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Diverticulosis & Diverticulitis
To understand diverticulosis, it is important to have a basic knowledge
about the anatomy and function of the intestine. The small intestine is
the long, thin segment of bowel that begins at the stomach and ends at
the large intestine or colon.The colon starts in the right lower abdomen
and forms a large question mark across the entire abdomen ending in the rectum.
Just above the rectum is the sigmoid (S-shaped) part of the colon. Liquid stool enters the right colon and, as it moves through the colon, it is dehydrated so that a formed stool eventually enters the rectum. The Sigmoid Colon
The sigmoid colon has the specialized job of contracting vigorously to
maintain a high pressure. This action regulates the movement of stool
into the rectum. And since the sigmoid is a high pressure part of the
colon, it is here that most diverticuli occur.
What is Diverticulosis?
Diverticulosis are pockets or projections extending out from the colon.
These occur very gradually over a long period of time. They occur at weak
points in the bowel wall. The pockets develop because of the pressure
exerted within by the contracting colon.
As noted earlier, since the sigmoid colon has the highest pressure in the colon, it is here that most diverticuli occur. Because of these balloon-like projections, the sigmoid often becomes thickened and narrowed. When this happens, significant changes in the bowel function can occur, such as discomfort, diarrhea, and/or constipation. Who Gets Diverticulosis?
Since it takes so long to develop, diverticulosis usually appears
later in life. However, it is not uncommon to see it in people
who are in their 30's. Eventually the colon, especially the
sigmoid colon, becomes studded with these pockets. This
disorder is mostly one of Western society. It is uncommon
in rural Africa and India. The diet in these areas consist
of unprocessed foods and grains with a very high fiber
content. So, increased fiber ingestion may have great benefit.
Symptoms of Divertiuclosis
As diverticuli form, few symptoms are noticeable, except
perhaps for intermittent spastic discomfort in the left
lower abdomen. Usually, there are no symptoms at all. When
diverticulosis is far advanced, the lower colon may become
very fixed, distorted, and even narrowed. When this occurs,
there may be thin or pellet-shaped stools, constipation,
and an occasional rush of diarrhea. The problem then
becomes a mechanical or structural one, and treatment
is more difficult.
Complications of Diverticulosis
It is, perhaps, remarkable that so few people have
complications of diverticulosis when compared with
the number of people who have the condition. Still,
complications do occur and they can be serious.
Diverticulitis is the most common.
Diagnosis of Diverticulitis
The medical history is the physician's most important tool in
diagnosing diverticulitis. The physical exam may find tenderness
present in the left lower abdomen. A barium enema x-ray usually
is required to determine the extent of the disorder.
Flexible sigmoidoscopy and colonoscopy are exams performed
through the rectum with a lighted, flexible endoscope.
These exams view the colon from inside and provide additional
information about the problem.
Treatment of Diverticulosis
Diverticulosis may be preventable. As noted, fiber, bran and roughage
should be an important part of the diet. Certain types of fiber,
such as wheat bran retain large quantities of water. This,
in turn provides a bulkier stool. This type of large, soft
stool may help decrease the pressure in the bowel over time.
Bulking agents are available in drug stores and can be
effective. The generic names for some of these products
are psyllium and methycellulose.
Bran and fiber can be found in vary palatable forms in many cereals, breads and other foods. Generally, a daily intake of 20 to 30 grams is recommended, beginning at a young age. It is known that emotional stress can increase spasms of the colon and, perhaps result in the formation of diverticuli. Stress should be controlled and treated if necessary. Also, medications can be used to decrease spasm in the colon. Surgery may be needed to remove the diseased portion of the colon when diverticulitis occurs at an early age or when there are recurrent episodes. When surgery is done in a non-emergency situation, a colostomy is usually not needed. Summary
Diverticulosis is a disorder that may be preventable if
treated early in life. At any stage, there is usually
effective therapy available. Diverticulitis, complication
of diverticulosis, can be readily diagnosed by the
physician an effective therapy is available. Working
with the physician, prevention and treatment programs
can be structured to obtain the best results for the patient.
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