Incidence rates of diverticulitis in the US is relatively high, with the condition afflicting as much as 200,000 individuals annually. Out of this, around 70,000 patients require hospitalization to treat bleeding as a result of diverticula related conditions. The probability of developing diverticulitis and diverticulosis increases with age. Around 5 to 20% of individuals with diverticulosis are likely to end up with diverticulitis. The statistics have a sub text which presents a clearer and different picture about the condition and the prevailing incident rates. Among age groups of 50 and above, the probability of women developing the condition is higher than the probability of males developing the condition. However, in age groups below 50, the probability of males developing the condition is higher than that of females developing the condition. Here is a look at all that you need to know about the condition, the symptoms, the various complications, the treatment methods, and the prevention protocols recommended by experts.
What is diverticulitis? How is it different from diverticulosis?
Diverticulitis refers to the condition when pouches begin to push the wall of the colon from the inside. As a result of this protrusion of the colon from the inside, the colon ends up infected in addition to being swollen. However, it is also possible for the protrusions to occur without actually being infected. This condition where the protrusion is without and infection is called diverticulosis. Diverticula refers to the pouches that caused the protrusion and possibly inflammation depending upon the condition. Statistics reveal that a large number of individuals have multiple pouches or diverticula but do not experience any kind of ill effects from the protrusions. However, when the pouch ends up with some kind of an infection, there is every possibility of it being very painful with various side effects.
Diverticulosis is one of the most common conditions among individuals who age. It affects roughly around 50% of people of both genders who are above the age of 50. Out of this, roughly 20% are estimated to end up with diverticulitis. However, there is little consensus regarding the actual figure of individuals with diverticulosis progressing into diverticulitis. While one school of thought argues that the prevalence rate is as high as 20%, others estimate that it could be as low as just 1% of the total number of diverticulosis cases.
The incidence rates of diverticulosis progressively increases with age, afflicting as much as 65 % of people above the age of 80 years. Additionally, there are conclusive studies that reveal young obese adults to be at high risk of ending up with diverticulitis. This adds to the growing number of digestive diseases that drain the US exchequer annually towards healthcare costs.
Here are important facts about diverticulitis which will help to give you a quicker understanding of the condition before reading the detailed information presented in the subsequent sections of this article.
· Diverticulitis refers to the condition of an infected pouch forming in the colon.
· Commonly reported symptoms of diverticulitis include passing of blood along with stools, pain in the lower abdomen area, and possible constipation.
· Common causes for the condition include a lack of dietary fiber.
· Diverticulitis can be treated by the patient at home, without the need for or hospitalization or intensive medical intervention.
· Surgical intervention for diverticulitis can sometimes be required when the condition persists, and the patient experiences problems continually.
What are the commonly reported symptoms associated with diverticulitis?
Before we look at the commonly reported symptoms that are associated with diverticulitis, it is it is important to understand that the symptoms of diverticulitis and diverticulosis are actually different. Despite the fact that the conditions are same or can be considered as interrelated, the actual symptoms of both the conditions are different.
Commonly reported symptoms associated with diverticulosis
In symptomatic diverticulosis, the commonly reported symptoms include pain in the lower abdomen. This pain is typically localized in the lower left side of the abdomen. In a large number of cases, the pain is triggered when the patient either consumes food or passes stools. In other cases it is also possible that the pain may be experienced even when not eating or passing stools. It has been reported that many patients experience considerable relief after passing gas. There are other symptoms that are also associated with diverticulosis. For instance, patients are known to experience change in bowel movements, which results in in a change in the habits associated with bowel moments. Passing of blood along with stools is another commonly reported symptoms associated with diverticulosis. Here it is important to understand that only a small amount of blood is passed the stool. Less common symptoms include diarrhea in in a limited number of patients, while constipation is a common symptom among patients with the condition.
Interestingly, a significant number of patients with diverticulosis are unlikely to experience any kind of symptoms as a result of the condition. Known as asymptomatic patients, these individuals may not even be aware of the condition for a very long time till the symptoms manifest in some form later.
Commonly reported symptoms associated with diverticulitis
The commonly reported symptoms associated with diverticulitis include conditions that are manifested when the pouches are inflamed. When the diverticula is not inflamed, the symptoms may differ or may not be experienced. These symptoms include severe and persistent pain, typically in the lower left side of the abdomen. However, the pain can also be experienced on the right side of the lower abdomen. Other symptoms include pain associated with urination. That is a possibility of patients experiencing the urge to urinate more frequently than normal. A large number of patients are likely to developed fever which could be persistent in nature. Vomiting and nausea also conditions that are typically experience by patients with the condition. Another condition that has been commonly reported among patients is bleeding from the rectum.
