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Diverticulitis

The world gets accustomed to various things over years, and this is very much true in case of the diseases. Diverticulitis is often heard these days, but if someone had uttered this a few decades back, it would have been considered a rare form of the disease. This disease is an inflammation of the diverticula. These are nothing but small pouches that are found around the intestinal walls. These pouches develop due to various reasons. They are not malicious when these pouches begin to develop. This stage of the pouch formation is called diverticulosis. Diverticulitis is the serious condition, where there can be multiple pouches, or there can be an abscess in them or there is an infection in the bowel.

The left side of the abdomen is where these pouches are often found. This is where the digestive tract ends by descending and the sigmoid colons are found. However, Diverticulitis can be found anywhere in the digestive tract. If they form in the first section of the small intestine they cause no problem or hardly any. When the diverticula bursts, and leads to infection, this condition called diverticulitis is formed. Abdominal pain and tenderness are the most common symptoms. This can also cause the white blood cells to grow in huge number.

The first attack of diverticulitis is considered the worst. Yes, the condition can recur, and if the first attack is mild, the patient can be relieved that no serious complications are on the card.

Diverticulitis and diverticulosis:

Diverticula, the small pouches are harmless, and when they do not get swollen or when they are not infected, the condition is called diverticulosis. There are no symptoms of diverticulosis, and there is no treatment required for the same. Symptomatic uncomplicated diverticular disease (SUDD) is the only symptom caused by diverticulosis. Abdominal pain, bloating and irritable bowel symptoms to are at times experienced. The condition takes 7 years to grow into diverticulitis.

Diverticulitis Symptoms:

Diverticulitis can never be found by the people who are affected by it because the condition does not produce many symptoms. Or the same can be associated with many other diseases. In most cases, a few other testings are only how this condition is diagnosed. Here are the most common symptoms of the condition listed

-  Pain in the abdominal area, in the, left lower part. This is where most often diverticulitis occurs.

-  In the left lower abdominal area, tenderness can be experienced.

-  Fever

-  White blood cells count surge in the blood

-  Constipation

-  Diarrhoea

-  Nausea

-  Urge to urinate more often

-  Burning sensation while urination

-  Vomiting

-  Bleeding in stool

Calling the doctor immediately should be done if there are chills, or swelling in the abdomen accompanied by vomiting. When rectal bleeding is found, again this is an emergency condition. For a few people, the abdomen is tightened and rigid, and unbearable pain is experienced. This can be because of peritonitis, the infection in the membranes of the abdominal cavity.

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Diverticulitis Causes:

There is no particular reason for diverticulitis to develop. But the common reason that everybody agrees to is that the faecal matter blocks the opening of the diverticula and can cause inflammation and infection. There are various reasons for this blockage.

-  Lack of fibre in diet: The low fibre diet is the often-suspected risk factor. Though a few studies prove it otherwise, the adequate fibre is recommended by the doctors.

-  Genes: It has been proved by the studies that family link can be one strong reason for the occurrence of diverticulitis. When in a family, the condition affects one member, the chances of getting affected for a sibling or child raises to 50%.

-  No exercise: Studies among the group of people who exercise and who hardly exercise has proved that lack of exercising increased the risk. Though it is not yet found how sedentary lifestyle can lead to this condition, the potential risk of diverticulitis is higher in people who do not exercise for even 30 minutes a day.

-  Obesity: Again there is no conclusion how the disease and being overweight are related. Still, the chances of internal bleeding are heightened in people who are of excess weight. The research is going to find the connection.

-  Smoking: Smoking is often connected to an ocean of health complications. Symptomatic and complicated diverticular disease is caused in a higher percentage of people who smoke compared with people who do not.

-  Vitamin D insufficiency: Study showed that people who were admitted due to diverticulitis had lower levels of Vitamin D. Another study also found that in places where sunlight is low, resulted in people getting hospitalized for diverticulitis. Though the role of Vitamin D in preventing diverticulitis is not known, the studies prove that enough Vitamin D can keep the disease away. Also, it has been seen that the sunlight is essential to produce Vitamin D by the body, and the link ensures again Vitamin D has a crucial role to play here.

-  Sex: Men are affected more in the age group of 50 and less. And in the age group of above 50, the women are more affected than men.

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How Diverticulitis is diagnosed?

The condition has symptoms that are akin to various other diseases. So, the doctor must recommend multiple tests to diagnose the presence of diverticulitis. The symptoms, medical history and genetic complications are evaluated by the doctor when the tests are done.

-  Blood test: The blood tests tell if the kidney related diseases are involved. Liver problems too can be identified

-  CT scan and ultrasound: These imaging tests give the clear picture of the GI tract, and help in determining where the pouches are formed

-  Urine and stool test: Various types of infections are identified from these tests.

-  Pelvic exam: In women, this helps in identifying gynaecological problems.

-  Pregnancy test: To check if the pregnancy is causing the symptoms

-  Barium X rays: These help in visualizing the colon. Under these X rays, the diverticulitis is seen as pouches that are filled with barium.

-  The direct visualization can be done by inserting flexible tubes through the rectum, and they are passed to the colon. The colonoscopes or the sigmoidoscopes can be used for the same. This test helps in ruling out the possibility of other diseases.

