Diverticular Disease

Dear Dr. B: Recently I was in hospital with left lower abdominal pain and fever. I had intravenous antibiotics and investigations showed I had diverticulitis of the colon. Thanks to my doctor I am feeling better. Can you please tell me more about diverticular disease and diverticulitis and how can I be cured of this “disease”? Yours Mr. DD.

Dear Mr. DD: Diverticular disease of the colon is a very common condition. But is it really a “disease”?

No. Many people have this condition and have no symptoms and are not even aware of its presence.

What does the term diverticular disease mean?

This means there are little sacks or pockets sticking out of the wall of the colon – called diverticula (if multiple) or diverticulum (if single). Usually, they are multiple and are mainly concentrated in the sigmoid colon in the left lower abdomen. There may be more in the rest of the colon. In Latin the word diverticulum means a wayside inn – presumably a place of ill repute!

Diverticulosis of the colon was first described in 1849. So it has been with us for a long time. But why do people get this condition is not very clear. It is an acquired condition. One textbook of surgery says that it is reasonable to believe that colonic diverticula develop at weak points in the bowel wall under the influence of increased intraluminal pressure.

Many other hypotheses have been advanced but one most convincing is the spasm of the muscles of the wall of the bowel with irregular contractions of the affected part that increases the intraluminal pressure.

This condition is very uncommon under the age of 35. Above 35 years the incidence increases steadily so that by the sixth decade nearly 30 percent of all patients have diverticulosis.

What is diverticulitis?

This is inflammation of the diverticula. Mr. DD, this is probably what you had if you were in hospital with pain and fever. Usually, the condition responds to antibiotics. Sometimes there is relentless inflammation and one may end up having emergency surgery because an abscess has developed. Emergency surgery involves removal of piece of infected bowel and temporary colostomy.

There are many complications associated with diverticulosis and diverticulitis. These are bleeding, bowel obstruction due to narrowing of the colon, perforation and peritonitis, fistula (tunnel) formation between the colon and urinary bladder, vagina, and small intestine. Diverticulosis does not turn into cancer but it can hide cancer and make diagnoses of cancer difficult.

Uncomplicated diverticulosis is generally believed to be without symptoms and is discovered incidentally during barium enema or colonoscopic examination. Ill-defined symptoms of abdominal discomfort, gas, bloating and some change in bowel habit are difficult to ascribe to diverticulosis. But could be part of the spastic bowel syndrome.

Doc, how can I get rid of the condition?

There is only one way to do this is to surgically remove the affected piece of bowel. When is the right time to do this depends on many factors including associated symptoms and complications. The best thing is to get a surgical opinion. Planned resection generally requires no colostomy.

Mr. DD, I hope this gives you enough information about your problem. Eat a healthy diet of fruits and vegetables, keep your bowels regular and discuss your options with your family doctor or a surgeon.

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