Diverticula in the intestine are found especially in the large intestine. If various diverticula have developed in the large intestine, this clinical picture is also called diverticulosis. Diverticula in the small intestine, on the other hand, occur rarely and the affected person usually has no complaints.
What are diverticula in the intestine?
In diverticula in the intestine, the intestinal wall bulges outward. The diverticula (protrusions), occur in both the large and small intestine. Diverticula in the intestine refer to protrusions of the intestinal wall, which occur particularly in the large intestine. In some cases they are congenital. However, they can also develop in the course of life. Medicine differentiates between true and non-genuine diverticula. True diverticula are protrusions in any part of the intestinal wall. Mostly they are congenital and are present only in isolated cases. So-called non-genuine diverticula are protrusions only in the inner layers of the intestinal wall. They are not congenital, but develop over time. These diverticula in the intestine develop in weak areas of the intestinal wall and bulge outward, causing diverticula to appear.
Causes
There are many causes of diverticula in the intestine. The exact process of formation is still not fully understood. Medical experts suspect an interaction between increased pressure inside the intestine and debility of the intestinal wall. Gaps exist in the muscular layer in the wall of the intestine, in which blood vessels run. With age, the degradation of the connective tissue increases, so that the gaps become more sensitive. If the pressure inside the intestine increases, the mucosa is forced out through the weak spots. Diverticula develop. This appearance is favored by a diet low in fiber. The section in front of the rectum is most affected by diverticular formation. Diverticula in the intestine appear more frequently in this area because the causes weakness of the intestinal wall and pressure occur together in it.
Symptoms, complaints and signs
In most cases, diverticula in the intestine do not cause any symptoms. However, if the diverticula become inflamed, abdominal pain sets in. Depending on the type of diverticula, the discomfort occurs either in the left lower abdomen or in the right middle or lower abdomen. In most cases, the pain decreases after bowel movements. In parallel, digestive disorders may occur. Many patients suffer from constipation, diarrhea, severe flatulence or a retention of the stool. Externally, this can be manifested by a pressure-painful hardening in the abdominal cavity. This so-called “roller” usually persists for a few days to a week and then recedes on its own. The symptoms of diverticulosis are accompanied by fever and a general feeling of illness. If the disease is not treated, further symptoms may develop. Possible sequelae include intestinal perforation, peritonitis, intestinal narrowing and the formation of abscesses. In addition, bleeding into the intestine and the formation of fistula tracts may occur. All these complaints are associated with increasing discomfort. As a rule, the affected person is no longer able to perform and feels listless and fatigued. Diverticulosis can be diagnosed quickly on the basis of these clear signs.
Diagnosis and course
Diverticula in the intestine (diverticulosis) require a thorough diagnostic procedure to rule out malignant intestinal tumors. Diagnosis begins with an accurate description of symptoms. Then, with the help of a colonoscopy and an X-ray contrast medium examination, other diseases such as irritable bowel syndrome or colon cancer can be ruled out. An inflammation of the diverticula can already be seen after a blood test. The number of white blood cells is increased and a high sedimentation rate of the blood cells is noticeable. If the inflammation has already spread to the urinary bladder, white or red blood cells are found in the urine. Ultrasound examination, computer tomography or magnetic resonance imaging are also used for closer examination of the inflamed diverticula. The course of this clinical picture usually presents itself without any problems. If treatment of the diverticula in the intestine is necessary, the affected person is symptom-free after consistent therapy.
When should one go to the doctor?
If the diverticula in the intestine become inflamed, a visit to the doctor is recommended.Abdominal pain, which typically occurs in the left lower abdomen, indigestion as well as fever indicate such an inflammatory process – then it is essential to seek medical advice. If symptoms of peritonitis or intestinal obstruction occur, the emergency physician must be called in. Likewise, if blood is noticed in the stool or there is a rupture of the intestine. Since these complications are life-threatening, they must be treated in the hospital. There – if not already done – the diverticula in the intestine are also identified as the cause. After diagnosis, the patient must stay in the hospital for about one to three weeks. Depending on the severity of the inflammation, surgery may be required to close any wounds. To avoid such a severe course, high-risk groups in particular – including people who eat a particularly high-fiber diet or are over 70 years old and patients with existing bowel diseases – should seek medical clarification when they first experience symptoms of intestinal diverticula.
Complications
Diverticula in the human intestine are usually harmless in nature. In some cases, however, they can lead to complications, some of them serious. When very many diverticula are found in the intestine, this is called diverticulosis. In 80 percent of cases, this condition occurs without symptoms. In some cases, however, inflammatory processes occur. The consequence is a so-called diverticulitis. If such diverticulitis is suspected, a doctor should be consulted immediately. If left untreated, this type of inflammation can lead to serious complications. The inflamed diverticula can form fistulas and abscesses that can lead to further problems. A particularly serious complication is narrowing of the bowel. This can go so far as to cause a complete blockage of the intestine. In this case, a so-called lleus is present. Another possible consequence is a rupture of the intestine. This must be treated immediately. If left untreated, this can have a fatal outcome. If the inflammation moves further up, infiltration of the peritoneum is possible. Illeus as well as inflammation of the peritoneum can lead to a life-threatening state of shock. Other possible complications relate to the treatment of these same conditions. Surgery of the bowel or peritoneum may result in fistula formation, pus collection, tissue damage, and infection.
