the intestinal wall and peri-intestinal tissues.In the presence of signs of acute pathology, CT is a more preferable diagnostic method than irrigography • Cystoscopy and cystography are indicated for the diagnosis of vesico-intestinal fistulas • Intravenous urography allows to establish possible involvement of the ureters in the inflammatory process • Angiography is a diagnostic method used for bleeding from a diverticulum; it is possible to carry out therapeutic measures through embolization of a bleeding vessel • Fistulography is used in the development of intestinal fistulas to establish their connection with the intestine.

TREATMENT

Mode • For diverticulosis with clinical manifestations, but without intoxication, symptoms of peritoneal irritation, leukocytosis, outpatient observation and treatment is possible • For diverticulosis with a complicated course, inpatient treatment is indicated in a specialized department (coloproctology) • For diverticulitis, restriction of physical activity is necessary.

Diet • All patients with diverticulosis are shown a diet with a high content of vegetable fiber • Wheat bran significantly reduces intracavitary pressure and accelerates the rate of migration of intestinal contents, moreover, coarse bran has this effect to a greater extent • It is necessary to exclude foods that cause flatulence (legumes, grapes, lentils, onions) and constipation (blueberries, rice).You should also exclude seeds, fruits with a large amount of grains and excessively coarse fiber (persimmons, pineapples, turnips, radishes, radishes).

Management tactics • In case of asymptomatic intestinal diverticulosis, detected by chance, there is no need for special treatment. Recommend a diet rich in plant fiber in order to prevent further progression of the disease and prevent possible complications • In case of diverticulosis with severe clinical manifestations, a set of therapeutic measures is used: a laxative diet, antispasmodics, drugs that regulate intestinal motor function, and agents that normalize the composition of the intestinal bacterial flora.In most patients with clinically expressed diverticulosis of the colon, conservative treatment gives a lasting effect the question of the need for surgical treatment is guided by the clinical picture, a combination of risk factors.

Indications for surgical treatment: •• Complications of diverticulosis that pose an immediate threat to the patient’s life – perforation of the diverticulum into the abdominal cavity with the development of diffuse peritonitis, intestinal obstruction, massive bleeding •• Presence of fistulas •• Formation of chronic infiltrates simulating a tumor •• Frequent exacerbations of chronic diverticulosis •• Currently, surgical treatment is increasingly used in uncomplicated, but clinically pronounced diverticulosis, which does not respond to complex conservative treatment.

Drug therapy • Diverticulosis •• Antispasmodics (papaverine hydrochloride 2% solution 1–2 ml s / c or i / m, bencyclan 0.05 g i / m or drotaverine 2% solution 2–4 ml i / m) with pain syndrome •• Pyridostigmine bromide 0.06 g 1-3 r / day orally or 2-5 mg s / c or i / m; metoclopramide 10 mg 3 r / day orally (before meals) or intramuscularly – to enhance the motility of the stomach and intestines in microclysters – with persistent constipation • Diverticulitis •• During the period of acute diverticulitis, it is recommended to prescribe antibiotics or •• derivatives of 5-hydroxyquinoline (chlorquinaldol) •• NSAIDs •• Escherichia coli, bifidobacterium bifidum or bificol – when dysbiosis is detected • Alternative drugs.Tobramycin and metronidazole, third-generation cephalosporins.

Surgical treatment

• The choice of the method of surgery in each specific case depends on the following factors: •• The nature of complications and the prevalence of the process •• Inflammatory changes in the tissues of the diverticulum, intestinal wall and surrounding tissues •• The presence of perifocal inflammation or peritonitis •• Of no small importance are concomitant diseases, often observed in the elderly.

• Routine colon resection with simultaneous anastomosis is preferable.The operation is performed approximately 6-12 weeks after the relief of an acute attack of diverticulitis.

• Colon fistulas in patients with diverticular disease should be treated surgically because they are in most patients, self-healing does not occur and chronic inflammation in the surrounding tissues leads to the development of chronic intoxication; with the formation of intestinal-vesical fistulas, there is a threat of developing an ascending urinary tract infection •• Surgical interventions in patients with complex fistulas (having several fistulous passages, incl.h. and blindly ending) in the presence of paraphistular cavities, it is advisable to carry out in several stages, which can reduce mortality and reduce the frequency of recurrence of the fistula.

