Intestinal diverticula are protrusions of the intestinal mucosa in structurally weak points – such as vascular gaps in the intestinal wall.
For lack of a better description they are small- sometimes large bulging sacs pushing outward from the colon wall.
Diverticula in the intestine are usually harmless, but can cause severe discomfort if they become inflamed.
Diverticulitis and Diverticulosis – In Brief
In diverticulosis there are numerous protrusions from the intestinal wall to the outside. If they become infected, we speak of diverticulitis. This can cause severe abdominal pain and fever, and symptoms such as blood in your stool. Sometimes the inflamed diverticula heal on their own with a light diet and sufficient fluid intake. In more severe cases, antibiotics and sometimes hospitalization are necessary. If this doesn’t help, or if complications such as a ruptured bowel or heavy bleeding occur, surgery may be necessary. In this case the removal of the part of the intestine where the diverticula are located. If the inflammation keeps coming back, for example narrowing the bowel, surgery may also be advisable.
What is diverticulosis / diverticulitis?
Especially in older people there are often bulges of the intestinal mucosa; mostly through gaps in the intestinal wall. These protrusions are known as the intestinal diverticulum. If there are numerous such intestinal diverticula, doctors speak of diverticulosis.
As long as the diverticula do not cause any symptoms – which is the case in over 80 percent – it is asymptomatic diverticulosis. This is harmless and does not require treatment. However, if symptoms occur, it is known as diverticular disease. The diverticula can become inflamed and cause severe discomfort and complications. This is known as diverticulitis. Less often, diverticula can lead to profuse bleeding into the intestines even without inflammation.
Strictly speaking, diverticulosis is usually a “false” diverticulum or “pseudodiverticulum”. This is how doctors call it when the entire intestinal wall does not protrude through the vascular gaps, but only the intestinal mucosa.
The so-called “real” diverticula are usually a congenital protuberance of the intestinal wall in the right part of the large or small intestine. These diverticula and the so-called Meckel’s diverticulum located in the small intestine are harmless in themselves, but can become inflamed and cause symptoms similar to appendicitis. In about three percent of all appendix operations, doctors accidentally discover a Meckel’s diverticulum.
More than 90 percent of diverticula occur in the penultimate segment of the colon (sigma, sigmoid colon) on the left side. Inflammation of these diverticula (sigmoid diverticulitis), which is usually a pseudo-diverticulum, manifests itself with severe pain in the left lower abdomen, but it can also extend over the entire abdominal cavity. In contrast to colon diverticula, diverticula rarely occur in the small intestine and usually cause no symptoms.
Causes and Risk Factors
Less than 10 percent of those under 40, but 50 to 60 percent of those over 70 in Western countries have diverticulosis. This age distribution is related, among other things, to the increasing weakness of the connective tissue in old age, which favors the “wearing out” of the intestinal wall. About 10 to 20 percent of people with diverticulosis experience symptoms of inflammatory diverticular disease (diverticulitis).
Risk factors that favor the development of diverticula are also permanently excessive pressure in the intestine – mainly caused by chronic constipation.
A low-fiber diet can lead to such constipation and contribute to the development of intestinal diverticula. In contrast to Asian and African countries, where diverticula occur much less often (less than ten percent), Australians eat too little fruit, vegetables and whole grain products on average. Too much red meat on the menu can promote protuberances as well as insufficient physical activity, genetic factors and obesity. With the increasing emergence of a “western lifestyle” in Asian and African countries, the number of people with diverticulosis is also increasing there.
Symptoms
In over 80 percent of cases, intestinal diverticula cause no symptoms. However, if the diverticula become inflamed, symptoms such as:
- Abdominal pain, with sigmoid diverticulitis typically in the left lower part of the body. With diverticulitis in the cecum or inflammation of the Meckel’s diverticulum in the right middle or lower abdomen. The abdominal pain often improves after a bowel movement or after the loss of air.
- Indigestion, such as constipation, diarrhea, or severe gas
- A tender induration (“roll”) in the abdomen, typically left in sigmoid diverticulitis. This is why one speaks of “left-sided appendicitis”
- Possibly fever, general feeling of illness
Complications
If such symptoms occur, a doctor should be consulted, because in rare cases diverticulitis can lead to serious and even life-threatening complications:
- Intestinal perforation
- Inflammation of the peritoneum (peritonitis)
- Abscess formation
- Intestinal constriction up to intestinal obstruction (ileus)
- Bleeding in the intestines
- Connecting ducts between different sections of the intestine or the intestine and neighboring organs (fistulas)
Diagnosis
The typical symptoms and history give the first clues that diverticulitis could be involved. During examination, the bowel sounds are assessed and the abdomen is palpated. Your naturopath can localize the pain and possibly feel a hardening in the lower abdomen.
Your physician will order a blood test which usually shows signs of inflammation. These include, for example, an increased number of white blood cells, an increased CRP value or accelerated blood sedimentation. An ultrasound examination of the abdomen (abdominal sonography) or computed tomography (CT) will then help to locate the inflamed diverticula and determine the stage of inflammation.
A colonoscopy should not be performed if diverticulitis is suspected due to the increased risk of a perforation in the intestine in the acute stage. However, four to six weeks after the inflammation has subsided, a colonoscopy is urgently recommended in order to rule out other causes of the disease (e.g. tumors, inflammatory bowel disease).
Therapy
Diverticula that are not causing discomfort do not require treatment. Treatment for diverticulitis depends on the stage of inflammation and whether complications have occurred. In the case of mild diverticulitis, if there is no fever or additional risk factors such as an immune deficiency, an attempt is made to see whether the body is able to contain the inflammation in the abdomen itself.
However, this is only possible if patients can drink enough and eat enough light or liquid food. Antibiotics are only necessary in the case of severe inflammation.
Prevention
High in fibre and healthy: whole grain products
You can help prevent the development of intestinal diverticula yourself:
- Eat more fruit and vegetables: five servings a day (“5 a day”)
- Reach for whole grain products like whole wheat bread, whole grain rolls and whole wheat pasta. Prefer these white flour products (such as light bread rolls or light toast)
- Don’t eat too much red meat
- Pay attention to normal weight
- Drink enough fluids, preferably two litres of water a day, unless there are medical reasons against it
- Get regular exercise. Go for a walk for at least half an hour a day and, if possible, do a sport that you enjoy – such as jogging, walking, cycling, or swimming
A High fibre diet can be administered in many ways. Celiac or Gluten Intolerant people must seek other forms of fibre like Psyllium or Flax seed and other seeds and GF grains like tapioca or maize.
