Diverticular Disease

Do you ever wonder what diverticular disease is really all about? If so, you're not alone. Diverticulosis, along with its associated complications, is a frequently misunderstood medical condition (even by many physicians!) Read on to learn more about this common disorder...

Simply put, diverticulosis is the condition of having one or more diverticula (small sac-like protrusions or herniations) within an internal organ -- most commonly in the colon (also known as the large intestine or large bowel), though they may also be found in the small bowel, esophagus, biliary system and urinary bladder. When they occur in the large intestine, these "pouches" or "pockets" are most often asymptomatic and are usually discovered incidentally when an individual undergoes a colonoscopy or other imaging procedure of the colon. Diverticulosis is a very common condition, especially in people over the age of 50, and is thought to result from increased pressure within the bowel, such as that which may be present in constipation. Due to this increased pressure and to an inherent weakness in the part of the muscular outer layer of the colon wall where blood vessels penetrate to nourish the colon, diverticulosis tends to be associated with increased straining to have a bowel movement. Therefore, a diet high in fiber and care to maintain adequate hydration (both of which help soften the stool and make it easier to pass) are usually recommended to prevent new or worsening diverticular disease.

Infrequently, one or more diverticula may become inflamed and even infected, a condition which is called diverticulitis. This diagnosis may be entertained by your doctor if you experience fevers, abdominal pain (especially in the left lower quadrant, where diverticula are most common) and changes in your bowel habits, and can range in severity from mild, uncomplicated disease that will resolve spontaneously to severe, complicated diverticulitis characterized by the formation of intra-abdominal abscesses that require surgical drainage and IV antibiotics. After your initial episode of diverticulitis resolves, your doctor will likely recommend a colonoscopy to exclude any other possible causes of your infection.

Another possible sequelae of colon diverticulosis is that of bleeding from within a diverticulum. Usually presenting as a painless, brisk, lower GI bleed, most cases of diverticular bleeding tend to stop spontaneously and no treatment is usually necessary by the time medical attention is sought. However, in the case of persistent bleeding this condition can quickly become dangerous if not identified and treated appropriately.

 

--Kenneth M. Banner, MD

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