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Diverticulitis, diverticulosis, what is it?

From the age of 40, diverticula are formed in the large intestine. These are small outgrowths, like small “pockets” of the size of a marble, located in different parts of the large intestine.

This is called colonic diverticulosis . Diverticulosis is a condition that affects the colon or large intestine. However, diverticula can be found throughout the gastrointestinal tract, including the esophagus, stomach, and small intestine.

The Diverticulitis is an inflammation of the diverticula related to infection.

Diverticular diverticulosis is a common phenomenon and in Western countries it is found in about 50% of people over 60 years of age. Most of the time, diverticula do not cause any symptoms . They are often discovered during a routine examination for other digestive problems. However, diverticulitis, where there is inflammation and infection of a diverticulum, causes severe pain .

Causes of Diverticulitis

The diverticula form when areas of weakness of the colon wall stretch under the pressure. If the pressure causes a small lesion on the wall of the diverticulum, the infection can be declared. A sedentary lifestyle, no physical activity and a diet with too little dietary fiber are often involved.

Complications of Diverticulitis

Diverticulitis can lead to abscess formation in the diverticulum, bleeding, occlusion of the colon or small bowel.

More rarely, diverticulitis can progress to the formation of a fistula, that is to say a duct that forms abnormally between the colon and various organs of the abdominal cavity such as the bladder, the small intestine uterus or vagina.

The diverticulitis can also lead to peritonitis so the wall of the diverticulum transformed into abscess tears, passing the contents of the intestine into the abdominal cavity. This causes an infection of the peritoneum, the membrane containing the intestines and the abdomen. Peritonitis requires emergency medical intervention.

When to consult

In case of fever over 38  o C , severe abdominal pain, nausea, vomiting or diarrhea, a doctor should be consulted immediately.

Symptoms of Diverticulitis

Common symptoms

  • Usually the pain is quite intense and sudden , at the bottom of the abdomen, on the left side . Sometimes the pain is of medium intensity, variable and gradually increases over several days;
  • Sensitivity of the abdomen;
  • Fever;
  • Nausea;
  • Constipation or diarrhea.

Less common symptoms

  • Vomiting;
  • bloating;
  • Blood flowing from the rectum ;
  • Frequent urination
  • Pain or difficulty urinating;
  • Sensitivity to the abdomen by wearing a belt or leaning forward .

Risk factors for Diverticulitis

  • Be over 40 years old
  • Consume little dietary fiber;
  • Being physically active

Prevention of diverticulitis

Basic preventive measures
An active lifestyle and a diet with a good amount of dietary fiber (legumes, whole grain cereals, fruits and vegetables) reduce the risk of diverticulosis and diverticulitis . Here are some general recommendations. See the sheet Customized Diet Diverticulosis and diverticulitis for detailed recommendations.

  • Gradually increase the intake of dietary fiber that must be consumed at the ration of 30 grams per day ;
  • Reduce the consumption of refined grain products ;
  • Drink enough;
  • Eat less meat and fat ;
  • Consume probiotics;
  • Have regular physical activity
  • Go to the bowel as soon as the need arises;
  • Although chew .
  • Avoid taking anti-inflammatories and corticosteroids in people who have already had diverticulitis.
Measures to prevent recurrence
  • Consume more dietary fiber , from 25g to 30g each day. Legumes (6 g per 125 ml) are the best source. A fiber supplement (Metamucil or other) is a good solution to achieve the recommended amount of fiber;
  • Drink more . The fibers absorb the liquid and help eliminate the saddle;
  • Go to the bowel as soon as the need arises;
  • Practice regular physical activity.

Medical treatments for diverticulitis

From 15% to 25% of people with diverticulosis will experience one day of diverticulitis . The treatments for diverticulitis vary according to the severity of the symptoms. The vast majority (about 85%) of people with diverticulitis can be treated without surgery.

Diverticulitis without surgical intervention

Food. Follow the adapted diet.

  • Follow a strict liquid diet without any food intake for 48 hours. Signs should improve within 48 hours, otherwise, hospitalization is advised.

In case of hospitalization, an infusion is put in place, as well as a suitable antibiotic treatment. The diet can be taken orally only when the pain will have disappeared completely under antibiotic treatment. At the beginning, for 2 to 4 weeks, the food must be without residue that is to say without fibers.

Subsequently, once the recovery is obtained, the diet should instead have enough fiber to prevent recurrence.

  • To receive parenteral nutrition (nutrition by the venous route, thus under perfusion);

Drugs. Of antibiotics are often necessary to control the infection. It is important to take them as prescribed to prevent the bacteria from adapting and developing resistance to the antibiotic.

To relieve the pain. Some analgesics counter such as acetaminophen or paracetamol (Tylenol, Tylenol  or other) may be recommended. More powerful painkillers are often needed even though they can cause constipation and potentially aggravate the problem.

Diverticulitis requiring surgery

Surgery is performed if diverticulitis is serious or complicated by abscess or perforation, or if the antibiotic is not effective quickly. Several techniques can be used:

Resection. Removal of the affected part of the colon is the procedure most often used to treat severe diverticulitis. It can be done laparoscopically, using a camera and three or four small incisions that avoid opening the abdomen, or by traditional open surgery.

Resection and colostomy.  Sometimes when surgery removes the area of ​​the bowel from diverticulitis, it cannot sew together the two remaining healthy bowel portions. The highest part of the large intestine is then brought to the skin through an opening in the abdominal wall (a stoma) and a bag is affixed to the skin to collect the stool. The stoma can be temporary, the time that the inflammation disappears, or permanent. When the inflammation has disappeared, a second operation makes it possible to reconnect the colon to the rectum.

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