• In case of profuse bleeding, it is necessary to perform hemicolectomy, most often left-sided •• The question of imposing a primary anastomosis should be decided individually, based on the general condition of the patient, the severity of anemia, and the quality of preoperative preparation of the colon.

• The choice of surgery for bowel perforation on the background of acute diverticulitis should be strictly individual •• Resection of the sigmoid colon with the imposition of a primary anastomosis is the most effective method of treatment in the event of local delimited abscesses.The presence of a delimited abscess is not considered a contraindication for the imposition of a primary anastomosis if the sections of the intestine involved in the anastomosis are not involved in the inflammatory process and there is no immunodeficiency state •• Resection of the sigmoid colon with the imposition of a primary anastomosis and removal of the unloading colostomy of the proximal anastomosis (for example) • Resection of the segment of the sigmoid colon involved in the pathological process with the removal of the end colostomy and suturing of the distal segment of the intestine (Hartmann-type operation).After the inflammatory process subsides (usually after 2.5–3 months), a reconstructive operation is performed, restoring the anatomical continuity of the large intestine.

Outpatient observation • Dispensary observation by a coloproctologist of the polyclinic • Irrigography, colonoscopy every 3 years for diverticulosis with clinical manifestations • With a persistent recurrence rate of diverticulitis, anti-relapse courses of treatment are indicated.

Course and prognosis • The prognosis for diverticular bowel disease in most cases is favorable, but in some situations it can lead to the development of severe and life-threatening complications. This can be explained not only by the severity of the complications themselves, but also by the predominant lesion of the elderly, often with concomitant diseases, as well as by the lower body resistance in this age group. bleeding, repeated bleeding occurs after several months or years.

Prevention. Prevention of constipation: adherence to diet and diet, active lifestyle, exercise therapy, massage.

ICD-10 • K57 Diverticular bowel disease.

Non-surgical treatments for colon diverticulitis (literature review) | Timerbulatov

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45. Picchio M., Elisei W., Brandimarte G., Di Mario F., Malfertheiner P., Scarpignato C., et al. Mesalazine for the treatment of symptomatic uncomplicated diverticular disease of the colon and for primary prevention of diverticulitis: a systematic review of randomized clinical trials. J Clin Gastroenterol. 2016; 50 (suppl 1): S64-9. DOI: 10.1097 / MCG.0000000000000669

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51. Tursi A., Brandimarte G., Elisei W., Picchio M., Forti G., Pianese G., et al. Randomized clinical trial: mesalazine and / or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease – a double-blind, randomized, placebo-controlled study.Aliment Pharmacol Th er. 2013; 38 (7): 741–51. Doi: 10.1111 / apt. 12463

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53. Sallinen V., Mentula P., Leppäniemi A.Risk of colon cancer aft er computed tomography-diagnosed acute diverticulitis: is routine colonoscopy necessary? Surg Endosc. 2014; 28 (3): 961-6. DOI: 10.1007 / s00464-013-3257-0

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90,000 Diverticular disease – treatment in St. Petersburg. Diverticular disease of the colon

Diverticular disease is a chronic disease that occurs due to the formation of a sac-like protrusion (diverticulum) in the intestinal wall, and, as a result, a stagnant process and the development of inflammation.

Sometimes there is a single diverticulum, but, as a rule, people most often have multiple protrusions in one part of the intestine.

Diverticula are divided into “true” and “false”, as well as “congenital” and “acquired”.

• True diverticula are most often congenital – due to a direct violation of the structure of the intestine. One of the features of a true diverticulum is that the walls of the diverticulum have all the layers that are characteristic of the intestine.True diverticula, for example, include Meckel’s diverticulum: protrusion of the wall of the small intestine at the confluence of the unsealed embryonic yolk duct as a developmental anomaly.
• False diverticula are acquired and represent a bulging of the intestinal mucosa outward through thinned places in its muscle layer.

As a rule, acquired diverticula are multiple and rarely occur in a single quantity.
Diverticulosis is a change in the intestinal wall with the presence of multiple diverticula in it without inflammatory processes occurring in them and not manifesting themselves clinically.
If an inflammatory process develops in the diverticulum, they talk about diverticulitis and, as a consequence, the development of diverticular disease.

