The human intestine (also known as the bowels) is broadly divided into two distinct parts: the small intestine and the large intestine. The small intestine begins after the stomach, and is further sub-divided into three regions: duodenum, jejunum, and ileum. Similarly, the large intestine is further subdivided into multiple regions: cecum, appendix, colon, rectum, and anal canal. Most of the digestion and absorption of nutrients happens in the small intestine. The main role of the large intestine is absorption of water and the compaction and storage of feces for defecation.
What is a diverticulum?
A diverticulum (plural: diverticula) technically refers to an outgrowth (in the form of a pouch) from the walls of a hollow tissue within the body. Abnormal diverticula may occur in the esophagus, pharynx, heart, stomach, gallbladder, urinary bladder, urethra, small intestine and large intestine (especially the sigmoid colon). However, it is the colon that is most commonly affected in diverticulitis.
What is diverticulitis?
A common condition among people over the age of 40 years is the formation of multiple diverticula along the walls of the large intestine or colon. This condition is also known as diverticulosis. Young people who suffer from constipation and are constantly straining during defecation may also develop diverticulosis. However, when the diverticulum or diverticula become inflamed then the condition is known as diverticulitis. Most of the time diverticulitis is due to an infection of these abnormal pouches in the colon.
Signs and Symptoms
Diverticula do not usually produce any signs and symptoms till they get infected or inflamed. The following are some of the typical signs and symptoms associated with diverticulitis or inflamed diverticula:
- Abdominal pain: Diverticulitis may produce tenderness and pain in the lower left region of the abdomen. In Asian populations, the pain may occur on the right side of the abdomen.
- Abdominal bloating: A bloating feeling and flatulence may also be present.
- Nausea and vomiting: Abdominal discomfort may be accompanied by nausea. In rare cases, vomiting may also occur.
- Changes in bowel movements: Diverticulitis may also cause changes in normal bowel movements, resulting in diarrhea or constipation.
- Fever: Chills and fever may also be present.
The above mentioned signs and symptoms of diverticulitis may either last only a few hours or may persist for several days.
Complications of Diverticulitis
Left untreated, diverticulitis may lead to the following serious and life-threatening complications:
- Spread of infection to other organs: The infection may spread to the organs that lie near the colon, such as the uterus, urinary bladder, and ureter.
- Colon obstruction: Inflammation results in scarring of the tissue. The scarring caused by repeated inflammation in diverticulitis may lead to an obstruction of the colon. This requires surgical intervention, which may be either planned or sudden depending on the extent of the obstruction.
- Intestinal abscess: Infection and inflammation in diverticulitis may also cause accumulation of pus (abscess) in the walls of the colon. Antibiotics or surgery may be prescribed for the treatment of intestinal abscess.
- Perforation of the colon: Diverticulitis may also lead to perforation of the walls of the colon. This is a dangerous situation that is characterized by an inflammation of the peritoneum (technically referred to as peritonitis). Fever, severe pain, weak but fast heart rate, restlessness and rapid breathing are some of the symptoms associated with a perforated colon. Surgery must be done immediately in case a perforation of the colon is suspected.
- Fistula formation: A fistula refers to the formation of an abnormal tunnel connection between two organs. Diverticulitis may lead to the formation of fistulas that may connect the colon to other adjacent organs such as the uterus, urinary bladder, skin of the abdominal wall, small intestine, and vagina. The inflammation may spread from the colon to these adjacent organs through the fistulas.
- Intestinal bleeding: On rare occasions, diverticulitis may also cause intestinal bleeding.
Read more on blocked colon.
Diagnosis of Diverticulitis
Diagnosis of diverticulitis depends on several factors. The presence of multiple diverticula on the intestinal wall (diverticulosis) may be suspected on the basis of the previously mentioned signs and symptoms, especially appearance of pain in the lower left side of the abdomen.
Computerized tomography (CT scan) or ultrasound of the abdomen may be done to confirm the presence of diverticula. The inflammation in diverticulitis results in an increase in the number of white blood cells known as leukocytes. This increase in leukocyte count can be found through a blood test. Once the inflammation subsides, colonoscopy or an X-ray with barium enema may be conducted to determine the extent of diverticulosis.
Treatment of Diverticulosis and Diverticulitis
Diverticulosis is a chronic condition and there is no permanent cure for diverticula. Medications and dietary factors do not get rid of diverticula. If the diverticula are not causing any symptoms and there is no infection then it may be left untreated. Instead the focus will be on managing the condition through dietary factors in particular which will prevent enlargening of the diverticula or the formation of new diverticula. However, sudden onset diverticulitis produces signs and symptoms that require treatment. The following are some of the treatment measures in case of diverticulitis:
- Antibiotics may be prescribed to treat infections in diverticulitis. In mild cases, oral antibiotics are given. When the infection is severe, antibiotics may be given intravenously.
- Painkillers (such as paracetamol) may be given to combat the painful symptoms. However, strong painkillers (such as morphine) are avoided since they may worsen constipation.
- Rest is always recommended for recovery.
- Suggested dietary changes may include intake of low-fiber foods (such as white rice, eggs, fish, seeds, poultry, white bread, pasta and fruits without peels) or a clear liquid diet (consisting of water, juices, broths, and gelatin). Vegetables with hard skins (such as peas and beans) are best avoided in this condition.
- Surgery is used as a last option when diverticulitis is chronic and other treatment measures do not help. In such cases, the affected part of the colon is removed surgically (through either open-abdomen surgery or laparoscopic surgery), and the ends of the remaining parts of the colon are joined together.