Diverticular Disease is a condition in which pockets protrude through inherent weak spots in the colon wall. Each pocket is called a “diverticulum” and multiple pockets are called “diverticula”. Diverticular Disease affects most commonly the sigmoid colon but can extend throughout the colon and even other parts of the gastrointestinal tract.
Most patients with Diverticular Disease do not have symptoms but those that do have altered bowel habits with left lower abdominal pain that worsens with eating and alleviates with defecation – a condition termed “Symptomatic Uncomplicated Diverticular Disease” (SUDD). A variety of other more serious gastrointestinal conditions though can mimic SUDD. It is important to visit Dr. Mantas to differentiate these conditions.
Scientists are not certain what causes Diverticular Disease. A widely accepted theory is that repetitive abnormally exaggerated colonic contractions around low fiber dense stool near structural weaknesses in the colon wall lead to increased intraluminal pressure and the subsequent formation of pockets. It was believed that low fiber diet played a critical role as diverticular disease emerged in the early 1900s in industrialized first world countries like the United States where fiber consumption began to decrease. Even though this is an attractive theory it does not appear to be substantiated in recent studies which show no change in Diverticular Disease incidence with fiber supplementation. Because most patients remain asymptomatic the true incidence and prevalence is hard to ascertain but it is appears that Diverticular Disease becomes more common as we age and approximately one out of four adults at age 50 years old has Diverticular Disease.
A diagnosis of Diverticular Disease begins with a thorough history and physical examination. If there are features suggestive of Diverticular Disease or any of its complications Dr. Mantas then proceeds with a combination of tests to clinch the diagnosis. These tests include blood/stool analysis, radiographic imaging and colonoscopy.
Aside from maintaining a high fiber diet no medical treatment is rendered for asymptomatic Diverticular Disease. However, if a patient suffers from “Symptomatic Uncomplicated Diverticular Disease” (SUDD) a variety of treatment measures may provide relief including the use of anti-spasmotics, topical anti-inflammatories, probiotics and antibiotics. Please visit Dr. Mantas to discuss your treatment options.
Patients with Diverticular Disease can develop a variety of complications which carry their own unique symptoms. When no complications are present the patient is said to have “diverticulosis”.
Diverticulitis is a serious complication of Diverticular Disease where the orifice of a diverticulum becomes obstructed leading to inflammation. It is heralded by the onset of significant left lower abdominal pain with additional symptoms of fever, chills, nausea, vomiting and change in bowels. Uncomplicated cases of diverticulitis can be treated with antibiotics and bowel rest. Complicated cases marked by the formation of obstruction, abscesses, perforation and/or fistulas require surgical intervention. For the patient who suffers from recurrent bouts of diverticulitis despite medical treatment it is recommended that they undergo a prophylactic partial colectomy of the diseased segment to prevent future episodes.
Diverticular Hemorrhage is a serious complication of Diverticular Disease where a blood vessel erodes through a diverticulum. It is heralded by the sudden passage of red or maroon blood from the anus sometimes mixed with stool. Bleeding is sometimes accompanied by abdominal cramping and symptomatic anemia with weakness, dizziness and lightheadedness. The bleeding spontaneously stops in ¾ of patients. In the remaining ¼ of patients who have persistent bleeding either colonoscopic hemostasis, angiographic arterial embolization or surgical resection is needed.
You should emergently seek a health care provider if you have any of these symptoms.
Despite controversy in how Diverticular Disease forms it is recommended that patients maintain a high fiber diet. In addition, the widely held belief that nut and seed avoidance decreases your risk of developing diverticulitis is unfounded. Recent studies though suggest that the use of NSAIDs may increase one’s risk of developing a complication and thus should be avoided.
A variety of other disorders can affect the colon, rectum and anus. Suggestive symptoms include diarrhea, constipation, bleeding, lower abdominal pain, anorectal pain and bowel urgency. Please visit Dr. Mantas if you feel that you have a colo-rectal-anal disorder. Other common colo-rectal-anal disorders include microscopic colitis and fecal incontinence.