Diverticulitis is a disease of the colon in which there are small protrusions of the intestinal mucosa. These can remain without symptoms (diverticulosis) or become inflamed. Only then one speaks of diverticulitis. In the western industrialized nations, 50-60% of the over-70s have diverticulosis, but only 10-20% also develop diverticulitis. This makes diverticulitis one of the most common diseases of the colon.
Causes
The causes for this disease are manifold. An important factor for the development of intestinal protrusions is age. The connective tissue becomes weaker over time, so that the intestinal mucosa is also less solid.
The increased pressure in the intestine can cause the bulges to form. They typically form at predetermined weak points of the intestinal wall, i.e. where the blood vessels supplying the intestine run. There are small muscle gaps in the intestinal wall which are naturally weaker than the muscular intestinal wall.
Due to the additional weakness of the connective tissue in old age, these weak points become even more sensitive and easily allow the bowel mucosa to bulge. This results in another factor that contributes to the development of diverticulosis: constipation. Elderly people suffer more frequently from constipation, since the intestinal motor function slows down with age, many medications additionally reduce the intestinal motor function and there is often a lack of exercise.
The diet in western countries also plays a major role, as too little dietary fiber is generally consumed. Countries in which more fruit, vegetables and wholemeal products are eaten have considerably lower numbers of patients suffering from diverticulitis. Vegetarians are also significantly less likely to suffer from diverticulitis.
Dietary fibers stimulate the intestinal movement. However, a diet low in dietary fiber reduces it, so that constipation occurs more frequently. In addition, the stool is very hard and firm in low-fiber diets.
In order to transport this solid stool further, the intestine must contract much more and work against greater resistance. This increases the pressure in the bowel and this in turn promotes the development of diverticula. Due to the constant contact with the excrements, the diverticula can also become inflamed.
The stool can accumulate in the sacs and cause the inflammatory reaction there through pressure on the mucous membrane. This is further promoted by constipation, since the stool then remains longer in the area of the diverticula. In the worst case, this local inflammation can further develop into an abscess (accumulation of pus in the tissue) and even break through into the free abdominal cavity (perforation).
This can lead to a life-threatening condition. Other causative factors of diverticulitis are obesity and certain genetic factors. Being overweight increases the pressure in the abdominal cavity.
This supports – just like constipation – the protrusion of the intestinal mucosa. Diverticulitis can also be promoted by stress or other psychological causes, such as grief or nervousness. This is because the psyche, among other things, has a strong effect on the intestinal activity.
This can be well explained by the influence of the psyche on the development of diarrhoea. Similar mechanisms also play a role in diverticulitis, which is favored by stress or mental agitation. If the body is under stress or is psychologically burdened, for example by nervousness, the sympathetic nervous system becomes more active, which ensures that more adrenaline is released.
Adrenaline increases the activity of the body, blood pressure and pulse rate rise. However, this is at the expense of intestinal work. Frequently there is a sudden reaction of the opponent of the sympathetic nervous system, namely the parasympathetic nervous system.
The parasympathetic nervous system promotes digestion. If the parasympathetic nervous system overreacts, this can result in diarrhoea. Other hormones that are released during psychological stress cause a reduced absorption of fluid and electrolytes in the intestines, which also promotes the development of diarrhoea.
The intestinal activity is therefore altered by stress or similar. This favors the development of diverticula. Likewise, diarrhea causes increased pressure in the intestine, which additionally increases the risk of diverticulum formation.
In addition to the changed intestinal activity during psychological stress, stress of any kind also affects our immune system. Especially permanent stress throttles the immune system. If the immune system is weakened by prolonged stress, such as mourning for the deceased partner, pathogens naturally have an easier time of it.Pathogens can therefore accumulate more easily in existing diverticula and, due to the immune system’s lack of defence, can lead to inflammation, i.e. diverticulitis.
In order to avoid these mechanisms, on the one hand prophylactic measures should be taken to avoid unnecessary stress or avoidable psychological strain in the case of a known diverticulosis. This also applies to an already existing diverticulitis. In order for the disease to heal well and for the bowel to recover, one should try to create an atmosphere free of stress and strain. Which unfortunately is often easier said than done.
