What is diverticula in the colon? Diverticular Outpouchings of the Colon

A diverticulum is an outward protrusion of a part of the intestine. It's like the thumb part of a mitten. These may occur in any part of the intestine but are especially common in the colon, or big intestine, where they are seen in about 15 percent of people over the age of fifty. Such colon outpouchings are related to aging. They are rare under age thirty five but can be observed in twothirds of individuals in their eighties.

They can occur singly or as clusters, so they may look like so many empty grape skins. Only about 10 percent of individuals who have them become symptomatic. A still smaller group requires surgery for complications.

Inflammation of a diverticulum is called diverticulitis. What causes it? 

The cause is unknown. A diverticulum is not specially related to constipation and squeezing down to have a bowel movement. The usual explanation, not necessarily true, is that the outpouchings are the result of aging and weakness in the same area through which the blood vessels pass. When a part of the bowel wall slides out, or herniates, through that same opening, it is termed a diverticulum.

Can it be prevented? 

There is some evidence that outpouchings are related to diet and that there is often an inherited predisposition 'to get them. The mere presence of these diverticula is not a disease, it is only a fact. For the majority of individuals they are of less significance than the shape of their toes. They become significant only when they get infected or their lining erodes sufficiently to cause bleeding.

How do you know that I have them? Can you see them on the rectal examination? 

They can't be seen or felt on rectal examination. The only way of making this diagnosis is by the X-ray examination with barium.

Do I have to be on a diet or take special precautions? 

Not really, although it might be a good idea to avoid eating pits and foods with seeds. Regulation of bowel habits is suggested. But it is hard to correct the long standing constipation. Diverticular inflammation that is recurrent or uncontrolled becomes a serious surgical problem.

What is acute diverticulitis? 

It's an acute inflammation in a diverticulum, something like an acute appendicitis on the left side. The opening becomes blocked and an infection develops. This infection can either resolve itself or form an abscess or perforate and thus flood the abdomen with pus or block the intestinal passageway.

What is done about it? In the milder cases it frequently improves with antibiotics and "bowel rest" treatment. Antibiotics are used because diverticulitis is a bacterial infection; the drugs destroy the bacteria and thus limit or eliminate the spread of infection. A bowel rest regime employs mild cathartics to cause elimination of hard, irritating stool or stool fragments that can block the opening of these outpouchings and interfere with their drainage. The diet is a bland one, and antispasmodics are administered. During a mild attack of diverticulitis it is best for the patient, as well as his bowel, to be at rest and somewhat sedated.

Is there a surgical method of curnig constipation so that I wont have to continue taking laxatives for the rest of my life? 

The ordinary type of constipation is a very common phenomenon and has been implicated as a cause of diverticulitis as well as diseases of the anus. It can be exasperatingly painful, be associated with bleeding from straining, and constitute a daily torment with which the nonconstipated are not sympathetic. When there is no apparent cause for this, it is called functional constipation. One can live with it ("Who calls it living?" said one patient) and no surgical treatment is advised, not because we don't want to help these people, but because there is no good simple surgical procedure for the correction of this not so simple problem. A collection of pus has to be drained, and if the colon segment which has the diverticula is badly diseased, that part of the intestine may have to be removed.

How does this cause obstruction of the bowels? 

The obstruction comes about in one of two ways. If the bowel gets inflamed, it swells and the opening is temporarily blocked. In other instances the inflammation heals with a scar. In the same way that a scar can wrinkle the skin, it can also narrow the tube through which bowel movements must pass. The first kind usually improves with treatment. In the second type the scarred part may have to be removed.

Can anemia and weakness and easy fatigability come from these outpouchings? 

Sometimes diverticula become irritated and bruised and are the source of intermittent bleeding and even of large hemorrhages. Such bleeding is often confused with hemorrhoid bleeding. The slow, intermittent bleeding can result in an anemia with the symptoms you've asked about. Persistent infection may also cause these symptoms. What do you mean, you can't tell exactly what it is? In spite of all examinations and blood studies it is sometimes not possible to differentiate between diverticular infection and cancer in that part of the intestine. Both can produce exactly the same symptoms and almost the same X-ray picture.

What do you advise in this instance? 

The symptoms of both diverticular disease of the colon and cancer of the colon can be a change of bowel habit, blood in the stools, and an abdominal mass. Even the X ray can fail to differentiate between the two. The diagnostician will refer to this as a "surgical colon." If it is cancer, it should come out, and if it is outpouching disease of this type, it should also be removed. Therefore, even though it is not possible to make a diagnosis beforehand, the decision is to remove it. The colon is too diseased to be of any value, and it can be a source of even further complications.

Will I require a colostomy? 

A permanent colostomy is almost never required for the treatment of this kind of intestinal infection. However, a temporary one for several weeks may be used to allow the inflammation to subside by not letting the stool pass over the inflamed area. Then the colostomy can be closed and the two parts joined so that the bowels will move in the regular way. The entire corrective procedure can often be done on one hospital stay of three or four weeks. However, if the infection was complicated, then the two procedures are separated by one or two months.

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