11 March 2019 These small pouches form when the mucosa and serosa of the colon bulge out of its wall. As a rule, the diverticula are small , ranging from a few millimetres to a couple of centimetres. There may be one or many (several hundred). Any pathological condition caused by diverticula is called diverticular disease . In many cases, people find out about diverticulitis by accident and it is not associated with any symptoms. This condition is called diverticulosis . What is the main cause of diverticula in the colon? The main causes of diverticulosis include: Changes in the motility and resistance of the wall of the colon; Shortage of dietary fibre. A low fibre intake results in harder stools in the colon . This forces the muscles in the wall to work harder to move them. As times goes by, this effort weakens the muscles and favours the formation of diverticula , especially in places where the blood vessels penetrate the colon wall, as they are naturally weaker. Although diverticula are more common in the descending and sigmoid colon, they may appear anywhere in the colon. Who may be affected by diverticula in the colon and what are the risk factors? Diverticulosis is a common problem in western countries and affects 30% to 50% of the population, although in most cases there are no symptoms. It affects men and women equally and its prevalence increases with age. The risk factors for diverticular disease include: Obesity; A sedentary lifestyle; Long-term with corticosteroids; Smoking and alcohol consumption. What are main symptoms of diverticula in the colon? Uncomplicated diverticulosis is usually asymptomatic . Symptoms appear if one of the three known complications of diverticulosis occurs: Bleeding : loss of blood with stools, which may be bright (more common) or dark red. This bleeding is generally heavy; Perforation : unbearable abdominal pain. This normally requires a visit to a hospital emergency unit. It often causes peritonitis and in most cases requires emergency surgery. The perforation is sometimes controlled by the patient’s defences and in these cases it develops into diverticulitis. Diverticulitis (the most common complication), in which the most frequent symptoms are: Abdominal pain (usually in the lower left quadrant) that may be constant or like cramps; Changes in bowel habits (diarrhoea or constipation); Bloated abdomen. These symptoms depend on the severity of the disease and any complications (abscesses, fistulas, infections, perforation of the colon wall, bowel obstruction). Symptoms may therefore range from insignificant, located in the affected area, to symptoms characteristic of an intra-abdominal infection. Other possible symptoms include: Fever and constipation alternating with diarrhoea; Anorexia (loss of appetite); Nausea; Vomiting. A more serious condition is usually reflected by the presence of: Plain throughout the abdominal region; Fever and chills; No production of gas or stools. How is diverticular disease diagnosed? The diagnosis of diverticular disease is based on: Clinical history; Symptoms; A physical examination; Any necessary diagnostic tests and exams (x-rays, ultrasound or abdominal CT scan). An opaque enema and/or a colonoscopy will always be necessary but should be avoided in the acute phase or when a perforation is suspected. Other exams may also be indicated to rule out conditions with similar symptoms to diverticular disease. How is diverticular disease treated? Treatment of diverticular disease depends on its severity and any complications. In acute uncomplicated diverticulitis with insignificant symptoms, treatment with antibiotics plus changes in diet may be sufficient, with no need for admittance to hospital. In patients with a fever, food intolerance and progressive or more severe pain, there is usually an indication for: Hospital admittance; Hydration with intravenous drips; Intravenous antibiotics. When is surgery recommended? Some of these patients may need scheduled surgery . These include: Patients who do not respond to the medication; Patients suffering recurring attacks; Patients who have had a previous attack with suspected perforation of a diverticulum, a bowel obstruction or inflammation of a neighbouring organ such as the bladder, with the occurrence of a fistula; Patients in whom colon cancer cannot be safely ruled out; Patients under the age of 50 who have had a previous attack requiring admittance to hospital. The operation in these patients consists of removal of the affected segment of the colon followed by immediate bowel reconstruction with no need for a temporary colostomy. In acute, complicated diverticulitis, emergency surgery may be necessary. The type of operation depends on a number of factors, such as: The patient’s clinical condition; Any complications; Their severity. The most common surgical procedure consists of removal of the affected part of the bowel and construction of a temporary colostomy (Hartmann’s procedure), followed by bowel reconstruction two or three months later. In some cases, it may be possible to remove the affected bowel segment and reconstruct the bowel in the same operation. What can be done to prevent diverticulitis? Some measures can be taken to help prevent diverticulitis and also, in people with diverticular disease, to try and avoid diverticulitis episodes or other complications. These measures consist essentially of changes in eating habits , especially increasing intake of fluids and fibre. Fibre is found in grains, fruit and greens. They are not completely digested or absorbed and so they remain in the bowel, where they pull in fluids by osmosis and give the stools form and volume. This stimulates bowel movement and results in stools that are soft but formed and easy to pass. Regular physical exercise (e.g. walking for about 30 minutes every day) favours normal bowel movements. Gastroenterologists and general surgeons can help treat this disease. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
