Diverticulitis

Nutritional, Oral and Gastrointestinal

Diverticulosis is the inflammation or infection of sac-like protrusions from the wall of the gastrointestinal tract, called diverticula. These sac-like protrusions, or pockets, occur at sites where the blood vessels pierce through the gut wall, in the lower-left part of the colon (sigmoid colon). Diverticula are generally not symptomatic and are rather common in middle age. It is when these diverticula become inflamed or infected (generally due to tearing) that the condition is called diverticulitis and gives rise to symptoms. Initial symptoms include fever and most often pain in the lower-left portion of the abdomen. Rectal bleeding can occur when the blood vessels near the diverticula are damaged. Patients with diverticulitis sometimes develop complications and suffer from a wider array of symptoms.

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Symptoms

  • Nausea and vomiting
  • Fever
  • Abdominal tenderness
  • Constipation
  • Diarrhea (less common)
  • Persistent pain in the low abdominal region

Types

Diverticulosis is the development of diverticula (small, bulging pouches) in the digestive tract. When these pouches become infected, diverticulitis occurs. There are two types of diverticular diseases.

Diverticulitis. This happens when waste products (i.e., bacteria and pieces of stool) get trapped in the pockets. These little sacs can tear and cause a loss of healthy gut bacteria and an increase in harmful bacteria.

Diverticular bleeding. This occurs when the blood vessels that bring blood to the surface of the intestinal walls burst in the diverticula. Signs of diverticular bleeding are bright red clots or dark red streaking in the stools. If you see any blood in your stools, see your doctor right away.

Risk Factors

  • Age (70% of people over 80 have diverticulitis)
  • Medical history of diverticulosis
  • Obesity
  • Lack of exercise
  • A low-fiber diet high in animal fat
  • Smoking
  • Medications (i.e., NSAIDs, aspirin, acetaminophen, corticosteroids, opioids, statins)

Diagnosis

Evaluation begins with blood testing for indicators of inflammation and quantities of different immune cells. The stool can sometimes be tested if there is a history of abnormal bowel movements. This is done to help rule out other diseases that may be suspected. An abdominal CT scan is performed to help confirm the diagnosis of diverticulitis.

Treatments

There is a range of treatment options available depending on the severity of the attack. Patients are started on antibiotics aimed at targeting the different species of gut bacteria. When these bacteria are contained within the confines of the intestinal wall, they are not harmful to the human host. But when they spread anywhere outside the gut, they can be dangerous. If there is perforation of the intestinal wall the resultant condition is so severe that it requires surgery. Abscesses can usually be drained directly through the abdominal wall using needles, forgoing the need for surgery. In the case of fistula formation, surgery is required for removal because they do not close on their own. If the patient continues to experience frequent symptomatic episodes, then surgical resection of the involved area of the bowel can be done.

After an initial attack, patients are usually advised to increase their intake of fiber. It is not clear what role fiber has in helping to prevent the development of the condition, but it is thought that because fiber causes the smooth passage of stool, less pressure is generated in the colon and this decreased the likelihood of diverticulitis being formed.

Alternative Treatments and Home Remedies

Demulcent herbs. Slippery elm bark, marshmallow root, and licorice are demulcent herbs that relieve irritation of the mucus membranes of the gastrointestinal tract. Aloe vera juice can help soothe muscle cramps and reduce spasms.

Prebiotics and probiotics. Small intestinal bacterial overgrowth (SIBO) can occur in people with diverticulitis. Prebiotic and probiotic supplementation can help decrease the harmful bacteria and balance with healthy bacteria in your gut.

Healthy diet. Eat a high-fiber diet (not during a flare-up) rich in vegetables and fruits like pears and papaya. Pears and papaya contain enzymes that help to reduce intestinal inflammation.

Reduce inflammation. Herbs like turmeric and ginger help to reduce inflammation and fight infection.

Take a walk. Regular exercise for 30 minutes a day greatly reduces your risk for diverticulitis. Moving the body, like during a brisk walk, helps promote the natural movement of food through the intestines.

Prevention

  • Reduce stress
  • Exercise regularly
  • Avoid smoking
  • Hydrate
  • Eat a high-fiber diet
  • Talk to your doctor about medications that may cause flare-ups

References

Bassoti, G., et. al. (2005, March). Alterations in colonic motility and relationship to pain in colonic diverticulosis. Clinical gastroenterology and hepatology, 3(3), 248-253. Retrieved from:https://pubmed.ncbi.nlm.nih.gov/15765444/

Bohm, S. K. (2015, April). Risk factors for diverticulosis, diverticulitis, diverticular perforation, and bleeding: A plea for more subtle history taking. Viszeralmedizin, 31(2), 84-94. Retrieved from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789955/

Kinney, K. (2019, April 26). How to prevent diverticulitis naturally through diet. Retrieved from:https://chriskresser.com/how-to-prevent-diverticulitis-naturally/

Mayo Clinic. (2020, May 07). Diverticulitis. Retrieved from Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

Strate, L. L. & Morris, A. M. (2019, April) Epidemiology, pathology, and treatment of diverticulitis. Gastroenterology, 156, 1282-1298. Retrieved from:https://www.gastrojournal.org/article/S0016-5085(19)30046-0/pdf

Strate, L. L., et. al.(2009, January 1). Obesity Increases the Risks of Diverticulitis and Diverticular Bleeding. Gastroenterology, 136(1), 1115-1222. Retrieved from: https://www.gastrojournal.org/article/S0016-5085(08)01694-6/fulltext

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