10 October 2011 (Monday) - Diverticulitis

Diverticula is the medical term that is used to describe the small pouches that stick out of the side of the colon. These small pouches are weak spots, much like a bubble forming on a worn inner tube.

Diverticula are very common and associated with ageing. It is estimated that 50% of people have diverticula by the time they are 50 years old, and 70% of people have them by the time they are 80 years old. Although diverticula can occur anywhere in the colon, 80% are found in the lower left side (sigmoid colon) because that is where the colon is the narrowest and the inner pressure the highest.

The majority of people with diverticula will not have any symptoms. However, twenty five per cent of people with diverticula experience symptoms such as abdominal pain and diarrhoea. People who experience symptoms are said to have diverticular disease.

The diverticula can also become infected and inflamed. Inflammation of the diverticula is known as diverticulitis. Diverticulitis causes more severe symptoms than diverticular disease, such as severe pain. It carries a risk of causing serious complications, such as the colon rupturing, which can lead to peritonitis.

 Once suspected, the diagnosis of diverticular disease can be confirmed by a variety of tests. Barium X-rays can be performed to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall.  Direct visualization of the intestine can be done with flexible tubes inserted through the rectum and advanced into the colon. Either short tubes (sigmoidoscopes) or longer tubes (colonoscopes) may be used to assist in the diagnosis and to exclude other diseases that can mimic diverticular disease.

In patients suspected of having diverticular abscess causing persistent pain and fever, ultrasound and CT scan examinations of the abdomen and pelvis can be done to detect collections of pus fluid.

Most patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high fibre diet and fibre supplements are advisable to prevent constipation and perhaps prevent the formation of more diverticula.

Patients with mild symptoms of abdominal pain due to muscular spasm in the area of the diverticula may benefit from anti-spasmodic drugs such as:

·         chlordiazepoxide (Librax),

·         dicyclomine (Bentyl),

·         atropine, scopolamine,

·         phenobarb (Donnatal)

·         hyoscyamine (Levsin).

Some sources also recommend avoidance of nuts, corn, and seeds to prevent complications of diverticulosis.

Whether these dietary restrictions are beneficial is uncertain.