Diverticulosis & Diverticulitis

Diverticulosis of the colon is a common condition affecting many Americans who are middle- aged or older. Only a small percentage of these people eventually require treatment.

What Is Diverticulosis?

Diverticulosis is the presence of pockets (diverticula) that develop on the wall of the large intestine or colon. They occur at weak areas in the bowel wall and are usually found on the left side (called the sigmoid colon), but they can be found anywhere throughout the colon.

What Causes Diverticulosis?

Diverticula occur gradually over time and are due to excessive pressure or spasms within the bowel. The amount of fiber and fluid intake affects what kind of action occurs in the bowel. The American diet is high in processed foods with the natural fiber being removed. When fiber and fluid are lacking, the stool becomes hard and dry. The muscles in the wall of the colon need to squeeze with greater force, causing a bulge to form in the colon wall, which eventually becomes a pocket or diverticulum.

What Are the Symptoms of Diverticulosis?

Diverticulosis presents in several different ways. Most people with diverticulosis have no symptoms. If they do, possible symptoms include left lower abdominal pain, diarrhea, cramps, and change in bowel habits. Some patients with diverticulosis can have severe rectal bleeding. These symptoms can also be the result of other conditions. An examination is necessary to make the correct diagnosis.

What Can I Do to Prevent Diverticulosis?

The prevention of diverticulosis and treatment of its symptoms are managed in the same way– with diet and occasionally with medication. You should increase your dietary fiber to 25 grams daily and liquid intake to 8-10 glasses daily. High-fiber foods and commercial fiber products add bulk to the diet, which helps achieve regular bowel habits. Fiber holds water, which helps to soften stool. Soft stool requires less pressure to move it through the colon. Diverticula formation may be reduced or even stopped.

High-fiber foods* can be found in most food groups.

• Legumes–The bean family excels in fiber, especially the soluble, cholesterol- lowering type. They include kidney, pinto, navy, lima, and baked beans.
• Whole grains–Wheat bran and oat bran are present in a variety of cereals and breads. The label should say that the bread contains whole wheat or whole grain. Plain wheat bread may lack fiber. One cannot always tell by the color. Some manufacturers artificially color bread brown to make it look more wholesome.
• Whole fresh fruits– Valuable pectin fiber is found in the skin and pulp. Figs, prunes, and raspberries have the highest fiber content.
• Cooked or stewed fruits–Prunes and applesauce are good choices.
• Green leafy vegetables–Lettuce, spinach, celery, and broccoli are good examples.
• Root vegetables–Potatoes, turnips, and carrots are excellent sources.
  

Since fiber can cause rumbling intestinal gas and even some mild cramping, the amount taken should be increased gradually. The goal should be 25 to 35 grams of fiber each day, which will usually produce one to two soft, formed stools a day.

General Rules

1. Drink plenty of liquids, including fruit or vegetable juices and water (8-10 glasses per day). Increasing the amount of fiber without adequate liquid will result in hard stools. Because caffeine acts as a diuretic, caffeine-containing products should not be considered part of your liquid intake.
2. Eat meals at regular intervals.
3. Get regular exercise.
4. It is often recommended that patients with diverticulosis avoid certain foods such as popcorn, nuts, and seeds because it was thought they may increase the likelihood of symptoms. There is no hard evidence of this in medical studies.

What Is Diverticulitis?

Diverticulitis is an infection due to a micro perforation of a diverticulum. It occurs when the diverticulum ruptures probably as a result of increased pressure within the lumen of the bowel. This results in a localized infection. Symptoms may include abdominal pain, chills, fever, or change in bowel habits. Complications can result in bowel perforation, abscess or infection into another organ. Mild cases can be managed with oral antibiotics and a modified diet. Severe cases require hospitalization with intravenous antibiotics and no food or fluid by mouth. Surgery becomes necessary with recurrent episodes, complications, or a poor response to medications. When surgery is required, the infected part of the colon is removed and the colon usually is put back together. Bowel activity typically returns in three to five days and becomes routine in approximately three weeks.

Fairfax Colon & Rectal Surgery and Diverticulitis

Patient with diverticulitis can present in a variety of ways – anything from nagging recurrent episodes of acute disease, to chronic low grade abdominal pain, to the unfortunate patient with a perforated colon and peritonitis. The surgeons at Fairfax Colon and Rectal Surgery have a vast experience with treating the broad spectrum of patients with diverticular disease. Whether we first see the patient in an office visit or during an admission to the hospital, we will review the history of the disease with the patient, recommend the appropriate evaluation (often a CT scan of the abdomen and eventually a colonoscopy), and determine if an operation is appropriate. The majority of elective colon operations we do for diverticular disease are able to be accomplished laproscopicly. This results in limiting the size of the abdominal incision, shortens the hospital stay and results in less discomfort in the post operative period.

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