Diverticulitis Treatment:

The treatment is decided by the severity of the condition. The medication is prescribed to suit the same. It has to be understood that diverticulitis is not complicated 75% of the time. Treatment is different for the complicated condition. Based on the severity, one might have to be hospitalized too.

Antispasmodic drugs are part of the treatment because one experiences severe abdominal pain.

-  chlordiazepoxide (Librax),

-  dicyclomine (Bentyl),

-  atropine, scopolamine, phenobarbital (Donnatal), and

-  hyoscyamine (Levsin).

As there are infections involved, one might also need antibiotics.

-  ciprofloxacin (Cipro),

-  metronidazole (Flagyl),

-  cephalexin (Keflex), and

-  doxycycline (Vibramycin).

Over the counter pain medication like Tylenol is prescribed to ease the pain.

Apart from medications, there are some dietary changes the doctors advise:

Short term clear liquid diet:

The digestive system obviously needs enough rest. But with the regular food intake, this is not going to happen. So, a short-term clear liquid diet is recommended. This continues until recovery.

The foods that are in this diet are:

-  water

-  ice chips

-  ice pops with frozen fruit puree or pieces of finely chopped fruit

-  soup broth or stock

-  gelatin (such as Jell-O)

-  tea or coffee without any creams, flavours, or sweeteners

-  clear electrolyte drinks

-  Low fibre diet:

For the mild symptoms, a low fibre diet is recommended. This is again to give time to the digestive tract to resume its function after getting enough strength.

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Surgical treatment for Diverticulitis:

The surgery is the last option. When medications do not help, surgical intervention is required. The collection of pus is removed, the sigmoid colon, which usually contains the diverticula is resected. If the diverticulum bleeds persistently, surgical removal is essential. The surgeon before this considers a lot of tests to ensure where the bleeding is coming from. In a few cases, the urinary bladder close to the diverticula is eroded and ruptured. The patient passes gas during urination as a result. In such cases, surgery is inevitable. When the diseases recur, again surgery is seen the solution. The colon is removed during the surgery, and in fact, almost all parts are removed. The patient has to stay in the hospital for a few days and must take enough rest. This is to ensure that the condition never comes back.

Complication:

Acute episodes are when the complications are often faced by the patients. The condition becomes severe when the complications are more. Fever, rectal bleeding and blood are stool is considered to be serious. The complications caused by the diseases are life-threatening.

Perforation and peritonitis:

Tiny punctures are caused by this disease in the diverticula. These can become huge, the abdominal cavity is filled with the contents of the colon. The abdominal cavity becomes swollen and gets infected. This condition is called peritonitis. The damaged part of the colon should be immediately removed, and also the damaged intestine is also removed through surgery. This procedure is called large bowel resection. The colon that is infected is removed, and the remaining healthy parts are joined together.

Abscess:

The infected pocket filled with pus is called abscess. The colon walls are developed with abscesses and phlegmons. This can lead to pain in the abdomen, bleeding, vomiting and nausea. Antibiotics are prescribed to treat the condition. The pus is drained from the abscesses using a tube. This is called percutaneous drainage.

Fistula:

The irregular connection between 2 organs is called fistula. The colon, bladder and vagina are connected by fistula that is caused by diverticulitis. Pain while passing urination, abnormal white discharge, and other symptoms are experienced based on the type of fistula.

Blocks in the intestine:

Blockages in the colon can appear when a stricture is formed. This is a severe narrowing formed in the colon because of the inflammation. This can block the stool passage. Bloating, and abdominal pain is the symptoms when the passage of stool is blocked.

Diet and diverticulitis:

The health of the digestive system is majorly decided by the diet one consumes. The management and prevention of the disease can be determined by the diet one takes. Foods that are rich in fibre, and keeping off processed foods can help in managing this disease, and in fact is necessary to maintain the health of the digestive system. Nuts and seeds aggravate the symptoms of diverticulitis and should be avoided. Compared with the high fibre diet, the Western Diet increase the risk of diabetes.

People who are vegetarians and affected by diverticulitis have a lesser reason for getting hospitalized for the condition, compared with people who are affected by the disease and take less fibre due to non-vegetarian foods.

Low FODMAP foods are recommended for people with irritable bowel syndrome. Dairy foods, onions, fermented foods and garlic are examples of these foods. The list of foods to be avoided by the people affected by diverticulitis includes:

-  canned foods

-  processed cooks

-  cooked fruits

-  seedless fruits

-  eggs, fish and poultry

-  low fibre cereals

-  cheese, yoghurt and milk

-  pasta and noodles

-  apples, pear

-  cabbage

-  beans

-  brussels

-  sprouts

while high fibre foods are recommended to prevent the disease, one should stay off from them, if affected by diverticulitis. This is because the digestive tract needs rest, and high fibre foods burden the intestines and make them feel heavy.

-  Dry and low fibre cereals

-  Processed fruits

-  Olive oil, and preferably all oils should be taken

-  Zucchini, pumpkins, and yellow squash

-  Potatoes that are peeled

-  Fruit and vegetable juices

Regardless of the foods to take or not to take for diverticulitis, it is vital to take 8 cups of water per day. The health of the GI tract is maintained this way. When the symptoms fade off slowly, taking in high fibre foods is recommended. Also, checking with the doctor before trying any diet plan is mandatory.

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Last updated on : 25-10-2018

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