What are the common causes for diverticulitis?
There are no specific or documented studies that clearly identify or isolate the main reason for the protrusion of the pouches. The pouches that push the colon outside are indicative of the prevalence of diverticulitis. However, the reason behind the formation of the pouches are not clearly known. A lack of dietary fiber is attributed to the condition, and experts have pointed out that the absence of adequate fiber in the diet is the primary reason for the formation of the pouches.
There is substantial evidence in support of this. For instance, dietary fiber is known to have a softening effect on the stools. As a result of this, stools are not hardened and pass out easily with greater motility. In the absence of adequate dietary fiber, these tools are known to hard in, which will affect the movement and motility of the stools throughout the system. Consequently, this will result in in considerable pressure on the colon, when the muscles are forced to move the stool down. As the hardened stools require more pressure, the effort of the muscles increase in this vital function. As a consequence of this strain on the colon and the muscles, diverticula formation occurs.
On a more granular level, the actual formation of diverticula is attributed to the weaker spots giving way as a result of pressure. The weaker spots on the outside layer of the colon end up giving way to the inner layer of the colon that pushes outwards as a result of the effort of the colon to move the stools down. This is one of the reasons that is attributed for the formation of diverticula as a result of hardened stools.
While there is a substantial body of evidence that it support this reasoning and logic, the subject still remains a matter of debate. The link between dietary fiber and diverticulosis continues to be investigated with various theories being put forth, either supporting or denying the link. To put this in perspective and in support of the theory about the link between dietary fiber intake and diverticulosis, a look at dietary habits throughout the globe will present a better picture.
In nations such as South Asia and Africa, the amount of dietary fiber intake is greater when compared with the amount of dietary fiber intake in western nations. Consequently, the incidence rates of diverticula related conditions is higher in western nations when compared with the incidence rates of diverticula in nations that have higher dietary fiber intake. While this evidence is not conclusive in nature, it supports the theory linking dietary fiber intake and diverticula related conditions.
Surprisingly, another school of thought suggests that there is no link between dietary fiber and conditions related to diverticula. While, no evidence has been put forth to support this theory, the experts who put forth this, suggest that increase dietary fiber intake may aggravate the condition or the possibility of ending up with diverticula related diseases. There have been other theories in the past linking various actions are habits with the condition. For instance, before 2008, there were there is which linked diverticula related diseases to the consumption of corn, certain nuts, and some types of seeds. However, study in the year 2008, established that there was no link between the consumption of nuts seeds and corn with diverticula related conditions.
What is the recommended diet for individuals diagnosed with the condition?
Individuals who have been diagnosed with the condition are recommended to go on a special diet. The purpose of the special diet is to ensure that the digestive system functions smoothly with lesser strain and effort. The idea is to ensure that the digestive system receives the rest it requires, while facilitating motility without much strain or pressure. The special diet comprises various stages which are designed to help the digestive system and facilitate motility. For instance, clear liquids are typically recommended for the first few days after the individual has been diagnosed with the condition. The clear liquids include (1) fruit juice without any kind of pulp ingredients, (2) broth from soups, which ensure that there is no solid matter, (3) plain water (4) gelatin which helps fill without any hard contents (5) ice pops and ice chips (6) beverages such as tea or coffee, without infusing any kind of cream in the beverage. As can be seen from the recommended intake of liquids and fluids, all hard matter or contents are avoided which will help to control the diet integrated manner.
The next stage of dietary recommendations, include the use of low fiber foods after the symptoms and conditions begin to ease. As the patient shows signs of relief from the symptoms, the following food products are recommended. #(1) refined white bread which is an excellent source of low fiber #(2) low fiber cereals #(3) food products such as white rice, noodles and pasta which are known to soften the stool in addition to being low fiber ingredients #(4) cooked fruits that are soft #(5) cooked vegetables that do not have seeds #(6) canned fruits and vegetables that are de-skinned and seedless #(7) cheese, eggs #(8) boneless fish and poultry products #(9) milk and yoghurt. As can be seen from the above, all recommended food products are carefully designed to ensure that there is no strain on the digestive.
Expert recommendations on food that needs to be avoided
Experts recommend that certain food products need to be avoided by patients who are diagnosed with the condition. These food products need to also be avoided by individuals who experience some of the symptoms that are indicative of the condition. For instance, an individual may not have been actually diagnosed with the condition but may be experiencing symptoms that are consistent with the condition. It would then be advisable to avoid certain foods that can aggravate the condition.
There are certain categories of foods that are known to trigger gastrointestinal problems. While the theory of popcorn, seeds and nuts being responsible for the condition has been debunked more than a decade ago, it is a fact that certain food products are known to cause or aggravate gastrointestinal problems. It is therefore necessary to identify and avoid all of the food products that can cause problems in the gastrointestinal tract.