Treatment and therapy
Treatment of diverticula in the intestine depends on the potential discomfort and degree of inflammation of the outpouchings. If the condition is symptom-free, no special treatment is necessary. However, if the affected person has physical complaints, measures to regulate the stool can improve the symptoms. A combination of a diet rich in dietary fiber, adequate fluid intake and daily physical activity is particularly suitable for this purpose. However, if complications such as inflammation are present, the treatment methods are different. In the case of mild inflammation of the diverticula, conservative therapy consists of taking antibiotics and antispasmodic drugs. If the inflammation is very severe, the patient is treated as an inpatient. Only in this way can the condition be comprehensively examined and treated. Surgical intervention is also possible as a therapy. This is recommended if the inflammation has caused a rupture of the intestine or if severe diverticular bleeding cannot be stopped. For this purpose, it may be necessary to remove the entire affected section of the intestine by surgery. Such surgery when diverticula are suspected in the intestine further helps to rule out the presence of colorectal cancer.
Outlook and prognosis
Often, affected individuals remain symptom-free for a long time. The course of the disease depends very much on how much the intestine has changed. If inflammation has not yet occurred, the prognosis is favorable, but even mild inflammation can still be treated relatively well in most cases. It becomes more difficult with a more extensive inflammation of the diverticula. As a result, the intestinal wall can be affected and become thinner. There is then a risk that the intestinal wall will tear and foci of pus will form in the abdomen. If this causes intestinal bacteria to spread in the abdominal cavity, there is a risk of life-threatening peritonitis.In addition, chronic inflammation in the context of diverticulosis can compress the intestine in such a way that a bottleneck develops inside, which promotes intestinal obstruction if the transport of the intestinal contents through the bottleneck is blocked. Another risk is that the disease can cause connections to form between other sections of the intestine, bladder and vagina, known as fistulas, which are uncomfortable for sufferers and difficult to treat. After a successfully treated inflammation, there is a risk of about 30% that intestinal diverticula will occur again. If diverticulosis occurs at a younger age, it usually requires surgical treatment at a later age.
Prevention
To date, the exact causes of diverticula in the intestine are unknown. However, medical experts currently believe that a high-fiber diet can prevent the outpouchings. Furthermore, adequate fluid intake and regular exercise can positively influence the activity of the intestines. More preventive measures for diverticula in the intestine are not known.
Follow-up care
Follow-up care for diverticula in the intestine (diverticulosis) is performed with the internist or gastroenterologist, sometimes in cooperation with the family physician. Immediately after therapy, a gentle diet that does not put additional stress on the patient’s intestines is important. In case of bleeding or similar unusual events, consultation with the attending physician should be sought. The diet is coordinated with the physician, but nutritionists or dieticians can also provide valuable assistance in this context. A diet rich in dietary fiber in conjunction with sufficient drinking are the optimal composition in many cases. Fruits and vegetables are advisable. Flatulent or spicy foods, on the other hand, as well as alcohol are something that the affected person should rather avoid in order to complement the treatment after diverticulosis with targeted aftercare. Diverticula can be promoted in their development by strong pressing and constipation. Therefore, the stool should ideally be kept soft and voluminous. If this cannot be achieved with a purely fiber-rich diet, psyllium products are often helpful. Particularly in the context of aftercare, however, it is important to discuss the use of psyllium products with the treating physicians in advance. Colonoscopy is both follow-up and preventive care. Its frequency is also determined by the physician. It detects early whether new diverticula are in the process of forming again and can thus enable early treatment.
What you can do yourself
Diverticula in the intestine (diverticulosis) are a form of the disease that, in addition to the classic medical therapies, also offers sufferers a whole host of options for self-help in everyday life. This is due to the fact that the disease is often accompanied by or caused by chronic constipation. Alleviating or, ideally, completely eliminating this constipation is one of the important therapeutic strategies that also require the active and, above all, consistent cooperation of the patient in order to be successful. An important factor in this context is sufficient drinking. It ensures sufficient fluid in the intestine and can help to prevent stool residues from being deposited in the diverticula, where they can lead to inflammation (diverticulitis). A diet rich in fiber has the same effect. It can be made even more effective by home remedies, such as taking psyllium husks. To this end, it often helps to switch from eating a few lavish meals to eating smaller portions more frequently during the day. In addition to a conscious diet, sufficient exercise can also improve the symptoms caused by diverticula in the intestine. Regular exercise and other movement-intensive activities also increase mobility in the intestines. The food pulp can be transported more efficiently and a deposit in existing diverticula can often be prevented. Endurance sports such as swimming, walking or cycling are particularly effective.