What Is Diverticulosis
Diverticulosis is an abnormal condition of the digestive tract characterized by the presence of several pouch-like outgrowths called diverticula on the intestinal wall. The large intestine is the most common location of diverticulosis.
- Muscular spasms of the intestinal wall may be causing the pouch-like bulges in areas of weakness.
- Diverticulosis may remain asymptomatic or the diverticula may bleed, resulting in bloody stools.
- Barium enema x-ray and colonoscopy help in diagnosing the condition.
- Following a diet high in fiber content and use of bulking agents like psyllium help in the management of the condition, by reducing the spasms.
The last portion of the large intestine called sigmoid colon is the usual location of diverticulosis but diverticula can occur elsewhere in the large bowel also. Diverticula may differ in size, the small ones measuring 1/10 of an inch in diameter but the larger ones may be 1 inch or more in diameter. Diverticulosis usually start developing after 40 years of age and the number of diverticula may increase as people get older. Almost everyone nearing 90 years of age may be having diverticulosis. Occasionally, a very large diverticula measuring up to 6 inches in diameter may develop in some people, but they often occur singly.
Causes
The muscular spasms of the large intestine, as it tries to move its contents forward, may be causing certain weak spots in the wall to bulge out and become pouch-like structures. The exact reason for the development of diverticula is still not understood clearly, but it is assumed that the strong muscular contraction of the intestinal wall may be causing this condition. The muscles usually have to contract extra hard to push small quantities of stool resulting from a diet that is deficient in fiber. The higher pressure produced during the stronger contraction of the intestine causes the ballooning out of the intestinal wall in spots where the wall is thinner or weaker. The points of entry of arteries that supply the wall of the intestine are the usual weak spots prone to the development of diverticula. People who have diverticulosis of the sigmoid colon are found to be having a thicker muscular layer on the wall of the colon. It is not clear why a very large solitary diverticulum develop in some people.
Symptoms
Diverticulosis is not a dangerous condition as long as it remains asymptomatic. Many people do not even realize that they have this condition until it is discovered during the diagnostic testing of some other intestinal disorder. However, when diverticula start bleeding, resulting in bloody stools, and when abdominal pain and cramping are present, the condition becomes serious. Diverticular bleeding can be heavy and may come out of the rectum even when the person is not defecating. Pieces of stool may get stuck in the diverticula, leading to inflammation, bleeding and infections. It may develop into a disease condition called diverticulitis. The artery nearer to the diverticula may get damaged in the inflammation. Diverticula may interfere with the normal bowel movements also.
Diagnosis
Disturbances in the bowel movements along with bleeding from the rectum and painful abdominal cramps are the usual symptoms which lead to further investigations and subsequent diagnosis. A viewing test called colonoscopy or an imaging test called barium enema x-ray may be conducted to detect diverticulosis. In colonoscopy, a flexible viewing tube called colonoscope is inserted into large intestine to view its interiors. But, if signs of inflammation such as severe pain and cramping are present, invasive procedures like colonoscopy are avoided, and a CT scan is done instead, to avoid the risk of rupturing the intestine.
Colonoscopy can identify the source of diverticular bleeding, but it may not be enough to attempt surgical repair if required. Other imaging tests such as radionuclide scans or angiography conducted after the intravenous administration of radioactive markers may be necessary to locate the exact spots of bleeding.
Treatment
The treatment focuses on decreasing muscular spasms of the intestine by bulking up the stool. A diet containing sufficient amounts of fruits, vegetables and unpolished cereals increase the fiber content and quantity of the stool. The larger bulk makes it easier for the muscular wall of the intestine to push the contents forward, reducing spasms as well as the pressure exerted on the wall. In addition to dietary modifications, bulking agents such as methylcellulose or psyllium may be taken too. Drinking plenty of water also helps in the smooth movement of stool.
Surgical intervention is not required when complications associated with diverticulosis such as infections, inflammation, severe bleeding or risk of rupture are not present. Slight diverticular bleeding may stop eventually without intervention. If bleeding continues, minimally invasive procedures using the colonoscope are often successful in stopping it. A drug is often injected into the bleeding site to form a clot which stems the bleeding. But if it recurs frequently or when the bleeding site could not be detected, partial or total removal of the large intestine may be required. But surgeries are done only when absolutely necessary.
A very large diverticulum may have to be surgically removed to prevent life threatening eventualities like severe infections and rupture.
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Yasser Elnahas
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