What is Diverticulitis ?

 Diverticulitis is a digestive condition that affects colon or large intestine. It results from the inflammation of single or more diverticula in the digestive tract. Diverticula can be described as small, bulging pouches formed anywhere in the digestive system, including stomach, small intestine and esophagus. However, large intestine is the most common site, where diverticula are found. The formation of diverticula is associated with aging. It is commonly seen after age of 40. The formation of diverticula is referred to as diverticulosis. When it causes certain health problems like severe abdominal pain, nausea and fever, then the condition is known as diverticulitis. Mild cases can be cured with the use of antibiotics, enough rest and dietary changes. But, in severe cases of diverticulitis, surgery may be required.

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Causes of Diverticulitis

Colon DiverticulitisThe major cause of diverticulitis is formation of small pouches or sacs, called diverticula. Colon is a part of large intestine. Diverticula are most commonly seen in the lower part of the colon, known as the sigmoid colon. Inflammation, irritation, swelling and infection in diverticula can cause diverticulitis. Diverticula tend to protrude through the weak spots of colon wall, causing infection. The narrow openings of diverticula may trap fecal matter, leading to infection. Obstruction in the narrow opening of the diverticulum may decrease blood supply, resulting in inflammation.

The exact causes of formation of diverticula are not clear. Consumption of low-fiber foods is considered to be the major cause. People who eat more processed food, including white rice, most breakfast cereals, white bread, crackers and pretzels are more likely to develop diverticulosis. When small pieces of stool or feces are trapped in diverticula, it results in infection and inflammation, known as diverticulitis.

Risk Factors

The factors that can increase the risk of diverticulitis are aging, low-fiber diet, lack of exercise, obesity and smoking. People over 40 are more likely to develop diverticula due to reduced strength and elasticity of bowel wall. High-fiber diet helps to keep the stools soft and prevents formation of diverticula. Diverticulitis is common in the industrialized nations like United States, where the average diet is rich in refined carbohydrates and low in fiber. Lack of exercise also increases the risk of diverticulitis. Being overweight is also contributing factor. Likewise, the smokers are more prone to develop diverticulitis.

Signs and Symptoms of Diverticulitis

Many people with diverticulitis have no noticeable signs and symptoms. However, they may experience cramping and bloating in the lower part of abdomen. The symptoms often start suddenly and they are quite severe. They may worsen with time. Some of the common signs and symptoms of diverticulitis are abdominal pain and tenderness, nausea and vomiting, constipation, diarrhea, fever, bloating, changes in bowel habits and bleeding from the rectum in rare cases. The abdominal pain is often sudden and intense and located in the lower left side of the abdomen. In some people, abdominal pain is mild at first and becomes severe with time.

Possible Complications

More serious cases may develop following complications:

–          There may be abnormal connection formed between various parts of the colon or between the colon and another body parts. The condition is referred to as fistula. The infected tissues, if come in contact with each other, can stick together. Due to formation of fistula, there may be bacterial infection in different body parts.

–          Another most common complication of diverticulitis is an abscess in the large intestine. An abscess is a cavity or lump filled with pus.

–          There may be hole or tear in the colon, known as perforation. Also, there may be narrowed area in the colon, referred to as stricture.

Diagnosis of Diverticulitis

The formation of diverticula doesn’t cause any physical problems. Many people come to know about diverticulosis during routine screening examination for intestinal problems. Diverticulitis can be diagnosed during an acute attack. Since abdominal pain is the most significant symptom of diverticulitis, the condition can be misdiagnosed with other health problems like appendicitis, pelvic inflammatory disease, irritable bowel syndrome, stomach ulcers, ectopic pregnancy, colon cancer, ovarian cancer, ischemic colitis and inflammatory bowel disease. Therefore, correct diagnosis is very important for proper treatment.

For the diagnosis of abdominal pain, the doctor carries out physical examination of abdomen for tenderness. Laboratory investigation like complete blood count is carried out to check white blood cells for the signs of infection. An imaging test like CT scan is carried out to visualize the pouches that are inflamed or infected. Other tests done for the diagnosis of diverticulitis are ultrasound of the abdomen and abdominal X-rays.

