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Diverticulitis: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Diverticulitis is a condition that affects the digestive system, especially the large intestine (colon). It occurs when small pouches called diverticula, which are normally harmless, become inflamed or infected. This can cause severe abdominal pain, fever, nausea, and changes in bowel habits. In some cases, diverticulitis can lead to serious complications, such as abscesses, bleeding, fistulas, blockages, or peritonitis. Therefore, it is important to know the causes, symptoms, diagnosis, treatment, and prevention of diverticulitis.

Causes of Diverticulitis

The exact cause of diverticulitis is not known, but several factors may increase the risk of developing it. These include:

  • Aging: The incidence of diverticulitis increases with age, as the colon wall becomes weaker and more prone to developing diverticula.

  • Obesity: Being seriously overweight increases the pressure on the colon and the diverticula.

  • Smoking: People who smoke cigarettes are more likely to experience diverticulitis than nonsmokers.

  • Lack of exercise: Vigorous exercise may help reduce the risk of diverticulitis by improving blood flow and bowel movements.

  • Diet high in animal fat and low in fiber: A low-fiber diet may cause hard stools that are difficult to pass, putting strain on the colon and the diverticula. A high intake of animal fat may also increase inflammation and infection in the diverticula.

  • Certain medications: Some drugs, such as steroids, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the risk of diverticulitis by affecting the immune system or causing ulcers in the colon.

Symptoms of Diverticulitis

The most common symptom of diverticulitis is sudden pain in the lower left side of the abdomen. However, some people may experience pain on the right side of the abdomen, especially those of Asian descent. Other symptoms may include:

  • Nausea and vomiting

  • Fever

  • Abdominal tenderness

  • Constipation or diarrhea

  • Rectal bleeding

The symptoms of diverticulitis may vary depending on the severity and type of the condition. Diverticulitis can be classified as acute or chronic, and as complicated or uncomplicated.

  • Acute diverticulitis: This is when diverticulitis comes on suddenly and goes away shortly with treatment. It usually causes mild to moderate symptoms that can be managed with antibiotics and painkillers.

  • Chronic diverticulitis: This is when diverticulitis recurs or persists for a long time. It may cause chronic inflammation and scarring in the colon, leading to more severe symptoms and complications.

  • Uncomplicated diverticulitis: This is when diverticulitis only causes inflammation and possible infection in the diverticula. It can be treated easily with medication and dietary changes.

  • Complicated diverticulitis: This is when diverticulitis causes secondary problems, such as rupture of a diverticulum, abscess formation, bleeding, fistula formation (abnormal connection between organs), blockage in the colon, or peritonitis (infection of the lining of the abdomen). It may require hospitalization and surgery.

Diagnosis of Diverticulitis

Diverticulitis is usually diagnosed during an acute attack. The doctor will ask about your medical history, symptoms, and medications. They will also perform a physical examination to check for abdominal tenderness and signs of infection. In addition, they may order some tests to confirm the diagnosis and rule out other causes of abdominal pain. These tests may include:

  • Complete blood count (CBC): To check for an infection or anemia (low red blood cell count) due to bleeding in the colon.

  • Urine test: To check for urinary tract infections or kidney problems.

  • Pregnancy test: For women of childbearing age, to rule out pregnancy as a cause of abdominal pain.

  • Stool test: To check for blood in stool or gastrointestinal infections such as Clostridium difficile.

  • CT scan: To get a detailed image of the abdomen and identify inflamed or infected diverticula. It can also show complications such as abscesses or perforations.

  • Liver function tests: To rule out liver problems as a cause of abdominal pain.

Treatment of Diverticulitis

The treatment of diverticulitis depends on the severity and type of the condition. The main goals are to control the infection, reduce inflammation, relieve pain, and prevent complications. The treatment options may include:

  • Medication: Antibiotics are used to treat bacterial infections in the diverticula. Painkillers are used to ease abdominal discomfort. Anti-spasmodics are used to relax the muscles in the colon and reduce cramps. Probiotics are used to restore the balance of good bacteria in the gut and prevent recurrence of diverticulitis.

  • Diet: During an acute attack, a clear liquid diet is recommended to rest the colon and prevent further irritation. This may include water, broth, tea, juice, or gelatin. Gradually, solid foods can be reintroduced, starting with low-fiber foods such as eggs, white bread, rice, or chicken. A high-fiber diet is advised after recovery to prevent constipation and reduce the risk of diverticulitis. This may include fruits, vegetables, whole grains, beans, nuts, and seeds. However, some people may need to avoid certain foods that may trigger diverticulitis, such as seeds, nuts, popcorn, or corn.

  • Surgery: Surgery is reserved for complicated diverticulitis or recurrent diverticulitis that does not respond to medication. There are two main types of surgery for diverticulitis:

    • Primary bowel resection: The surgeon removes the diseased segments of the colon and reconnects the healthy segments. This can restore normal bowel function and prevent further attacks of diverticulitis.

    • Bowel resection with colostomy: The surgeon removes the diseased parts of the colon and creates an opening (stoma) in the abdomen for waste to pass out. A bag (colostomy) is attached to the stoma to collect the waste. This is usually a temporary measure until the inflammation subsides and the colon can be reconnected.

Prevention of Diverticulitis

Diverticulitis can be prevented by following a healthy lifestyle and taking care of your digestive system. Some of the preventive measures are:

  • Eating a high-fiber diet: Fiber helps soften stools and ease their passage through the colon. It also helps prevent diverticula from forming or becoming inflamed. Aim for at least 25 grams of fiber per day from fruits, vegetables, whole grains, beans, nuts, and seeds.

  • Drinking plenty of water: Water helps hydrate the body and keep stools soft and bulky. It also helps flush out toxins and bacteria from the colon. Aim for at least eight glasses of water per day or more if you exercise or live in a hot climate.

  • Exercising regularly: Exercise helps improve blood circulation and bowel movements. It also helps reduce stress and inflammation in the body. Aim for at least 30 minutes of moderate physical activity per day or more if you can.

  • Quitting smoking: Smoking damages the lining of the colon and increases the risk of infection and inflammation in the diverticula. It also weakens the immune system and impairs wound healing. Quitting smoking can improve your overall health and reduce your risk of diverticulitis.

  • Avoiding certain medications: Some medications, such as steroids, opioids, and NSAIDs, may increase your risk of diverticulitis by affecting your immune system or causing ulcers in your colon. Talk to your doctor before taking any medication and use them only as prescribed.

  • Managing stress: Stress can affect your digestive system and cause spasms or contractions in your colon. It can also trigger inflammation and lower your immunity. Try to manage stress by practicing relaxation techniques such as deep breathing, meditation, yoga, or massage.

Diverticulitis is a serious condition that can affect your quality of life and lead to complications if left untreated. However, by knowing the causes, symptoms, diagnosis, treatment, and prevention of diverticulitis, you can take charge of your health and avoid or manage this condition effectively.

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