Diverticulosis (diverticular disease): symptoms and treatment

Gastroenterologist

Belousov

Evgeniy Leonidovich

20 years of experience

Candidate of Medical Sciences, Member of the Russian Gastroenterological Association.

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Intestinal diverticulitis is inflammation of the diverticula. This is the name given to blindly ending protrusions of the intestinal wall. Inflammation forms against the background of stagnation of intestinal contents. Most often, this problem occurs in women - one and a half times more often than in males. The risk of encountering this disease increases with age - usually starting at age 40 and older.

Generally speaking, this disease has become more common in recent years, which is usually associated with poor diet and the fact that people pay little attention to their own health.

Symptoms and signs

Diverticulitis is characterized by many symptoms, but the problem is that very often they are similar to the symptoms of other diseases: for example, problems with the kidneys or female genital organs. But a person should still be alert to the following signs of the disease:

• pain in the lower abdomen. Usually it is point-like, it bothers only in a specific place - and it can hurt for several days, then fading, then starting again. The sensation intensifies with sudden muscle contractions: during laughter, coughing, physical activity;
• increased pain after bowel movements, during pressure;
• bowel disorders - intestinal diverticulitis manifests itself as both constipation and diarrhea;
• the presence of blood in the stool - usually the bleeding is not very abundant and is observed only in a tenth of patients;
• fever, chills. When it comes to diverticulitis, symptoms of this nature are rare, but they are also possible;
• loss of appetite - the patient does not feel like eating;
• nausea, vomiting, general weakness of the body - these signs of diverticulitis are very similar to the symptoms of poisoning.

If a patient has intestinal diverticulitis, the symptoms, although misleading, are still quite pronounced and bright, and therefore require immediate consultation with a doctor for a thorough examination.

Another important clarification about diverticulitis: the symptoms in women and men will be similar, although in the latter this disease is less common. In this case, we are talking only about the prevalence of the disease, but not about the fact that it manifests itself in different ways. The only peculiarity is that women can confuse this disease with “female-style” ailments, but there are nuances here, because there will still be some signs similar to poisoning.

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Incidence of diverticular disease

Of all the diseases of the colon, intestinal diverticula are one of the most common in the modern world. The incidence of diverticular disease averages 20% in European countries; moreover, in older age groups of the population (60–80 years), the incidence increases, reaching 40–50%, and among patients over 80 years of age, the incidence reaches 60–65%. In our country, diverticula of the large intestine are found in approximately 17-28% of gastroenterological patients. The incidence of the disease in men and women is approximately the same.

Reasons for development

Diverticulitis of the sigmoid colon and other parts of the intestine is caused by a number of reasons:

• eating foods that don't have enough fiber. For proper intestinal function, a person needs to consume a sufficient amount of dietary fiber;
• complication due to infectious colitis, intestinal infections - the risk of a problem occurring against the background of weakened immunity is especially high;
• decreased muscle tone and deterioration of peristalsis - as a rule, this happens against the background of age-related changes, then colon diverticulitis manifests itself;
• dysbacteriosis, which also entails a general decrease in immunity;
• infection with worms, as a result of which the intestinal microflora is disrupted, the mucous membrane is damaged - and because of this, diverticulitis of the sigmoid colon begins;
• heredity is also one of the significant factors.

Some of the factors that cause intestinal diverticulitis are something that can be avoided if you lead a healthy lifestyle and monitor your condition, regularly visiting doctors for prevention and timely treatment.

Classification of diverticular disease

• Uncomplicated.
  This form is detected accidentally during an X-ray or endoscopic examination of the intestine. Blood tests usually show no changes. The examination must be carried out to assess the extent of intestinal damage, prognosis of the course of the disease and the choice of a method for preventing complications or treatment.
• Complicated
  , occurring with an acute inflammatory process (diverticulitis, diverticular infiltrate, diverticulum perforation, abscess, peritonitis), a chronic inflammatory process, as well as bleeding. A chronic process includes situations when inflammation cannot be eliminated within 6 weeks, or it occurs again. In severe cases, an infiltrate, narrowing of the intestine, or a fistula from a destroyed diverticulum may form.

Risk factors

Before you learn how to treat diverticulitis, it is worth addressing the risk factors. In this case, these include the already mentioned heredity, age, as well as poor nutrition and lifestyle, which contribute to impaired peristalsis. For example, people who sit a lot, hardly move, and have weak muscles are at risk. Many people hardly associate sports and peristalsis, but developed abdominal muscles really help the intestines to function properly. But you can’t get too carried away with heavy sports - otherwise there will be a backlash.

We also include anyone who does not follow the drinking regime into the risk zone - without a sufficient amount of moisture, the contents of the intestine become too dense, which can cause damage to its walls. Those who abuse bad habits, do not follow basic hygiene rules and do not take good care of their health are also in danger.

Forecast

The prognosis is usually favorable if the disease is detected in a timely manner and the necessary preventive and therapeutic measures are started, provided that the patient follows all the necessary recommendations. However, if the need for prevention is ignored, diverticular disease can lead to the development of severe complications that threaten the life and health of the patient. Moreover, the disease is more common among older people who have a variety of concomitant diseases and lower body resistance.

Diagnosis of diverticulitis

To diagnose diverticulitis, symptoms are not the only thing the doctor will rely on. This will require a whole range of research:

• consultation with both a gastroenterologist and a proctologist. Palpation, examination, history taking;
• colonoscopy;
• radiography with contrast;
• Ultrasound of the abdominal organs;
• laparoscopy (in some cases);
• blood biochemistry (will show inflammatory processes in the body).

