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Diverticulosis describes a ballooning out of a section of the large intestine (colon). It occurs when the inner lining (mucosa) of the colon weakens and forms one or more sac-like projections (diverticula) that push through the muscular layer of the colon. When those pouches become inflamed, or if they rupture, the condition is called diverticulitis.
The number of diverticula in an individual may range from just one to clusters of ten or more and may vary in size from a few millimeters to several centimeters. Generally, diverticulosis produces no symptoms and may only be discovered incidentally by a barium enema. However, when food backs up in the little pouches and bacteria begin to thrive there, the blood supply becomes compromised, and the result may be abscesses, local adhesions and possible perforation. In diverticulitis, complaints may range from mild abdominal discomfort to life-threatening peritonitis.
The definitive cause of diverticulosis is not known, but low-fiber diets are suspect and so treatment is directed to correct this. The theory is that low-volume stools create more work for the muscles lining the colon. They become hypertrophied (enlarged) and thickened and are eventually replaced by unforgiving fibrotic tissue that is vulnerable to diverticulosis.
In 95% of the patients, diverticulosis or diverticulitis affects the section of colon that lies immediately before the rectum (sigmoid colon) (Joffe).
Risk: Risk factors for diverticulosis and diverticulitis include a high-fat and low-fiber diet, decreased activity levels, advancing age, and postponement of defecation. Individuals in the US, Australia, United Kingdom, and France have high (and increasing) incidence rates of diverticulosis and/or diverticulitis. The disease is uncommon in Africa and Asia. Both sexes are equally affected. Diverticulosis affects 5% of individuals by the time they reach their forties, 33% to 50% of those age 50 and older, and more than 65% of those over 80 (Joffe). Incidence and Prevalence: Although millions of individuals have diverticulosis, less than one-third ever develop symptoms associated with the condition. Ten to twenty percent of individuals with diverticulosis eventually develop diverticulitis (Joffe). |
Source: Medical Disability Advisor
| History: Individuals with diverticulosis are often asymptomatic. Only about one-fifth of individuals with diverticulosis complain of colicky pain in the left side of the abdomen that is relieved by a bowel movement. Other symptoms may include diarrhea, constipation, gas pains, upset stomach, or painless rectal bleeding (hemorrhage). Individuals with diverticulitis complain of fever and acute pain (mild or severe) localized to the left side of the abdomen. They may also report constipation or increased frequency of defecation. Other symptoms of diverticulitis include nausea, vomiting, painful urination, and/or increased urinary frequency. Physical exam: Exploration of the abdomen with hands and fingers (palpation) may reveal a firm, tender section of colon that lies immediately before the rectum (sigmoid colon). Examination may also reveal a distended abdomen that is resonant or drum-like in tone (tympanic). With diverticulitis, palpation over the left lower quadrant of the abdomen produces pain. The individual may also respond to abdominal palpation by contracting (guarding) the abdominal muscles. A tender mass in the abdomen and decreased bowel sounds may also occur in individuals with diverticulitis. The rectum may be tender on examination. Tests: Tests for diverticulosis or diverticulitis include a complete blood count (CBC) with differential, urinalysis and urine culture, occult blood testing of the stool, and barium enema followed by x-rays to demonstrate the presence of either condition. Abdominal x-rays may reveal perforation of the diverticulum. CT may be useful in diagnosis. Ultrasound may reveal diverticula that contain infection (abscess). A flexible, fiberoptic viewing scope can be inserted through the anus and into the colon (sigmoidoscopy or colonoscopy) to assess for bleeding or strictures. X-rays may be taken following injection of a radiopaque dye into a vein (intravenous pyelogram) to rule out other conditions that produce symptoms similar to diverticulosis and/or diverticulitis (e.g., left ureter mass or colovesical fistula). |
Source: Medical Disability Advisor
| Dietary modification is central to the management of either diverticulosis or diverticulitis, and a high-residue diet with fiber is recommended. Individuals with mild symptoms are treated on an outpatient basis, advised to drink plenty of fluids, and given oral antibiotics. Those with more severe symptoms of diverticulitis may be hospitalized and treated using intravenous fluids and antibiotics. If individual has nausea and vomiting and bowel rest is prescribed, feeding may be done intravenously (total parenteral nutrition, or TPN). Oral feeding may then be resumed gradually with clear liquids and gradual advancement to a soft, low-roughage diet. Stool-softeners and antispasmodic drugs may also be recommended.
