Diverticulitis - Causes, Symptoms, Treatment

Published: 28th July 2008
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The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material. Pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to as diverticula.





Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear. Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This obstruction may result in distension of the diverticula secondary to mucous secretion and overgrowth of normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then ensue. Alternatively, some believe that increased intraluminal pressure or inspissated food particles cause erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation.





Causes





Small, protruding sacs of the inner lining of the intestine (diverticulosis) can develop in any part of the intestine. They are most common in the colon, especially the sigmoid colon. These sacs, called diverticula, occur more often after the age of 40. When they become inflamed, the condition is known as diverticulitis. Diverticula are thought to develop as a result of high pressure or abnormal pressure distribution in the colon. High pressure against the colon wall causes pouches of the intestinal lining to bulge outward through small defects in the colon wall.





The development of colonic diverticulum is thought to be a result of raised intraluminal colonic pressures. The sigmoid colon (Section 4) has the smallest diameter of any portion of the colon, and therefore the portion which would be expected to have the highest intraluminal pressure. The postulate that a lack of dietary fiber, particularly non-soluble fiber* (also known in older parlance as "roughage") predisposes individuals to diverticular disease is supported within the medical literature





Symptoms





The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.





When symptoms of diverticulitis improve, you may ease off of the diverticulitis diet and gradually add more fiber back into your diet. A high-fiber diet is very important in preventing future diverticulitis attacks. As you increase your fiber intake, increase your fluid intake as well.





Treatment





The treatment you need depends on how bad your symptoms are and whether you have an infection. You may need to have only liquids at first, and then return to solid food when you start feeling better. If you have an infection, your doctor may prescribe antibiotics. Take them as directed. Do not stop taking them just because you feel better.





If your condition calls for home treatment, expect to remain quiet for a few days. You'll also temporarily need to avoid all whole grains, fruits and vegetables so that your colon can rest and heal. Once your symptoms improve - often in two to four days - you can gradually start increasing the amount of high-fiber foods in your diet. In addition, your doctor will likely prescribe antibiotics to help kill the bacteria causing your infection.





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