Frequency of diverticular disease

Of all the diseases of the colon, intestinal diverticular disease is one of the most common in the modern world.The incidence of diverticular disease averages 20% in European countries; moreover, in older age groups of the population (60–80 years old) the frequency increases, reaching 40–50%, and among patients over the age of 80 years, the incidence reaches 60–65%. In our country, diverticula of the large intestine are found in about 17-28% of gastroenterological patients. The incidence of the disease in men and women is approximately the same.

Classification of diverticular disease

• Uncomplicated. This form is detected incidentally during X-ray or endoscopic examination of the intestine. Blood tests usually show no change. The examination must be carried out to assess the prevalence of intestinal lesions, prognosis of the course of the disease and the choice of a method for preventing complications or treatment.
• Complicated , proceeding with an acute inflammatory process (diverticulitis, diverticular infiltrate, diverticulum perforation, abscess, peritonitis), chronic inflammatory process, as well as bleeding.A chronic process refers to situations when inflammation cannot be eliminated within 6 weeks, or it occurs repeatedly. In severe cases, an infiltrate, narrowing of the intestine, or a fistula from a destroyed diverticulum may form.

Causes of diverticula

The occurrence of this disease does not have any specific cause. It is due to a combination of many factors. There is an opinion about the predisposition of some people to this disease due to congenital underdevelopment of the muscular layer of the intestinal wall.As a result, they develop diverticula with age or under the influence of any factors.

Congenital predisposition plays a role in people with hereditary connective tissue dysplasia syndromes (Marfan, Ehlers-Danlos syndromes, when there is a collagen deficiency in the human body), and a combination of diverticular disease of the colon with diseases associated with a decrease in the elasticity and strength of connective tissue (hernia , Varicose veins, visceroptosis, polycystic).
However, congenital tissue inferiority is not the only cause of pathological changes in the intestinal wall.

The high incidence of diverticular disease in the elderly is associated with a gradual decrease in the tone of the colon wall as the body ages. Diverticular disease is a chronic disease that occurs due to the formation of a sac-like protrusion (diverticulum) in the intestinal wall, and, as a consequence of the stagnant process, the development of inflammation in them.The muscle layer of the colon becomes thicker and less elastic. The supporting connective tissue loses its elasticity and the intestinal wall becomes less elastic. Therefore, diverticula appear in older people more often than in young people.

It is also known that diverticula are reliably more likely to occur with a decrease in the diet of plant fibers and cellulose. Therefore, in vegetarians, diverticular disease occurs 3 times less often than in people who limit the intake of vegetables and fruits.Foods with a low fiber content poorly stimulate intestinal motility, the movement of contents through the colon slows down, which increases the absorption of water and, as a result, constipation develops. The retention of feces in the intestine, together with a violation of the normal intestinal microflora, leads to inflammation and progression of diverticular disease. This can also explain the more frequent appearance of diverticula in the sigmoid colon (constipation plays the role of a resolving factor).

The clinical picture in about two cases out of three is not accompanied by any complaints (asymptomatic diverticulosis), pathology is discovered by chance during endoscopic or X-ray studies. Most often, the first signs of diverticular disease are pain and functional disorders in the form of constipation or diarrhea. There are complaints of recurring abdominal pain, more often in the left iliac region or lower parts, disappearing after the act of defecation.Pains of varying intensity can exist for a long time – from several weeks to months. Increased pain is sometimes accompanied by an increase in temperature, signs of intoxication may appear (dry mouth, nausea, tachycardia). Also, bloating and profuse flatulence, various dyspeptic disorders are often noted, which sometimes hides under the guise of irritable bowel syndrome.

Complications of diverticular disease of the colon

• Diverticulitis. This is an acute inflammation that occurs in diverticula in a quarter of patients with diverticulosis. Signs of the development of inflammation can be the appearance of pain and tension in the muscles of the anterior abdominal wall, fever, chills, bloating, stool disturbances in the form of diarrhea or constipation.

• Diverticulum perforation. Against the background of an inflammatory process in the diverticulum, part of its wall may collapse, and the contents of the intestine enter the abdominal cavity.In this case, local or diffuse peritonitis develops. With perforation (rupture of the wall) of the diverticulum into the retroperitoneal tissue or the space between the mesenteric leaves, infiltrates or abscesses appear.