Typical western diet includes a low fiber and high fat combination, which is regarded as a recipe for increased risk of developing diverticulitis. Study safe conclusively proved that this dietary habit is one of the reasons for the increased prevalence rates of diverticulitis among adults and age populations in western nations. Experts therefore recommend that it is essential to avoid food products that are typical of this unhealthy combination. For instance, the choice of deep fried foods and refined grains as a staple diet is to be avoided. Similarly excessive use of red meat and full fat dairy products are also to be avoided. This will help cut down on the high fat and low fiber diet combination, help to reduce the probability of developing diverticulitis.
Additionally, experts also recommended that the choice of food products should be based on experiences of individuals. For instance, certain food products may have proven side effects on a particular individual. The same food product may not have an effect on another individual. Therefore, the advice is to choose food products and ingredients that do not have any aggravating effects on the system during or after consumption. This can only be on the basis of individual experiences and cannot be a general assumption.
Common risks that are associated with diverticulitis
While there is no conclusive evidence or proof which establishes the reasons behind the development of diverticulitis, there are theories that are both established and under study. For instance, one of the reasons for or infections in the diverticula is attributed to the rapid multiplication and spread of bacteria in the stools. The actual formation of the bacteria is itself attributed to the blockage of the intestines by stool, which results in an infection. When the diverticula is blocked as a result of hardened stool, the possibility of rapid multiplication of bacteria exists, which in turn causes the infection.
Age is regarded as one of the common risk factors that are associated with the development of diverticulitis. The prevalence rates of diverticulitis is the highest among aging individuals, followed by individuals who are obese. Therefore the risk factors are higher among older adults. Next in line are young adults who are obese, which exposes them to the risk of developing diverticula related conditions. Smokers are known to belong to the high risk category of individuals who may develop diverticula related conditions. This is attributed to the various health complications that arise as a result of smoking. Individuals who do not have adequate exercise of some form of physical activity are also known to belong to the high risk category. Here it is important to note that this condition automatically applies to obese individuals who are known to have inadequate or no exercise. The next category of high-risk individuals are those who consume unhealthy dietary combinations that include high fat and low fiber dietary intake. As mentioned earlier, the typical diet of individuals in western nations include large amounts of animal fat, with very low levels of fiber intake. The last category of high risk individuals includes those who are on certain medications. There are studies which indicate that medication have an effect on the diverticula. For instance, certain medications that belong to the opiates category are known to have undesirable effects. Similarly non-steroidal anti-inflammatory drugs that are used to treat various conditions are also known to be responsible for triggering diverticula related conditions. Steroids are also reportedly responsible for triggering aggravating diverticula related conditions. Finally, genetic inheritance is also a possibility. Studies have revealed that certain patients have inherited the condition genetically. Research into this angle is ongoing and conclusive evidence will emerge when the studies are completed.
What are the diagnostic methods used to determine the condition?
Various techniques are presently in used to diagnose the condition. Here it is important to note that are many illnesses and diseases present symptoms that are very similar to diverticulitis. For instance, patients with irritable bowel syndrome present symptoms that are almost similar to that of diverticula related conditions. This makes the whole diagnostic effort more challenging. As a result of this, a number of tests are used to determine the conditions associated with diverticula related conditions. This is in an effort to rule out misdiagnosis due to similarities in the symptoms.
Typically, doctors prescribe certain blood tests, in an effort to rule out the possibility of other conditions. This helps to cleanly determine and diagnose the condition more effectively. Some of the more common tests that are used include the following.
Colonoscopy as diagnosis – this procedure involves the use of a colonoscope to facilitate a good view of the inside of the colon. The colonoscope comprises a thin tube with camera on the end that is inserted into the colon. The point of entry of the colonoscope is through the rectum, and this helps the specialist to view the inside of the colon for indications of diverticula related conditions. Prior to the actual procedure, the patient is administered a laxative which helps to clear the bowels. In the absence of a clear view, the specialist would not be able to identify the condition. This makes it necessary for bowel clearing prior to the procedure. The procedure is conducted with a local anesthetic. The procedure is also not performed when the patient has a reported episode of the condition. It is only performed after clear resolution of the condition to rule out the possibility of cancer. This is typically performed around one and half months after the episode of diverticulitis subsides.
Barium enema x ray method as a diagnosis for diverticulitis – this procedure involves the use of a tube that is inserted in the rectum. The tube serves as a channel for squirting of barium liquid into the rectum. After the liquid has been introduced into the rectum, and x-ray is used for the purpose of imaging. Barium liquid as properties which make it visible in in an x-ray screening. Consequently, the internal organs of the human body which are generally not visible on x-ray, end up becoming visible when coated with barium liquid. This procedure of barium enema x-ray is not painful, despite the fact that it happens to be an invasive method.
