How are diverticula formed?
With age, the wall of the colon becomes less elastic. If a person eats little fiber and suffers from constipation, the intestines have to create high pressure to move the dense contents. In places where the vessels pass through the muscle layer, the wall is weakest - there the mucous membrane protrudes outward, forming diverticula. In countries with a Western diet, a significant proportion of people over 60 have them.
- Asymptomatic diverticulosis
- Diverticular disease with symptoms without inflammation
- Acute uncomplicated diverticulitis
- Complicated diverticulitis - abscess, perforation, fistula, stenosis
- Diverticular bleeding
Causes and risk factors
The main factors are related to lifestyle and age. Inflammation occurs when intestinal contents stagnate in the diverticulum and its wall is damaged. The idea that diverticulitis is caused by seeds, nuts and popcorn has not been confirmed by research.
- Age over 50
- Low fiber diet, high in red meat
- Chronic constipation
- Obesity and inactivity
- Smoking, taking NSAIDs and glucocorticoids
Symptoms
Uncomplicated diverticulosis usually does not cause complaints. Sometimes there is bloating and dull pain in the lower left that goes away after stool. Diverticulitis manifests itself differently: the pain becomes constant, fever and weakness appear. In older people, symptoms may be erased even with serious complications.
- Pain in the left iliac region
- Fever, chills
- Constipation or, less commonly, diarrhea
- Nausea, bloating
- Blood in the stool due to diverticular bleeding
Diagnostics
If diverticulitis is suspected, the method of choice is a CT scan of the abdominal cavity: it confirms inflammation and identifies complications. Colonoscopy in the acute period is not performed due to the risk of perforation - it is performed 6-8 weeks after the inflammation has subsided in order to evaluate the intestine and exclude a tumor, the symptoms of which may be similar.
- Complete blood count and CRP
- CT scan of the abdomen with contrast
- Abdominal ultrasound
- Colonoscopy after inflammation subsides
- Urinalysis to exclude urological causes
Treatment and prevention
Asymptomatic diverticulosis is not treated; a diet with sufficient fiber and regular bowel movements are recommended. Mild uncomplicated diverticulitis is often treated on an outpatient basis: a gentle diet, pain relief, and antibiotics if indicated. In severe cases, abscess or perforation requires hospitalization, drainage of the abscess or surgery. After several severe episodes, elective removal of the affected area of intestine may be discussed. The treatment regimen is determined by the doctor: self-administration of antibiotics can hide the development of complications.
- Eat more vegetables, fruits, whole grains and legumes
- Drink enough water
- Treat constipation, do not abuse laxatives
- Regular physical activity, normal weight
- Stop smoking, be careful with NSAIDs