• Bleeding. Occurs in about 25% of patients with diverticular disease. For many people, it may be the first and only manifestation of the disease. Usually, bleeding is associated with ulceration of the diverticulum wall as a result of chronic inflammation.Also, a pressure ulcer can form at the site of a fecal stone with damage to a blood vessel. The intensity of bleeding can be different: from a slight admixture of blood in the feces (sometimes there is latent bleeding, which is manifested by a gradual increase in anemia), to massive profuse bleeding, accompanied by collapse and even leading to death.

• Intestinal obstruction. The cause of intestinal obstruction can be an inflammatory process around the diverticulum or an adhesive process, leading to deformation of the intestine and impaired movement of feces along it.In rare cases, intussusception (screwing in) of a portion of the intestine with diverticulum or smooth muscle spasm may occur.

• Intestinal fistulas. May occur when a diverticulum perforates and an abscess breaks out into a nearby organ (so-called “internal fistulas”). Men are more likely to develop fistulas with the bladder, women – with the vagina. With the formation of an intestinal-urinary fistula, air or an admixture of feces may appear in the urine.

Diagnosis of diverticular disease

• Irrigoscopy – X-ray examination, in which the lumen of the colon is filled with a contrast suspension and its condition is assessed during filling and after emptying the colon.
• Colonoscopy can detect the presence of multiple diverticula, signs of inflammation or intestinal bleeding, and may be useful for detecting associated lesions such as polyps and cancer.
• MSCT (multislice computed tomography). Suitable for the differential diagnosis of diverticulitis and tumor lesions of the colon.

Treatment

The main goal of the treatment of diverticular disease is to normalize bowel function, prevent disease progression and complications, and relieve exacerbations.

Diet

Since diverticular disease occurs more often in people who limit the consumption of vegetables and fruits in food, all patients with diverticulosis should use foods high in vegetable fiber and pectin. Wheat bran is very useful (especially coarse bran), which significantly reduces the pressure inside the intestine and accelerates the speed of movement of the contents through the intestine.

It is imperative to exclude all foods that cause increased gas formation (legumes, lentils, grapes, sauerkraut, pastry and yeast dough, onions) and constipation (blueberries, rice).It is also advisable to exclude seeds, fruits with a large amount of grains and excessively coarse fiber (persimmons, pineapples, turnips, radishes, radishes).

Drug treatment

• In an uncomplicated course, the disease does not require the use of medications. The need to take medication arises depending on the clinical manifestations.
• Antispasmodics are used for abdominal pain.
• When dysbiosis is detected – drugs that help restore normal intestinal microflora.
• For persistent constipation, drugs are taken to enhance the motility of the stomach and intestines: lactulose preparations, vaseline or olive oil by mouth or in microclysters.
• In case of diverticulosis with clinical manifestations of inflammation, it is necessary to use the whole complex of therapeutic measures: a laxative diet, antispasmodics; drugs that regulate the motor function of the intestine, and agents that normalize the composition of the intestinal bacterial flora.

Surgical treatment

The need for surgical treatment for diverticular disease can arise both urgently and routinely.This happens when complications arise that can threaten a person’s life (bleeding, perforation, peritonitis).
Routine surgical treatment is always aimed at eliminating the threat of such complications. The choice of the method of surgery in each case depends on the prevalence of the process, inflammatory changes in diverticula, the state of the intestinal wall and surrounding tissues, the presence of inflammation outside the lumen of the intestine or peritonitis. It is important to consider comorbidities often seen in older people.As a rule, resection (removal) of the affected part of the large intestine is routinely performed with the simultaneous imposition of an anastomosis.
Surgical treatment in our Clinic is performed laparoscopically, which allows patients to quickly return to active life. Planned surgery is always performed during remission, 2-3 months after the acute attack of the disease has been removed. Colon fistulas are an indication for planned surgical treatment, since it is not possible to achieve their self-healing, and chronic inflammation leads both to the development of rough scars that disrupt the movement of intestinal contents, and to the development of chronic intoxication and a decrease in immunity.With the formation of intestinal-urinary fistulas, there is a threat of developing an ascending urinary tract infection and kidney damage.

