Diseases and Procedures

Diverticulosis & Diverticulitis

You may be having trouble in your colon (large intestine). Small pouches may have formed in your colon wall. Many people have this condition, called diverticulosis. If these pouches become infected or inflamed, a painful and more serious condition called diverticulitis has developed. Aging may contribute to colon conditions, but eating plenty of unprocessed, high-fiber foods may make a difference in the health of your colon.

Pressure Causes Pouches
A healthy colon is a flexible tube lined with muscles. These muscles help move stool (waste) through your colon into your rectum (the lower part of the colon) and out of your body. With enough fiber and water, stool stays soft and passes smoothly through your colon. But if pressure builds up inside your colon, diverticulosis may occur.

Diverticulosis
Without enough fiber and water in your digestive system, stool becomes harder. Your colon's muscles have to squeeze more to more the harder stools through your colon. That extra pressure can cause the lining of the colon wall to bulge out into pouches called diverticula. This usually occurs in the colon's muscular, lower left section (sigmoid), though it can also occur in other parts of the colon. Diverticula may take years to develop and there are often no noticeable symptoms. If you do have symptoms, they might include mild cramping, bloating, constipation, diarrhea, or urgency. In rare cases, heavy rectal bleeding can occur with diverticulosis. Any bleeding, even small amounts, should be reported to your doctor.

Diverticulitis
Diverticulitis occurs when the diverticula become infected or inflamed. The cause of these infections is unknown, but it is possible that they begin when stool lodges in the opening of the diverticula. Infection can lead to complications such as swelling or rupturing of the diverticula. Symptoms often include pain, fever, and chills. In severe cases, infection of the abdominal cavity (peritonitis) may result.

YOUR EVALUATION

To diagnose your colon condition, your doctor will take your medical history, examine you thoroughly, and do one or more diagnostic tests. After the evaluation, your doctor will talk with you about a treatment plan to control your condition.

Medical History and Physical Examination
During your evaluation, your doctor will probably ask you questions such as:

• What are your symptoms?
• If you feel pain, where exactly do you feel it?
• Have you had similar problems in the past?
• What kinds or food do you normally eat?

Your doctor will ask you questions like these before doing a physical and rectal exam. Your stool may be examined, as well.

Diagnostic Tests
Diagnostic tests, such as a barium enema, sigmoidoscopy, or colonoscopy, may be used to help pinpoint your problem or rule out other colon disorders. Imaging tests, such as a CT scan, may also be done for further evaluation.

MANAGING YOUR CONDITION

Treatment for diverticular conditions depends on severity. If you have a mild case of diverticulosis, changing your diet may be all you need to do to keep the condition under control. Your doctor may also prescribe medications to help relax your colon and relieve pain. Diverticulitis often requires additional treatment.

If You Have Diverticulosis
The two main keys to controlling diverticulosis are liquid and fiber (roughage). Fiber absorbs water as it travels through your colon, helping your stool stay soft and move smoothly. Plenty of liquids and high-fiber foods can often keep diverticulosis in check. Over-the-counter stool-bulking agents may also help. Some cases of diverticulosis may require stool softeners or antispasmodic medications for pain. Talk with your doctor about how exercise may also help.

If You Have Diverticulitis
If your diverticulitis symptoms are mild, your doctor may begin treatment with a temporary liquid diet and oral antibiotics. Then, if your symptoms are relieved, a high-fiber diet may be started. If your diverticulitis is severe, you may need hospitalization and IV (intravenous) antibiotics. Surgery may be necessary if other types of treatment don't successfully control your problem, or if complications develop.

IF YOU NEED SURGERY

If your symptoms don't improve with nonsurgical treatment, you may need surgery to remove part of your colon. This may be done through open surgery or laparoscopy. Open surgery is done through a single incision made in the abdomen. With laparoscopy, surgery is done using special instruments inserted through small incisions. Your doctor will discuss your surgical options with you. In some severe cases of infection, emergency surgery may be necessary.

Colon Surgery: Resection
To remove the problem area, an incision is made in your abdomen and the affected section is taken out. Diverticula in other parts of your colon usually do not need to be removed.

To reconnect the colon, the two remaining ends are reattached. In some cases, a procedure called a colostomy is needed to create a temporary opening for waste elimination.

Risks and Complications
As with any surgery, complications are rare, but possible. These may include bleeding, infection, or injury or surrounding nerves. Your doctor will talk with you about any other risks associated with your particular surgery.

Preparing for Surgery
Before surgery, you may be asked to drink a laxative solution and follow a clear diet to cleanse your colon. A doctor will tell you about the type of anesthetic that will be used to keep you asleep and pain-free during surgery.

As You Recover
Since your colon won't be able to handle solid food right away, you will be given IV medications and fluids for a few days after surgery. Within a day or two, you will get up and walk around. This improves both your circulation and your bowel function. The nurses will help you with breathing exercises to prevent lung problems such as pneumonia. You'll go home in about a week. Once you are home, you will be back to your normal activities within 3 to 6 weeks.

KEYS TO COLON HEALTH

After you've been treated for diverticulosis or diverticulitis, you can help keep your colon healthy with the right diet. Include plenty of high-fiber fruits, vegetables, and whole grains in your meals. Also drink plenty of liquids such as water and juice. Your doctor may also recommend avoiding seeds and nuts. Small diet changes can present future problems.

Get Enough Fiber
You need 25 to 30 grams of fiber each day to keep your colon working at its best. It is easier than you may think to add fiber to your diet. Try choosing the fiber-rich foods listed below. For even more fiber, you can add pure (unprocessed) bran to your food or drinks. You can top cereal with pure bran, add it to a baking recipe, or stir it into some juice. Your doctor may also recommend a stool-bulking agent such as psyllium or methylcelluose.

• 1 medium apple = 4 grams
• 1 medium pear = 4 grams
• 1 medium orange = 3 grams
• 1 c. strawberries = 3 grams
• 5 dried prunes (uncooked) = 3 grams
• 1 baked potato (w/skin)= 5 grams
• 1/2 c. cooked frozen peas = 4 grams
• 1/2 c. cooked fresh spinach = 2 grams
• 1/2 c. cooked frozen corn = 2 grams
• 1/2 c. cooked green beans = 2 grams
• 1/2 c. cooked lentils = 8 grams
• 1/2 c. cooked kidney beans = 6 grams
• 1/3 c. all-bran cereal = 10 grams
• 1/3 c. wheat flakes = 3 grams
• 1/2 c. shredded wheat = 3 grams
• 2 slices whole-wheat bread = 4 grams
• 2 slices rye bread = 4 grams
• 1/2 c. cooked brown rice = 2 grams
• 3 T. unprocessed wheat bran = 6 grams
• 3 T. unprocessed oat bran = 3 grams

Get Enough Liquids
Liquids help your body digest food and move it through your system. Most people should drink at least 8 glasses or liquid each day (but avoid coffee and sodas, since they may cause spasms and pressure in your colon). Talk with your doctor and consider the follow ideas:

At work, bring a bottle or a jug of water with you. Pour yourself a cup every hour or so. With your meals and between meals, drink plenty of liquids. When you exercise, take water with you to replenish the liquid your body loses.

A Healthier Life
The same habits that help keep your colon healthy also help keep your whole body healthy. Along with getting enough of the right food, you need to get enough exercise and rest. Play your favorite sport. Take walks. Keep stress under control by making time to relax. You'll feel a lot better.