Diverticular disease consists of three conditions that involve the development of small sacs or pockets in the wall of the colon, including diverticulosis, diverticulitis and other complication of diverticulosis including bleeding, strictures or formation of fistulas.
Diverticulosis is the formation/presence of numerous pockets, or diverticula, in the lining of the bowel. Diverticula, which can range from pea-size to much larger, are thought to be formed by increased pressure on weakened spots of the bowel wall. Diverticula can form due to excessive straining or constipation but may also develop due to weakness associated with ageing. They are most common in the lower portion of the large intestine (called the sigmoid colon).
Diverticulosis is very common and occurs in 10% of people over age 40 and in 50% of people over age 60. Most people will have no or few symptoms from diverticula. Symptoms may include abdominal pain, bloating, nausea, loose stools or pellet like stools.
Complications can occur in about 20% of people with diverticulosis. Complications may include rectal bleeding, divertculitis, strictures, obstruction, divertcular abscess, peritonitis or fistula formation.
Diverticular bleeding is a common complication and may occue due to damage to the small blood vessels that are next to the diverticula.Most bleeding with settle on its own but patients need to be investigated to rule out other causes of bleeding including polyps and cancers. Occasionally patients need antibiotics, blood transfusion or other intervention to stop the bleeding.
Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with faeces, allowing bacteria to build up, causing infection. Diverticulitis, infection and inflammation of diverticula, can occur suddenly and without warning.
Symptoms of diverticulitis may include:
- Alternating diarrhea and constipation.
- Painful cramps or tenderness in the lower abdomen.
- Chills or fever.
Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity causing the following problems:
- Peritonitis (a painful infection of the abdominal cavity)
- Abscesses (“walled off” infections in the abdomen)
- Obstruction (blockages of the intestine)
These complications need hospital admission, antibiotics and may need radiological or surgical intervention. Surgical intervention usually involves resection of bowel which may be performed by a laparoscopic technique if a surgeon familiar with this technique is available.
Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. A common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon. Thia may also be possible laparoscopically in most cases.
How Can Diverticulosis Be Prevented?
High fibre diet is recommended to prevent diverticulosis and complications of divertcultis. Patients may develop symptoms and complications inspite of a high fibre diet as the entire pathophysiology of divertculosis is not clear.