Treatment for Diverticulitis

Diverticulitis can be treated in various ways. The treatment option depends upon the severity of the symptoms. Mild cases can be treated with home care; while in severe case, hospitalization may be needed. The doctor usually prescribes antibiotics, which should be taken in the recommended dose and course. Also, antispasmodics to relive cramping and analgesics to relive pain are given. Additionally, you are advised to include more fiber in your daily diet and avoid processed foods. Consumption of more amount of fiber can help prevent future attacks. Once diverticula are formed in the large intestine, they will remain permanently. What you can do is to make simple changes in your lifestyle and dietary habits and prevent recurrent attacks of diverticulitis.

Precautionary Measures:

  • You need to include high-fiber foods in your diet such as fresh vegetables, fruits and whole grains, which can help soften the stools and make it pass more quickly through the colon. This helps to reduce the pressure in the digestive tract. Daily consumption of minimum 20-35 grams of fiber is recommended. However, make sure to add fiber gradually to avoid gas, bloating and abdominal discomfort.
  • You should drink plenty of fluids to support the action of fiber. The fiber absorbs the water and makes the stools soft. If you don’t drink sufficient liquids, then you may suffer from constipation.
  • Don’t fail to respond to bowel urges. Never delay the bowel movements, as it can lead to harder stools, which need more force to pass. It results in increased pressure in the colon.
  • Regular exercise is also very important. It promotes normal bowel function and decreases pressure inside the colon. Daily exercise of at least 30 minutes is recommended.
  • During an acute attack of diverticulitis, you need to remain on a liquid diet. It includes water, broth, gelatin, clear carbonated drinks and ice pops. The liquid diet helps to the intestines to repair the damage and relax for some time. You may include low-fiber foods like eggs, yogurt, peanut butter and cooked vegetables in your diet, as the symptoms start to fade. After the complete recovery, you can take high-fiber diet that includes uncooked fruits and vegetables, whole grains and dried beans to prevent more attacks of diverticulitis.
  • When you suffer from acute attack of diverticulitis, you need to take enough rest and relax your colon. It can accelerate the healing process.

Hospitalization:

If you have more severe attack or you have developed complications of diverticulitis such as an abscess, then you may require hospitalization to receive intravenous antibiotics. If the abscess is developed, it should be drained by inserting a needle through the skin.

Surgery for Diverticulitis

If you have recurring diverticulitis, or developed complications like fistula, abscesses or perforation, then the surgery is recommended to remove the diseased part of colon. There are two types of surgical procedures such as primary bowel resection and bowel resection with colostomy. In primary bowel resection, the diseased part of intestine is removed and the healthy segments of colon are reconnected. This procedure is known as anastomosis. This eases normal bowel movements. If done with laparoscopic surgery, it can be performed through 3-4 small incisions with rapid recovery. If there is excess inflammation in the colon and rejoining of colon and rectum is not possible, then bowel resection with colostomy is required. During colostomy, an opening or stoma is made in the abdominal wall and the unaffected part of colon is connected to the stoma. The waste passes through the opening into the bag. Once the inflammation is healed completely, a second operation is performed to reconnect colon and rectum.

Alternative Treatments

The sufferer is suggested to take supplements such as fiber supplements like insoluble fiber supplements such as glucomannan and psyllium, as well as soluble fiber supplements like oat bran or flax seed and other supplements like glutamine, omega-3 fatty acids and probiotics like Lactobacillus acidophilus, Lactobacillus plantarum and bifidobacteria.

You may also use the herbs like flaxseed, slippery elm, cat’s claw, wild yam, chamomile, licorice and marshmallow in the form of dried extracts or tinctures. These herbs can provide a great relief in diverticulitis as well as strengthen and tone the body systems. Also, homeopathic medicines like belladonna, colicynthis and bryonia can be used to relive abdominal pain and cramping due to diverticulitis.

Diet for Diverticulitis

A diverticulitis diet is recommended along with antibiotics in case of mild or uncomplicated diverticulitis. It begins with intake of clear liquids for a few days. You are allowed to take the beverages like clear soda, broth, fruit juices like apple or grape juice without pulp, ice chips, plain gelatin, ice pops without addition of fruit or fruit pulp and plain water. Once you start feeling better, you can gradually include low-fiber foods like canned or cooked fruits without seeds or skin, canned or cooked vegetables like peas, green beans and potatoes, eggs, poultry, fish, refined wheat and white bread, low-fiber cereals, milk, low-fat yogurt and cheese. When you completely recover from the symptoms, you can gradually come back to a regular diet.

With balanced lifestyle, nutritious, fiber-rich diet and regular exercise regimen, you can overcome and prevent the painful symptoms of diverticulitis and stay healthy and fit.

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