Diverticular disease occurs when pouches (diverticula) in the intestine, usually the large intestine or colon, become inflamed. Most diverticula occur in the sigmoid colon, the curved part of the large intestine closest to the rectum, and they tend to become more numerous as we age.
Diverticulosis is the presence of many diverticula along the intestinal wall. It occurs more commonly in countries such as the U.S. where the diet is generally low in fiber. More than 50% of adults over age 70 have diverticula, and 80% have no symptoms.
Diverticulitis occurs when one or more diverticula become inflamed. The inflammation may be local (just in the area of the diverticulum), or may spread to the abdominal lining (peritoneum), called peritonitis. Small (microscopic) or large perforations (holes in the intestinal wall) occur in 15 - 20% of people who have diverticula.
Often diverticula cause no symptoms, although you may experience irregularities in bowel habits. If symptoms do appear, they may include the following:
Some people with diverticulitis develop fistulas, or abnormal passageways from the intestines into the abdomen or to another organ such as the bladder. This may lead to a urinary tract infection, gas in the urine, pain while urinating, or a more frequent need to urinate.
Some people develop peritonitis, an inflammation of the lining of the abdomen. Symptoms of peritonitis may include sudden abdominal pain, muscle spasms, guarding (involuntary contraction of muscles to protect the affected area), and possibly sepsis, the term for an infection that has spread to the blood. Peritonitis can be life threatening if left untreated.
The cause of diverticular disease is unknown, but several factors may contribute to changes in the wall of the colon. These include aging, the movement of waste through the colon, changes in intestinal pressure, a low fiber diet, and physical abnormalities.
These factors increase the risk for developing diverticular disease:
The following may contribute as well:
Your health care provider will examine your abdomen for tenderness, swelling, and guarding and may try to detect any unusual mass around the intestines. Your health care provider may also test your blood, urine, and stool for signs of infection or blood. A computed tomography (CT) scan, ultrasound, and other imaging techniques may help locate diverticula and any inflammation, fistulae, abscesses, or other abnormalities.
To help prevent diverticular disease:
For mild symptoms, your health care provider may recommend a clear liquid diet and prescribe antibiotics. More serious cases may require hospitalization, intravenous (IV) feeding to rest the intestine, IV antibiotics, and IV antispasmodics, which relax the intestine. Eating a high-fiber diet and taking psyllium supplements may help following an attack.
Your doctor may prescribe antibiotics to fight infection, antispasmodics to relieve cramping, and analgesics to relieve pain.
If you have repeated episodes of diverticulitis, respond poorly to medical therapy, or have other complications, your health care provider may recommend removing part of the colon. If you have severe complications, or if your condition worsens within 1 - 2 days of attack, you may need surgery right away.
Nutrition plays an important role in preventing and treating gastrointestinal disease, especially diverticulosis. You may help minimize attacks and improve treatment results by following specific dietary recommendations.
Eat a diet that is high in fiber (25 - 35 g per day). One study suggested that the following foods were associated with a lower risk of diverticular disease: cucumber, lettuce, spinach, and whole-grain bread. Food is the best source of fiber, but you may also use fiber supplements to increase the amount of fiber you take in every day. Common kinds of fiber supplements include insoluble fiber supplements such as psyllium and glucomannan (3 - 5 g per day of either supplement). Your doctor may also suggest soluble fiber supplements, such as flax seed and oat bran, which can be less irritating than insoluble supplements. Talk to your doctor to find the right combination for you.
Glutamine (400 mg 4 times per day, between meals) is an amino acid found in the body that helps the intestine function properly. While there is no evidence that glutamine helps reduce symptoms of diverticular disease, it may be beneficial for overall intestinal health. Do not take glutamine if you are diabetic or have seizures, liver disease, or a history of mania or manic episodes.
Omega-3 fatty acids, such as those found in fish oil, may help fight inflammation. (On the other hand, some omega-6 fatty acids, found in meats and dairy products, tend to increase inflammation.) If you have diverticulitis, eat a diet rich in omega-3 fatty acids, or take a supplement (1,000 mg 1 - 2 times per day). This type of diet may also help prevent colon cancer. Do not take high doses of a fish oil supplement if you are on blood thinning medication. Omega-3 acids have a blood thinning effect and can increase the effect of blood thinning medications, such as Coumadin (warfarin) and aspirin.
Probiotics, such as Lactobacillus acidophilus, Lactobacillus plantarum, Saccharomyces boulardii (250 mg, taken daily between meals) and bifidobacteria, help maintain the health of the intestines. In one study, people who had diverticulitis were more likely to remain symptom-free after 1 year when they were treated with Lactobacillus casei and mesalazine.
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
The following herbs are often used to treat gastrointestinal illness:
While few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths may recommend one or more of the following treatments for diverticular disease based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a person.
Acupuncture may help relieve pain and other symptoms. Acupuncturists treat people with diverticular disease based on an individualized assessment of the excesses and deficiencies of qi (or energy) located in various meridians. Acupuncture and Chinese medicine in general may promote gastrointestinal health.
If you develop a fever, tenderness in the abdomen, or bleeding from the rectum or in the stool, tell your health care provider right away. You may be hospitalized for a fever higher than 101°F, worsening symptoms, signs of peritonitis, or increased white blood cell count found in laboratory tests.
Most patients with diverticulitis respond well to antibiotics and bowel rest. About one third of people who develop diverticulitis have a second episode, and of this group, half generally have a third attack. About 20% of patients develop complications after the first attack, 60% after a second attack. Complications may include:
If you have experienced bleeding once, you are at high risk for bleeding again.
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