Diverticular Disease

What is diverticulosis?

Diverticulosis occurs when small bulging pouches or small blisters appear along the lining of your large intestine or colon. These are known as diverticula, and does not cause any symptoms.Diverticula are most commonly found in your colon, which is the lower part of your large intestine. It is common especially if you are 40 years old and above, and seldom causes problems.

Diverticulosis happens as you age, as your large intestine becomes weaker with age. The weak places of your colon give way under the pressure of hard stools passing through your large intestine. This results in the formation of bulges which protrude through your colon wall.

What is diverticulitis?

Diverticulitis is when one or more of these small pouches or blisters gets infected or inflamed.

Diverticulitis can be very painful and requires treatment.

What causes diverticulitis?

Often, diverticulitis is caused when a hard stool or undigested food is trapped in one or more of the pouches and blocks the pouch, Bacteria in the stool quickly multiplies and spreads, resulting in an infection.

Am I at risk of developing diverticulitis?

Risk factors of diverticulitis include:

  • Ageing which is related to the weakening of bowels over time
  • Being overweight or obese
  • Consuming a diet low in fruits, vegetables and whole grains leading to insufficient fibre
  • Constipation which places strain on your muscles during bowel movement and constant strain increases your risk of developing diverticula and diverticulitis
  • Smoking
  • Certain medications such as steroids, opiates and non-steroidal anti-inflammatory drugs (NSAIDS), including ibuprofen and naproxen
  • Having a family history of diverticulitis, particularly if they develop it under 50 years of age

How do I know if I have diverticulitis?

Common symptoms of diverticulitis include:

  • Severe abdominal pain and/or tenderness usually in the left side of your lower abdomen, which may worsen when you move about
  • Fever
  • Nausea or vomiting
  • Constipation or diarrhoea
  • Loss of appetite
  • Feeling of bloatedness or gas
  • Fatigue or not feeling well
  • Bleeding from your rectum, usually bright red blood in your stool

Do consult your doctor immediately should you have any of the above symptoms.
How is diverticulitis diagnosed?

Your doctor will ask your symptoms and perform a physical examination to check for pain and tenderness in your abdomen and blood in your stool. Following that, you may be scheduled for further tests such as:

  • Blood tests- This checks for infection which is indicated by a high count of white blood cells
  • Colonoscopy- A small, flexible tube with a camera attached at one end is inserted through your rectum to check if diverticula is present
  • Barium enema X-ray- A liquid is squirted through a tube inserted into your rectum. This coats the inside surface of your internal organs to confirm the presence of diverticula.
  • Diagnostic imaging tests- A CT scan or ultrasound scan is used to look inside your internal organs for infected or inflamed pouches, and indicates if a complication such as perforation or an abscess has occurred.
  • Fecal occult stool tests- This checks for blood in your stool.

What are the possible complications of diverticulitis?

Complications may occur in up to a quarter of people with diverticulitis.

Diverticulitis may result in:

  • Abscess- This is a cavity filled of pus or lump in your tissue. Surgery may be necessary to clear the pus.
  • Fistula- Abnormal tunnels connecting two parts of your body such as between your bowels or bowel to bladder. Surgery may be necessary to treat the fistula.
  • Intestinal obstruction- Your colon may become partially or completely blocked due to infection and scarring. If this happens, emergency medical treatment is required.
  • Peritonitis- Infection spreads into the lining of your abdomen due to one of the infected diverticula bursting. This is a serious and life-threatening condition and surgery is needed in most cases.

Why surgery for diverticulitis?

Surgery is necessary for patients with persistent bleeding or complications as mentioned above, especially if these do not respond to antibiotics. Surgery is also recommended for patients with frequent and repeated attacks of diverticulitis which may disrupt one’s daily life. Patients with a weakened immune system which makes them more susceptible to infections may also be recommended to undergo surgery. Sometimes, surgery may be carried out in emergency cases where there is a perforation (hole) in the bowel and you experience severe abdominal pain.

Surgery has proven to be highly beneficial for those with recurrent episodes as it prevents the possible complications if left untreated. Around 11 in 12 people have no recurrence of symptoms after surgery.

What is surgery for diverticulitis?

Surgery for diverticulitis may involve drainage of any pus and resection, where the part of your intestine which contains the infected diverticula is surgically removed. This prevents future episodes of diverticulitis.

There are two main types of surgery to treat diverticulitis, namely, a primary bowel resection and a bowel resection with colostomy.

A primary resection is a procedure whereby your surgeon removes the diseased segments of your intestine and reconnects the healthy segments, which is called anastomosis. This enables you to have normal bowel movements. You will be advised to have open surgery or a laparoscopy, depending on the extent of your inflammation.

A bowel resection with colostomy is performed if you have a large amount of inflammation which makes it not possible to reconnect your colon and rectum. In these cases, a stoma (opening) in your abdominal wall is connected to the healthy segment of your colon. This allows waste to pass through the opening into a bag. After the inflammation has gone down, the colostomy may be reversed and your bowel rejoined.

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