Diverticulitis is defined as balloon-shaped sacs that protrude from the large intestine (colon). They are usually formed by the weak part of the large intestine muscle. A sac is called a diverticulum, and if there are too many of these sacs, it is called diverticulosis. When these sacs become inflamed for a specific reason, the disease that can occur is called diverticulitis. This disease should be taken seriously and treatment should be started immediately. It is especially seen in adults over the age of 40. While the incidence over the age of 50 is 30%, the incidence over the age of 80 increases to 70%.
Symptoms such as intense abdominal pain, fever, chills and abdominal swelling can be caused by many different conditions, but can also be caused by diverticulitis, which is an intestinal disorder. The treatment of this disease may vary depending on the age of the affected person, different disorders and the spread of the disease. If the symptoms of diverticulitis are not severe, home treatment and diverticulitis diet can be done, but if conditions such as abscess, fistula, obstruction, perforation of the intestinal wall occur in the intestines, surgical treatment can be applied.
What are the symptoms of diverticulitis?
The formation of a large number of diverticula is called diverticulosis or diverticular disease. Some of the symptoms that occur are as follows;
- Swelling in the affected part
- Mild abdominal cramps
- Pain and tenderness in the area where diverticulitis occurs
- Abdominal swelling
- Problems passing gas and not being able to go to the toilet
- Fever and chills
- Fatigue
- Nausea, vomiting
- In rare cases, bleeding in the stool
- Constipation
- Diarrhea in some cases
Who is at risk for diverticular disease?
For years, it has been thought that chronic constipation has an effect on the formation of diverticula. In individuals with constipation, the large intestine exerts more intense force to mobilize feces, causing increased pressure in the large intestine. This increased pressure can lead to the formation of diverticula in the weak parts of the large intestine. Inadequate dietary fiber intake is thought to increase the danger of constipation and predispose to diverticulum formation. Apart from these, other danger factors for this disease are as follows;
- Being over 50 years old
- Male gender
- Obesity
- Not getting enough exercise
- Smoking
- Differences in gut microbiota
- Hereditary predisposition
Can Diverticulum Development be Prevented?
There are some methods that prevent the development of this disease. Some of the techniques that help prevent the development of diverticula are as follows;
Regular exercise: Movement lowers colon pressure and prevents constipation. It is generally recommended to exercise regularly for half an hour every day.
Eating healthy foods: It is necessary to make it a habit to take plenty of fiber starting from childhood and adolescence.
Drinking water: It is recommended to drink at least eight glasses of water daily. Other beverages such as tea, coffee are not a substitute for water. Consuming a lot of tea and coffee together with these can lead to constipation.
Along with these, meditation techniques to reduce stress and not smoking are among the techniques that contribute to preventing the development of diverticula.
How is Diverticulitis Diagnosed?
Diverticula are usually asymptomatic and usually occur during the examination of a different condition. When diverticulitis occurs, symptoms occur. Patients usually present to a specialist with abdominal pain. The specialist will take the patient's history and then perform a physical examination. If necessary, he/she may perform a rectal check (rectal check). This can detect rectal bleeding, the formation of a palpable mass, pain or tenderness in the rectum and other problems. Some conditions can give symptoms like diverticulitis. Additional tests may be needed to exclude these conditions. Some of these tests can be listed as follows;
- Abdominal ultrasound
- Abdominal MRI
- Abdominal tomography
- Stool test
- Urine test
- Liver, kidney problems, blood fluid test
- Pelvic control to rule out gynecological problems in women
- Pregnancy test
In addition, the specialist may order a colonoscopy in an acute situation to rule out ulcerative colitis or Crohn's disease. In sigmoidoscopy, a thin tube with a light and a camera at the end is passed through the rectum into the sigmoid colon and the diverticulitis is evaluated. Angiography can also be used to diagnose diverticula. This technique is used to identify the site of bleeding in case of very heavy bleeding.
What are the Complications of Diverticulitis?
Diverticulitis can be mild, especially when it is initially diagnosed. However, side effects can be seen in up to 25% of cases. Some of the side effects are as follows;
Abscess Formation of a sac with pus in the part with diverticulitis
Phlegmon Phlegmon is an inflammatory condition that spreads under the skin or into soft structures. It can spread more widely than an abscess. While abscesses have a sac wall that restricts the inflammation, phlegmon does not.
Fistula A fistula is a connection between two organs or between the skin and an organ that should not normally exist.
Diverticulitis perforation: In some cases, diverticulitis progresses and perforates. The contents of pus and feces spread into the abdominal cavity. This is a risky condition that leads to widespread intra-abdominal inflammation, referred to as peritonitis.
Intestinal obstruction: Due to the inflammatory phase that develops due to this condition, edema may occur in that part and prevent the movement of feces.
How is diverticulitis treated?
In less severe cases, home treatment techniques may be recommended. In such cases, the specialist may recommend some dietary and lifestyle changes. These can be summarized as eating a diet rich in fiber, consuming plenty of water, and doing plenty of exercise. People with diverticula may be advised to reduce red meat and eat more fruits, vegetables and cereals.
Diverticulitis treatment can be planned according to the age of the patient, the presence or absence of other health problems and the severity of the disease. Early treatment is necessary to prevent complications of diverticulitis. In mild cases, the affected person is started on oral antibiotics, painkillers and antispasmodics. The patient is advised to take a watery diet and rest in bed. Complications and the time required for a follow-up visit to a specialist are indicated.
In more serious cases, the individual will be hospitalized. Antibiotics and painkillers are given intravenously. The patient's oral intake of food may be temporarily stopped. When the acute period ends, a watery diet is started.
If the diverticulitis turns into an abscess, the abscess must be drained through the skin with ultrasound or tomography. If this is not possible, surgery can be performed.
Ifdiverticulitis ruptures , peritonitis, a common inflammation of the peritoneum, may develop. The affected person will then need urgent surgery. In these people, the pain and tenderness increase and the fever does not decrease, even though they usually receive antibiotics intravenously. In such cases, the surgeon will operate on the sick person, clean the abdomen and remove the problematic part of the intestine. However, if the patient does not have a perforation of the intestine, abscess and severe intestinal infection, the ends of the intestine are joined and the abdomen is closed. If these complications are present, the affected person may need a colostomy for a while. After approximately ten to twelve weeks, if the inflammatory condition recovers and the general condition of the individual is good, the colostomy is closed and the person can continue his/her normal life.
Diet and nutrition advice for diverticular disease
If diverticular disease is present, the specialist will recommend a diet program that suits the individual. In general, it can be helpful to consume less red meat. More fiber is also recommended.
To avoid this disease, you should drink plenty of water, exercise and avoid constipation. Not smoking can reduce the risk. Obese people are advised to lose weight.