Management of Diverticular Disease
The intestine is divided into the large and small intestine. The large intestine absorbs nutrients from the food that you eat and pushes the remaining undigested waste towards the anus. High fibrous foods like fruits and vegetables soften the undigested material and help in easy movement of stools. However, low-fiber foods can produce small and hard stools that are expelled with increased strain while passing. This straining can create weak spots in the wall of the intestine leading to diverticular diseases, conditions that cause the development of small sacs or pouches. The conditions include diverticulosis, diverticular bleeding, and diverticulitis.
Diverticulosis is a condition where a large number of small pouches, known as diverticula, develop in the lining of the bowel. They can be small or large and are formed with increased strain during bowel movements, or when gas, waste, or liquid put pressure on the weak portions of the walls of the intestine. This is a common condition that can be found in 10% of people above age 40 and 50% of people over the age of 60.
Diverticular bleeding occurs when there is an injury to the blood vessels lying adjacent to the diverticula.
Inflammation and infection of the diverticula is known as diverticulitis. When waste material blocks the diverticula, they can become inflamed due to bacterial invasion. Increased pressure on the colon wall or a block at the entrance of the diverticula can reduce blood supply and lead to infection and inflammation.
What are the Signs & Symptoms?
People suffering from diverticulosis do not have any serious symptoms, but when infection or inflammation occurs, the condition is known as diverticulitis and symptoms can be sudden in onset. The common symptoms include:
- Abdominal pain and tenderness in the left lower abdomen
- Pain worsens while eating and relieves after flatulence or passing stools
- Alternating episodes of constipation and diarrhea
- Bleeding from the rectum
- Abdominal bloating
- Alternating diarrhea with constipation
- Nausea and vomiting
- Fever and chills
Diverticular diseases can lead to other complications:
- Peritonitis: rupture of diverticula and leakage of intestinal contents into abdominal cavity
- Blockage in colon or small intestine due to scarring
- Abscess formed by collection of pus
- Fistula: abnormal passage between intestine and abdominal wall or intestine and bladder or vagina
What are the methods of Screening and Diagnosis?
As people with diverticulosis show no symptoms, diagnosis usually occurs during routine screening examinations such as colorectal cancer screening or other intestinal tests.
When you present with symptoms of diverticulitis, your doctor will examine your medical history with relation to your diet, bowel habits, and current medications used, and will perform a physical examination. He/she may also conduct a digital rectal examination, where a gloved and lubricated finger will be inserted into your rectum to check for abnormalities. You may be recommended the following diagnostic tests in order to determine the extent of damage to your intestine:
Imaging tests like X-rays, ultrasound and CT scans
Sigmoidoscopy: A flexible tube with a camera fitted at one end (sigmoidoscope) is introduced through the anus to visualize the inner lining of the sigmoid colon (lower 1/3rd of the colon) and rectum.
Colonoscopy: A flexible tube with a camera fitted at one end (colonoscope) is introduced through the anus to visualize the entire large intestine.
Blood tests: A sample of your blood is analyzed in the laboratory for infection.
You may also be recommended to undergo angiography to identify the site of bleeding if you have heavy rectal bleeding. Angiography is a procedure performed to visualize blood vessels after injecting a contrast material into the arteries.
What are the Treatment Options?
Treatment for diverticular diseases depends on the severity of symptoms. People showing no symptoms of diverticular diseases are recommended a high-fiber diet to avoid constipation and increased stress on the colonic wall. Your doctor may prescribe medication for pain and antibiotics for infections.
In patients with recurrent episodes of diverticulitis, leading to complications such as abscess, perforation, or fistula, surgical treatment may be recommended. Surgery involves removing the diseased portion of your colon. There are two types of surgery:
- Primary Bowel Resection: During this procedure, the affected portion of your intestine is removed and the healthy ends are reattached using a procedure known as anastomosis. Depending on the extent of damage to your intestine, primary bowel resection can be performed laparoscopically or using an open surgery technique. During an open surgery, your surgeon will create one long abdominal incision, while a laparoscopic procedure can be performed through 3 or 4 small incisions. The recovery process is usually faster with laparoscopic surgery. The advantage of primary bowel resection is that you will be able to have normal bowel movements after the surgery.
- Bowel Resection with Colostomy: When you have severe inflammation in your intestine, making it difficult to re-join your colon to your rectum, your doctor may perform bowel resection with colostomy. During a colostomy, your doctor will create a surgical opening (stoma) in your abdominal wall and join the healthy part of your colon to the stoma. Waste from the colon flows through the stoma into a collecting bag (colostomy bag) attached to the stoma. Your surgeon may be able to perform another surgery to re-join your colon and rectum once the inflammation has healed.