Diverticulitis is caused by infection of bulges in the intestinal wall. Diverticulitis must be treated as soon as possible or it can lead to life-threatening complications.
What is diverticulitis?
Abdominal pain associated with diverticula in the intestine is a typical symptom. Diverticulitis is the inflammation of outpouchings (diverticula) in the lining of the intestine. These diverticula are mainly found in the large intestine, but more rarely they also occur in the small intestine. A distinction is made between true and false diverticula. In true diverticula, the entire muscular layer of the intestinal wall bulges outward; in false diverticula, the bulge consists of mucosal tissue that pushes through a hole in the intestinal wall. The saccular diverticula are usually caused by a weakness in the connective tissue, but they can also be congenital. Diverticula occur frequently and often remain without symptoms. If many of these protrusions form, this is called diverticulosis. Only when the diverticula become inflamed is there diverticulitis and discomfort occurs.
Causes
The causes of diverticulitis are not precisely known. It is thought that a diet low in fiber initially causes the outpouchings to form. The lack of fiber causes the feces to become very hard and puts extra strain on the intestinal wall. Those affected suffer from constipation. If the connective tissue weakens with age, the muscular layer of the intestine gives way over time and diverticula form. In the further course, diverticulitis can occur when feces accumulate in the bulges and can no longer be transported out of the intestine. The fecal debris damages the intestinal mucosa, it becomes inflamed and diverticulitis develops.
Symptoms, complaints and signs
In most cases, intestinal diverticula do not cause symptoms or discomfort. Problems can occur when the diverticula become inflamed. Then, severe abdominal pain occurs primarily, typically localized in the left lower abdomen (in sigmoid diverticulum) or in the right middle or lower abdomen (in Meckel’s diverticulum or coecal diverticulitis). Usually, the symptoms improve after defecation or the expulsion of air from the intestine. Accompanying the stomach pain, various digestive disorders may occur. Many sufferers experience flatulence, diarrhea or constipation, accompanied by a strong feeling of discomfort. Furthermore, there may be a pressure painful hardening in the abdominal cavity. Fever and circulatory problems may also occur. If diverticulitis is not treated, the symptoms and complaints mentioned can develop into serious complications. This can lead to a narrowing of the intestine or even to a rupture of the intestine. If the intestinal contents enter the inside of the stomach, peritonitis can occur, which is usually manifested by cramp-like pain and a strong feeling of illness. Untreated diverticulitis can cause bleeding into the intestine, and fistula formation between different sections of the intestine or from the intestine to an adjacent organ cannot be ruled out.
Course
The initial signs of diverticulitis are similar to those of appendicitis. Affected individuals suffer pain in the lower abdomen, but usually on the left side rather than the right as in appendicitis. On the left side is the sigmoid colon, a part of the intestine where diverticula are particularly common. The pain feels dull. Often, the hardened bowel can be palpated through the abdominal wall, and the pressure on the bowel is painful for the patient. Constipation and flatulence occur, but diarrhea is also possible. Fever occurs in some affected individuals. Sometimes mucus, blood or pus is found in the stool. If diverticulitis is not treated, it can lead to life-threatening complications. The intestinal walls may swell, abscesses (encapsulated collections of pus) and fistulas (tubular duct from an abscess) may form, and the inflammation may extend to the point of intestinal perforation and subsequent peritonitis. The symptoms give the physician the first clues to a possible diverticulitis. A physical examination with palpation of the abdomen and listening to bowel sounds will provide further information. Sonography (ultrasound examination), X-rays and a blood test can be used to confirm the diagnosis of diverticulitis.A colonoscopy can provide final certainty, but it is not advisable in the acute state of diverticulitis, as the inflamed intestinal tissue can easily be damaged in the process.
When should you go to the doctor?
Since this is a serious and life-threatening condition, a doctor should be consulted in any case and as soon as possible. In the worst case, the affected person may also die as a result of the disease. A doctor should be consulted if the patient suffers from pain in the abdomen and lower abdomen that persists over a long period of time and does not go away on its own. Diarrhea and constipation may also indicate the disease and should be checked if they are not related to an infection or certain eating habits. Furthermore, the doctor must be consulted immediately if blood is evident in the stool. This may include calling 911 or going to the hospital if the person is unable to be transported due to the pain. Flatulence may also indicate the disease. In acute emergencies, an emergency physician should always be consulted directly. However, the disease can also be diagnosed and treated by a gastroenterologist. Usually, there is a positive course of the disease.
Treatment and therapy
Diverticulitis must be treated immediately to avoid complications. If there is only a slight inflammation, even a temporary change to liquid food can help. The intestine is thereby relieved and the mucous membranes can calm down. In addition, antibiotics are administered to counteract the inflammation. If a severe form of diverticulitis is present, food must be completely avoided and the patient must be switched to intravenous liquid nutrition. Antibiotics are also administered to the body in stronger doses by means of an infusion. After a few days, the patient can begin to gradually switch back to solid food. If abscesses have formed, they must be opened and drained. This procedure takes place through the skin by means of a tube. If diverticulitis has already progressed to the point where there is a risk of intestinal rupture, surgery is necessary. This involves a surgical procedure to remove the part of the intestine where the inflamed diverticula are located. Sometimes an artificial bowel outlet is needed after this surgery, but it can usually be removed once the diverticulitis has healed.
Outlook and prognosis
Diverticulitis must be treated by a doctor in any case, otherwise it can lead to serious complications and even death of the affected person. If the disease is not treated, the affected person will suffer from severe pain in the abdomen and also in the lower abdomen. There is also diarrhea and constipation and, as the disease progresses, a high fever and bloody stools. Similarly, there may be inflammation in the appendix or even in the peritoneum, and surgical intervention is always necessary to treat these inflammations. The affected person is significantly restricted in his daily life by diverticulitis and also suffers from a reduced quality of life. In most cases, diverticulitis can be treated well by diet and by taking antibiotics. However, examinations are also necessary after treatment, as abscesses may have formed. These must then be surgically removed. If removal does not occur, intestinal perforation may also occur. In some cases, the affected persons are dependent on an artificial bowel outlet. As a rule, the life expectancy of the affected person is not reduced if diverticulitis is detected and treated early.
Prevention
One can prevent diverticulitis by paying attention to a high-fiber, healthy diet. Eating a high-fiber diet softens the stool, prevents constipation, and reduces the risk of developing diverticulitis.
Here’s what you can do yourself
So-called diverticula, protrusions of the intestinal mucosa or of the entire intestinal wall, often occur in the descending branch of the colon. If the protrusions become inflamed because of the long residence time of the intestinal contents in the diverticula, this is diverticulitis. It usually announces itself by pain in the left lower abdomen.If, in the further course, additional symptoms such as constipation or diarrhea or flatulence, fever, nausea and vomiting occur, this is an acute case that should not be cured with self-help measures but requires immediate clinical treatment. In milder cases, and as a preventive measure, the self-help measure is to establish a diet plan with light food left as natural as possible. It is also important to include a high percentage of indigestible fiber in the easily digestible diet. For example, many vegetables and fruits are high in fiber and meet the criteria for a healthy diet. Dietary fiber stimulates intestinal peristalsis and results in less time for the food pulp to remain in the intestine, reducing the risk of inflammation in the diverticula. If acute diverticulitis is not treated, serious complications including intestinal rupture may occur, requiring immediate surgical treatment to prevent severe peritonitis.
