What is
diverticulosis?
The colon (large intestine) is a long tube-like structure that
stores and then removes waste material. With increasing age in a
person, pressure within the colon causes bulging pockets of tissue
(sacs) that push out from the colon walls. A small bulging sac
pushing outward from the colon wall is called a diverticulum. More
than one bulging sac is referred to as diverticula. Diverticula
can occur throughout the colon but are most common near the end of
the left colon called the sigmoid colon. The condition of having
these diverticula in the colon is called diverticulosis, also
known as diverticular disease. This condition is uncommon before
the age of 40 years, but its incidence increases after this age.
What are the causes?
Although not proven, a low-fibre diet is believed to be the main
cause of diverticular disease. Lack of fibre in diet causes
constipation, which in turn makes the muscles strain to move stool
that is too hard. A diet without sufficient fibre also makes the
stools small, requiring the bowel to squeeze harder to remove the
smaller stool. This is the main cause of increased pressure in the
colon. This excess pressure might cause the weak spots in the
colon to bulge out and become diverticula. Diverticular disease is
common in developed or industrialised countries—particularly the
United States, England and Australia—where low-fibre diets are
common. The disease is rare in countries of Asia and Africa, where
people eat high-fibre vegetable diets. Fibre is the part of
fruits, vegetables and grains that the body cannot digest. Some
fibre dissolves easily in water (soluble fibre). It takes on a
soft, jelly-like texture in the intestines. Some fibre passes
almost unchanged through the intestines (insoluble fibre). Both
kinds of fibre cause stools to retain more water and become easier
to pass (either soluble or insoluble fiber will do this). Thus, we
can broadly outline the factors that can cause diverticular
disease as follows:
* A diet low in fibre content or high in fat
* Increasing age
* Constipation
* Connective tissue disorders, which can weaken the colon wall
What are the symptoms?
Whereas most patients with diverticular disease have no or few
symptoms, some patients do develop bleeding, infection (diverticulitis),
changes in bowel movements (diarrhoea or constipation), bloating,
cramps (often in the left lower abdomen) after meals or otherwise
and even colon obstruction.
Sometimes, symptoms include nonspecific chronic discomfort in the
lower left abdomen, with occasional acute episodes of sharper
pain. The discomfort is sometimes described as a general feeling
of pressure in the region, or pulling sensation. A tickling
sensation may be felt as the small pockets fill and unfill; a
feeling like gas may be moving in areas outside the colon. At the
first occurrence of bleeding, a doctor should be contacted.
How is it diagnosed?
Since most people do not have symptoms, diverticulosis is often
found through tests ordered for another ailment. Colonoscopy is
the most used test for diagnosis. Other tests include abdominal
x-ray, barium enema, CT scan or MRI.
How is it treated?
Most often, diverticulosis requires no treatment. Increase in
hydration by increasing fibre content in the diet or removing
factors resulting in constipation helps decrease the incidence of
new diverticula or possibly keep them from bursting or inflating.
However, if there is an infection (diverticulitis), surgery is
required to decrease relapse or other complications.
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