Patients who have a documented history of diverticular disease, generally undergo physical examination conducted by the specialist. Doctors who treat the condition, understand the symptoms associated with the condition, by probing the individual with questions about medical history. The combination of the physical examination and the medical history will conclusively indicate the presence or absence of the condition.
Blood tests are used to determine infections. The presence of a large number of white blood cells indicate an infection. However, it is added that infections and diverticulitis can also be present even when white blood cell count is not high. This is used as a supporting diagnosis for diverticulitis.
Patients who do not have a recorded history of diverticular disease bill required to undergo an additional round of tests. The purpose of these additional tests are to rule out the possibility of illnesses that present with similar symptoms. For instance gallstones and hernia are also known to have similar symptoms. The purpose of the test are to rule out these conditions before treatment it is initiated for or diverticulitis.
The best method recommended by experts is a CT scan. Computed tomography scans are regarded as the most detailed examinations when it comes to ruling out other conditions with similar symptoms. This CT scan will accurately determine if the infection is localized or if it has spread to other parts of the body. It will also help to determine the presence of an abscess. The next best option is to use the barium enema x-ray as explained above.
What are the treatments available for diverticulosis?
Depending on the nature of the condition, it is possible for patients to treat diverticulosis themselves without the need for medical intervention. This typically involves the use of painkillers that helps to alleviate the condition. Most importantly, self-treatment involves a change in dietary habit. Patients who have been diagnosed with the condition need to change their dietary intake, by consuming more dietary fiber.
Patients who are on painkillers that include ibuprofen are advised to limit the use of these medications. This is mainly to avoid the probability of internal bleeding, in addition to the possibility of causing a stomach upset. Pain that is associated with diverticula related conditions is often relieved through acetaminophen. This medication is available as an over the counter medication and does not require a prescription for the same.
Self-treatment for diverticular disease involves first exchange in dietary intake, which includes the consumption of more dietary fiber. Patients are recommended to take more fruits and vegetables. This will help in softening the stool and also help regulate the bowel movements. Smooth and motility and soft stools will help to greatly elevate the condition and also prevent aggravating diverticula related conditions.
Other self-treatment methods include the use of bulk forming laxatives. These laxatives are used for relieving constipation and help individuals manage the condition more effectively. It is necessary to note that more water needs to be consumed when on bulk forming laxatives. This will help to give the best outcomes from the laxatives, which is smoother motility and softer stools. This is also available as an over the counter purchase, which dispenses with the need for a medical prescription, making this a good self-treatment choice.
Exceptions when self-treating
Individuals who resort to self-treatment, need to consult a doctor, when rectal bleeding is experienced. This should not be attempted to be treated at home without medical intervention. While it is true that the amount of blood that is passed through the rectum or along with stools is relatively less, it is necessary to seek medical advice to treat the symptom at the earliest.
Antibiotics are also prescribed by doctors as a part of treatment regimen for diverticulitis. While pain killers and laxatives can be used effectively as part of self-treatment options, the use of antibiotics may be necessary when the condition is moderate to severe. This automatically mandates the need for seeking medical advice for treating the condition. Depending on the antibiotics prescribed for treating the condition, it is possible that certain individuals may experience mild side effects as a result of the medication. For instance, it is possible that diarrhea, drowsiness, vomiting and nausea may be experienced by users when on a course of antibiotics. It is necessary to know that antibiotics is a course and individuals need to take the complete course, even if positive results are experience within the first two days of taking antibiotics. Commonly prescribed antibiotics include ciprofloxacin, doxycycline, cephalexin and metronidazole.
Important information for patients on contraceptive medication
Patients on contraceptive medication, are advised that the antibiotics may result in degradation of the effect of the contraceptive pills. This effect may last for as long as one week after the antibiotic course has been completed. It is therefore necessary that women on contraceptive medication rely on additional methods of contraception during this period.
Is hospitalization necessary for treating diverticulitis?
Hospitalization is generally not necessary for most of the cases of diverticulitis. However, in a limited number of cases hospitalization may be necessary when the conditions persist for the intensity of the symptoms are heavy. This is typically necessary when pain killers are not effective enough, or when the individual is unable to consume adequate liquids due to some reason. Other reasons for hospitalization include the need for or using injectable antibiotics in place of oral antibiotics. Patients with other complications are a poor immune system are also recommended hospitalization as it requires a higher level of care and treatment, it includes intravenous administration of antibiotics and rehydration.