• Surgical elimination of fistula is a complex surgical intervention requiring the participation of highly qualified specialists. In our clinic, when planning such interventions, related specialists (urologists, gynecologists, endoscopists) are involved, if necessary. With intestinal bleeding, conservative treatment (hemostatic therapy) is most often prescribed or endoscopic stopping of bleeding is performed.The operation is performed only if conservative treatment methods are ineffective.
• Surgical treatment for diverticulum perforation. If surgery is urgently needed, a colostomy may be placed to reduce the risk of postoperative complications. Reconstructive surgery with the closure of the colostomy and restoration of intestinal continuity is performed after the inflammatory process subsides (after about 3 months).

Dispensary supervision

Patients with diverticular disease should be seen regularly by a gastroenterologist or coloproctologist.Colonoscopy in the absence of complaints is performed once every 3 years.
If pain and other manifestations of the disease occur, the examination should be done as soon as possible. With frequent recurrent recurrences of diverticulitis, regular anti-relapse courses of treatment are indicated.

Forecast

The prognosis, as a rule, is favorable, if the disease is detected in a timely manner, the necessary preventive and therapeutic measures are started, provided that the patient follows all the necessary recommendations.
However, if the need for prevention is ignored, diverticular disease can lead to the development of severe complications that threaten the life and health of the patient. Moreover, the disease is more common among older people with a variety of concomitant diseases and less body resistance.

Prevention

Among preventive measures, a varied and balanced diet is of primary importance. Due to the fact that a diet low in plant fiber predisposes to the formation of diverticula, in order to reduce the risk of developing the disease, it is necessary to include large quantities of plant products.
Since the timely detection of diverticula plays an important role, it is extremely important to undergo a preventive examination and regularly perform an endoscopic examination of the intestine.

Loperamide for diarrhea – instructions for the use of capsules for adults

Number of views: 497

Date of last update: 02.07.2020

Contents:

Indications for use

Contraindications loperamide acts
Drug interaction
Special instructions

Loperamide hydrochloride is a powder, the color of which varies from white to yellow.It is used as an active ingredient in drugs for the treatment of diarrhea. One of these drugs is the modern drug IMODIUM ^® Express.

Indications for use

The doctor may prescribe loperamide for adults and children over 6 years of age:

• for acute and chronic diarrhea of ​​various genesis;
• as an adjuvant for infectious diarrhea;
• as a stool-regulating agent for ileostomy.

How to drink loperamide for diarrhea, the attending physician will tell. The dosage and duration of admission are selected depending on the severity of symptoms and individual characteristics.

Contraindications

Instructions for use IMODIUM ^® Express says that you should not take loperamide:

• for individual intolerance to the substance,
• intestinal obstruction,
• diverticulosis,
• during the first trimester of pregnancy and lactation less than 6 years old.

It is forbidden to take medicine for bloody diarrhea, accompanied by fever, with pseudomembranous and ulcerative colitis. Care should be taken to treat liver failure.

How loperamide works

Loperamide has an antidiarrheal effect: it gives density to stool, reduces the volume and frequency of bowel movements.

The substance interacts with opioid receptors located on the annular and longitudinal muscles of the intestinal walls, and inhibits the release of acetylcholine and prostaglandins.As a result, intestinal peristalsis slows down and the duration of the passage of food through the gastrointestinal tract increases, which ensures the formation of fecal masses of a dense consistency.

Also, loperamide tones the anal sphincter, due to which the feces are retained in the intestines, and the urge to defecate becomes more rare.

The action of loperamide can begin within an hour after taking IMODIUM ^® Express. The active substance is completely absorbed by the liver and excreted from the body.The half-life is 9-14 hours.

Drug interaction

Simultaneous administration with cholestyramine weakens the effect of loperamide. In combination with ritonavir and co-trimaxozole, the effectiveness of the active substance increases.

Constipation may occur if loperamide is taken with opioid analgesics.

Special instructions

If within two days the pills for diarrhea did not give the desired effect, you must stop taking and contact a gastroenterologist to find out the cause of the diarrhea.If the medication is accompanied by flatulence or constipation, then it is canceled.

Treatment with loperamide does not replace the correction of water and electrolyte balance that occurs with diarrhea.