Diverticular Disease

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Diverticular disease is one of those illnesses that seems to be a curse of affluence. It is a condition of the digestive system that is mostly found in the industrialized nations of the world where the standards of living are quite high. A poor diet has everything to do with diverticular disease, and it seems to be a logical result of the obsession that we have, especially us Americans, with putting processed low-fiber junk into our bodies and calling it food. The bright side of all this is that we can lessen the affects of this malady simply by choosing to make some much needed changes in our diet and lifestyle.

What is Diverticular Disease?

Diverticular disease is also known as diverticulosis. Diverticulosis refers to a condition wherein the inner layer of the large intestine (colon) herniates or bulges out through the outer muscular layer of the colon. These pouches of tissue are called diverticula. Most diverticula develop toward the end of the large intestine, known as the sigmoid colon. Diverticulitis occurs when the diverticula become inflamed or infected. Diverticulitis afflicts approximately 10-25% of individuals who have diverticulosis. Most diverticula are sized at a maximum of 3 cm in diameter, but occasionally larger ones occur that may be up to 15 cm in diameter. Health professionals call these “giant diverticula.” These are theorized to form by intestinal gas lodging inside an already existing diverticulum and causing it to stretch and expand.

The majority of folks who develop diverticulosis are symptom free, and never even know they have it. Sometimes the diverticula are discovered in the midst of diagnosis or treatment of other digestive tract conditions. Diverticulosis is most common in older folks. It is estimated that 20-50% of us will have some diverticula by the age of 50. Approximately half the people in the United States over the age of 60 are thought to have diverticulosis to some degree.

As stated above, this condition is found predominantly in the industrialized nations of North America and the European Union. Researchers believe this is due to the low fiber diet of these nations. A low fiber diet produces smaller volumes of stool that force the colon to narrow and contract itself in order to move the stool along the digestive tract and out the rectum. Over time, this increased stress on the muscles of the intestinal wall causes them to develop weak spots and leads to the development of diverticula.

Diverticulitis, or the inflammation of the diverticula, happens when a fecalith becomes trapped inside a diverticulum pouch. A fecalith is composed of hardened stool, undigested food, and bacteria. Due to the blockage, blood supply is decreased and an infection often gets a foothold in this area.

Diverticulitis is three times more likely to affect the left side of the sigmoid colon, since this is where most diverticula occur. This is why one of the clues to diagnosing diverticulitis is a patient complaint of pain in the lower left side of the abdomen coupled with a fever indicating infection. Men are at three times greater risk than women of developing diverticulitis, and the risk also increases with age. A family history of the illness also seems to put one at greater risk.

Infections due to diverticulitis are especially of concern in the elderly. They are more susceptible to complications that can become very serious and life-threatening. Occasionally isolated pockets of infection called abscesses may form inside the intestinal walls or even on the outside surface of the intestine. These diverticula may become filled with pus, and due to expansion, they may actually perforate the intestinal wall. If this infected matter enters the abdomen, a dangerous condition known as peritonitis may occur. Peritonitis is an infection of the lining of the abdomen, called the peritoneum. This is a serious condition that can be fatal, especially in the elderly or those with other health conditions. Other complications include the formation of structures called fistulas. These fistulas are tunneling sores that connect organs that were never intended to be connected. An example would be a connection between the intestine and the bladder. Fistulas can be paths whereby infection can spread. Scarring can also be a problem, leading to intestinal obstructions. Both of these complications can be life threatening as well.

Internal bleeding is also considered a potential complication. It is not found frequently, but when it does occur, the bleeding can be severe. About half the time the bleeding will cease on its own. Visual rectal bleeding can also be a symptom, but this is fairly rare.

Any infection or complication in the digestive tract can lead to several types of cancer. It is very foolish to allow any of these conditions to go unchecked. Prevention by proper diet, as we will cover below, is the best course. But if a condition reveals itself, deal with it swiftly!

How is Diverticulitis Diagnosed?

Common symptoms for diverticulitis include:

  • Cramps
  • Bloating
  • Constipation and/or diarrhea
  • Abdominal pain (especially in the lower left quadrant)
  • Internal bleeding
  • Bloody stools
  • Chills
  • Fever
  • Nausea
  • Vomiting

There are several diagnostic tools often used to determine the presence of diverticulosis/diverticulitis. If you are experiencing symptoms that seem to suggest this diagnosis, your health care provider may suggest one or more of these tests. A word of caution here: these procedures are invasive and may be dangerous, depending on the extent of the illness and the skill of the technician. If things go awry, it may make the condition worse, even to the point of perforating organs or the intestines.

