Diverticulitis is a disease of the large intestine, mainly of the last part of the colon, the so-called sigmoid colon (Colon sigmoideum). In this disease, there are protrusions of the intestinal mucosa (diverticula). In most cases, these bulges do not affect all mucosal layers of the intestinal wall and should therefore be correctly called pseudodiverticula. If many such bulges occur, the clinical picture is initially called diverticulosis, which is ultimately referred to as diverticulitis due to the addition of inflammatory processes. This inflammation of the intestinal wall bulges can then lead to pain, usually localized on the left side.
Causes of pain
Pain in diverticulitis is caused by inflammatory processes within the bulges of the intestinal wall (diverticula). During these inflammatory processes many immune cells migrate into the inflamed diverticula. There they release, among other things, pain messengers (PGE2, bradykinin, cytokines, TNF), which ultimately lead to the patient’s perception of pain.
The inflammation usually develops at the bottom of thickened fecal matter within the diverticula, where it leads to undersupplied pressure points (pressure necrosis) and ultimately to diverticulitis. The faeces in the diverticulum over a longer period of time is also a good breeding ground for unwelcome bacteria. These further worsen the local inflammatory reaction.
Symptoms of pain
Besides fever, nausea, loss of appetite, constipation and an increase in white blood cells (leukocytosis) as a sign of an inflammatory reaction, pain is the most important symptom of diverticulitis. The pain is usually located in the left lower abdomen and is called left-sided appendicitis because of its character, which appears similar to appendicitis. However, in some patients the pain radiates into the back.
The pain may vary depending on the stage of diverticulitis. For example, in chronic, recurrent (recurrent) diverticulitis, the pain occurs after pain-free intervals mostly in the left lower abdomen. The pain character in early stages of an acute, uncomplicated diverticulitis is rather dull, but in later stages there is defensive tension when touching the painful area, as well as palpable hardening (resistance).
Furthermore, in the further course of the disease, severe pain can occur due to the breakthrough of a diverticulum (perforation). If the inflammation spreads throughout the entire abdominal cavity (peritonitis), the pain is no longer limited to a small area, but encompasses the entire abdominal cavity and can lead to severe concussion and touch pain. Finally, diverticulitis can culminate in the symptom complex of a so-called “acute adomen”, which, in addition to severe abdominal pain, is characterized by a deterioration of the general condition, defensive tension and shock symptoms and always represents a clinical emergency. In some cases, the pain, which is normally located in the left lower abdomen, can become so severe that it radiates into the back and forces the affected person to adopt a stooped posture.
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