Approximately 20% of individuals with diverticulitis require surgical intervention because of failure to respond to medical treatment or bleeding (hemorrhage) that cannot be controlled (Joffe). The affected bowel segment is removed (bowel resection), and the cut ends of the bowel are then joined together (anastomosis). In some cases, a 2-stage procedure is used (Hartmann procedure), in which a temporary opening is created for emptying the bowel (colostomy) with anastomosis delayed until a later time. A second surgery is then performed 2 to 3 months later to create the anastomosis and close the temporary colostomy. |
Source: Medical Disability Advisor
| Most of individuals can expect to have total relief from the diverticulitis and/or diverticulosis symptoms within 7 to 10 days following dietary modifications and medical therapy. However, the vast majority of individuals will develop symptoms within 5 years following medical treatment, with a recurrence usually occurring within the first year. The outcome for individuals treated surgically for diverticulitis using a single-step bowel resection and anastomosis or the Hartmann procedure is usually very good. The mortality rate following either type of surgery is low. |
Source: Medical Disability Advisor
| Following abdominal surgery, pulmonary toilet techniques may be useful in preventing postoperative pulmonary complications. Also, certain exercises may be performed to reduce postoperative pain and speed recovery, including progressive relaxation and deep-breathing techniques. These exercises may be performed several times per day until pain from inhalation/exhalation is less noticeable These are especially valuable during the first 48 hours after surgery and should be performed 3 to 5 times per day during this time. Individuals may continue with these exercises for 4 to 6 weeks until recovery from surgery is complete and pain is no longer noticeable while walking or breathing. |
Source: Medical Disability Advisor
| Complications of diverticulosis or diverticulitis include intra-abdominal abscess, colonic stricture, bowel obstruction, infection that has spread to the peritoneal lining of the abdomen, and rectal bleeding. Fistulas (channels) from diverticulitis may involve surrounding structures such as the bladder, vagina, uterus, or abdominal wall. |
Source: Medical Disability Advisor
| Work restrictions are usually necessary for individuals treated with surgery. They cannot lift heavy objects or perform hard manual labor for 4 to 6 weeks following return to work. Light sedentary duties should be assigned during this time. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Is individual asymptomatic?
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Does individual report colicky pain in the left side of the abdomen that is relieved by a bowel movement?
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Does individual have diarrhea, constipation, gas pains, upset stomach, or painless rectal bleeding (hemorrhage)?
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Has fever occurred, or acute pain (mild or severe) localized to the left side of the abdomen?
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Does individual defecate frequently?
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Are symptoms such as vomiting, painful urination, and/or increased urinary frequency present?
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Does exploration of the abdomen with hands and fingers (palpation) reveal a firm, tender section of colon lying immediately before the rectum (sigmoid colon)?
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Is abdomen distended with a resonant or drum-like tone (tympanic)?
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Has individual received adequate diagnostic testing to establish the diagnosis, such as a complete blood count (CBC) with differential, urinalysis and urine culture, occult blood testing of the stool, and barium enema followed by x-rays to demonstrate the presence of either condition?
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Were abdominal x-rays done? CT or ultrasound?
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Does individual have diverticulosis or diverticulitis?
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If diagnosis is uncertain, were conditions with similar symptoms ruled out?
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Has the patient had recurrent attacks?
Regarding treatment:
- Since dietary modification is central to the management of either diverticulosis or diverticulitis, did individual comply with recommended diet?
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Did condition respond favorably to a high-residue diet with fiber?
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If symptoms were severe, was hospitalization and treatment with intravenous fluids and antibiotics required?
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Following discharge, did individual follow instructions regarding clear liquids with gradual advancement to a soft, low-roughage diet?
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Were stool-softeners and antispasmodic drugs effective?
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If required, was surgery performed as a result of failure to respond to medical treatment or from hemorrhage that could not be controlled?
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If colostomy was necessary, was it temporary? Was date set for second procedure to create the anastomosis and close the temporary colostomy?
Regarding prognosis:
- Have symptoms persisted despite dietary modifications and medical therapy?
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Is this a recurrence of the condition?
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Does individual have a coexisting condition such as irritable bowel syndrome (IBS), colon cancer, Crohn's disease, ischemic colitis, ulcerative colitis, tumor, or angiodysplasia that may complicate treatment or affect recovery?
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Has individual experienced any complications related to the condition?
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Source: Medical Disability Advisor
| Joffe, Sandor, and Apasia Kachulis. "Colon, Diverticulitis." eMedicine. Eds. John L. Haddad, et al. 14 Jun. 2004. Medscape. 23 Oct. 2004 <http://emedicine.com/radio/topic183.htm>. |
Source: Medical Disability Advisor
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