  • Angiography involves inserting a tiny tube called a catheter into an artery in the leg. The catheter is steered into one of the primary arteries of the intestinal system. With the help of a contrast dye, any bleeding can be located and traced to determine the source of it. In addition to the precautions taken against an invasive procedure, I personally am not thrilled at the thought of having a dye put into my body. I would definitely get another opinion before agreeing to an angiography.
  • A colonoscopy is also used to locate bleeding within the colon. A small tube equipped with a camera is inserted into the intestine through the rectum. The camera broadcasts its images onto a monitor that can be viewed by the physician.
  • A barium enema may be prescribed to trace bleeding too. This involves injecting a liquid barium mixture into the rectum. Again, I would be careful with this. My approach with any health care decision is to make myself aware of all the possible complications or side effects, analyze if it is absolutely necessary, learn if there are any alternatives (what are my options), and determine if it is worth the risk.

If a patient who has been diagnosed with diverticulitis in the past has recurring symptoms, it is fairly easy to determine if the condition has returned. Abdominal pain in the lower left quadrant along with a fever is a very good indicator. A physical exam may reveal abdominal tenderness, and a rectal exam may disclose an abnormal mass that is painful.

What Treatments Are Available for Diverticulitis?

Conventional medical treatment usually involves hospitalization and often involves a time of fasting from food (and sometimes liquids). Patients are then given liquids and nutrients intravenously, and antibiotics are used as well to fight the infection. The problem with antibiotics is the fact that they are so over prescribed these days, that many infectious agents have developed immunity to them.  Sometimes physicians will prescribe blood transfusions if internal bleeding is present, as well as blood clotting drugs.

Surgery is rarely recommended in simple cases of diverticulitis, but some complications may call for surgical intervention. Infections such as peritonitis can be life-threatening, and in fact the death rate from them is rather high. Sometimes an abscess must be surgically drained, or if that fails the affected section of the intestine must be removed. If a large part of the intestine is taken out, a colostomy will be performed. This is when the intestine is no longer connected to the rectum, and an incision must be made in the abdomen whereby the end of the intestine is put through the abdominal wall. The patient must wear a colostomy bag to collect feces. A colostomy may be temporary, and the intestine may be reconnected after healing has taken place. Sometimes colostomies are permanent and patients must adjust to it and learn to manage.

Are There Any Natural Treatments or Preventative Therapies?

Diet is probably the most important factor in both treating and preventing diverticulitis. A high fiber diet is generally recommended. Eating lots of fiber will also help prevent all kinds of other intestinal and digestive tract disorders, such as constipation, irritable bowel syndrome, and hemorrhoids. High fiber diets have been shown to lower cholesterol and help with weight loss, so eating this way is your body’s friend for lots of good reasons:

  • Load up on fresh fruits, organic and locally grown if you can get them. Dried fruits such as prunes, raisins, and apricots are especially good. All kinds of berries are on the good list, as well as apples (skin on please), pears, oranges, and mangoes.
  • Fresh vegetables are great too. Broccoli, chard, peas, spinach, and other dark green leafy vegetables. All kinds of dried peas and beans, such as lentils, lima beans, kidney beans, chick peas, black-eyed peas.
  • Nuts and seeds are excellent sources of fiber, particularly almonds and whole flaxseed.
  • Whole grains, such as popcorn, barley, and brown rice. Whole wheat pasta, whole grain muffins and breads, and bran cereals will bolster your fiber levels too.
  • Stay away from dairy, red meat, fried foods, spicy foods, sugar, and coffee. These only tend to irritate the gut.
  • As always, drink ample amounts of clean, fresh water. This will help to flush the body of contaminants, and keep all systems operating smoothly.
  • One final note about diet: use common sense. Sometimes a food may be high in fiber, but difficult for you to digest. If this is a problem, you can always use a food processor to chop things like nuts and seeds into a finer consistency.

Psyllium husks are recommended to bulk up and soften the stool. As with any laxative, use in moderation as too much can irritate the intestinal wall.

A good probiotic can be useful as well to help restore the friendly bacteria in the gut.

One final recommendation would be using a high quality colon cleanse. A good cleansing regimen will help to keep diverticula from forming and/or dissolve ones that may be already present.

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