Over time, small pouches may form in the colon wall, known as diverticulosis. If these pouches become infected or inflamed, a painful and more serious problem called diverticulitis develops. Although aging may contribute to colon problems, diet makes the real difference in colon health. We rarely see diverticular problems in countries where people eat plenty of unprocessed, high fiber foods. A healthy colon is a flexible tube lined with muscles. These muscles help move stool through the colon into the rectum (the lower part of the colon) and out of your body. With enough fiber and water, the stool stays soft and passes smoothly through the colon. Without enough fiber and water in the digestive system, stool becomes harder and the colon’s muscles must squeeze more to move the harder stools through the colon. That extra pressure can cause the lining of the colon to bulge out into pouches called diverticula. This usually occurs in the colon’s muscular, lower left section (sigmoid), though it can also occur in other parts of the colon. Diverticula may take years to develop, and often present no symptoms. If patients have symptoms, they might include mild cramping, bloating, constipation, or diarrhea. Diverticulitis occurs when the diverticula become infected or inflamed. Infection can lead to complications such as swelling or rupture of the diverticula. Symptoms often include pain, fever, chills, cramping, diarrhea, or constipation. Rupture or bleeding can be severe complications of diverticulosis. Rupture can lead to peritonitis, abscess formation, formation of a fistula (connection) to the bladder or other structures, or stricture (blockage). Bleeding can be rapid and require transfusion. Emergency surgery may be necessary and can often result in the need for a colostomy. This is usually reversible with further surgery after about three months.
Diagnostic tests may be used to pinpoint the problem or rule out other colon disorders. A CT scan can evaluate for diverticulitis. A barium enema is an x-ray that allows visualization of the colon after filling it with barium. It can show narrowing of the colon, growths, or pouches in the colon wall. A colonoscopy involves the use of lighted tube to look directly into the colon.
Treatment for diverticular problems depends on their severity. For a mild case of diverticulitis, a change in diet may be all that is necessary. The surgeon may also prescribe medications to help relax the colon and relieve pain. If diverticulitis symptoms mild, treatment may begin with a temporary liquid diet and oral antibiotics. A high fiber diet may be started once symptoms are relieved. Severe diverticulitis may require hospitalization and intravenous antibiotics. Surgery may be necessary if other types of treatment do not successfully control the problem, or to prevent recurrence and complications of the diverticulitis.
If symptoms do not improve with nonsurgical treatment, surgery may be necessary to remove the diseased portion of the colon. In some severe cases of infection or rupture, emergency surgery may be necessary. Generally, after two or three bouts of diverticulitis, the problem is likely to persist and surgery should be considered.