It is important to understand that many tests, even if they cause distress for the patient, are very important to identify diverticulitis, the treatment of which should be different from other problems. The same colonoscopy is one of the most effective tools that allows you to distinguish between inflammation of diverticula and ulcerative colitis, intestinal obstruction, and colon tumor. And the more accurate the diagnosis, the higher the chance that the doctor will select a high-quality, working treatment.

In our clinic in the center of Moscow, diagnostics are carried out at the highest level - only using modern, most effective and safe equipment. Thanks to this, if intestinal diverticulitis is diagnosed, the treatment will also be of high quality.

The mechanism of development of complications of diverticulum

Diverticular disease is a progressive disease. Diverticula do not undergo reverse development. The risk of developing diverticulitis after a diverticulum persists for 5 years is approximately 10%. If the disease lasts more than 10 years, the risk increases to 25%.

Diverticulitis:

With diverticular disease, inflammatory changes develop in the wall of the diverticulum. The absence of a muscle layer leads to the fact that intestinal contents stagnate in them without the possibility of evacuation. This leads to the formation of fecalitis (fecal stone) in the lumen of the diverticulum, followed by inflammation in the wall of the diverticulum.

Diverticulum perforation:

Inflammatory changes may be limited to the diverticulum wall with its swelling and infiltration. With aggressive microbial flora, inflammation takes a malignant course and can lead to perforation of the diverticulum wall, which in turn can be delimited by the adjacent fatty tissue of the intestinal suspension or mesentery with the formation of an abscess.

Violation of the integrity of the diverticulum wall can lead to serious complications in the form of peritonitis when the diverticulum is localized on the free edge of the intestine.

Relapses of diverticulitis:

When acute inflammation is relieved, restoration of the diverticulum wall does not occur. The damaged mucosa is replaced by granulation tissue, coming into close contact with the tissues surrounding the diverticulum, creating favorable conditions for a chronic inflammatory process and subsequent relapses of acute diverticulitis.

Bleeding from a diverticulum:

Damage to the inflamed mucous membrane of the diverticulum by fecalitis when it comes out of the mouth or the development of a bedsore can lead to bleeding.

Fistula formation:

When inflammatory changes spread to nearby abdominal organs and/or the anterior abdominal wall, fistulas may form. Through such anastomoses, intestinal contents can spread into the lumen of the bladder, the uterine cavity, and even onto the anterior abdominal wall.

Treatment

When a diagnosis of diverticulitis is made, treatment is prescribed individually, depending on the patient’s condition. In some cases, treatment in a medical facility is required; if the situation is not so advanced, you can be treated at home, periodically visiting the clinic.

Diverticulitis is treated in the following ways:

• drug therapy. This usually involves taking antibiotics;
• a strict diet for diverticulitis with a sufficient amount of fiber, without harmful foods;
• surgical intervention (in very complex, serious cases during exacerbation or complications).

The outcome of the disease will largely depend on the patient: on his timely visit to the doctor, compliance with all recommendations and, of course, the right lifestyle.

Which doctor should I contact?

Diverticulosis is a gastrointestinal disease, and treatment is most often carried out by a gastroenterologist. The primary task of the doctor is:

• Excluding diagnoses with similar symptoms;
• Purpose of examination;
• Determining a strategic approach to treatment.

During the treatment process, you may need to consult other specialists: a proctologist, a surgeon, a therapist, a pediatrician and geriatrician, an endoscopist and a nutritionist.

Prevention

Preventive measures for the formation of diverticulitis look like this:

• a healthy lifestyle with proper nutrition, drinking regimen and sufficient exercise;
• maintaining the immune system in good condition - for example, taking the necessary vitamins during the cold season;
• timely solution to any problems related to the intestines, be it diarrhea or constipation.

Diverticulitis, the symptoms and treatment of which are already clear to you, is not for nothing called an age-related problem. Very often it arises against the backdrop of a combination of factors that a person has ignored for a very long time and did not take into account. If you take good care of your health, you can significantly reduce the risk of such a problem.

Diet

Since diverticular disease occurs much more often in people who limit their intake of vegetables and fruits, all patients with diverticulosis need to use foods high in plant fiber and pectin. Wheat bran (especially coarse bran) is very useful, which significantly reduces the pressure inside the intestine and accelerates the rate of movement of contents through the intestines.

It is imperative to exclude all foods that cause increased gas formation (legumes, lentils, grapes, sauerkraut, butter and yeast dough, onions) and constipation (blueberries, rice). It is also advisable to exclude seeds, fruits with a large number of grains and excessively coarse fiber (persimmons, pineapples, turnips, radishes, radishes).

How to make an appointment with a gastroenterologist

You can make an appointment with a gastroenterologist at Meditsina JSC (academician Roitberg’s clinic) on the website - the interactive form allows you to select a doctor by specialization or search for an employee of any department by name and surname. Each doctor’s schedule contains information about visiting days and hours available for patient visits.

Clinic administrators are ready to accept requests for an appointment or call a doctor at home by calling +7 (495) 775-73-60.

Convenient location on the territory of the central administrative district of Moscow (CAO) - 2nd Tverskoy-Yamskaya lane, building 10 - allows you to quickly reach the clinic from the Mayakovskaya, Novoslobodskaya, Tverskaya, Chekhovskaya and Belorusskaya metro stations .

Causes of colon diverticulosis

The main causes of diverticula on the intestinal walls are dystrophic changes in their muscle layer and impaired peristalsis. Often such changes are accompanied by ischemic and degenerative changes associated with age-related changes in the body. That is why the largest percentage of patients diagnosed with diverticulosis are elderly.

The onset of pathological changes in the intestines can be provoked by:

• lack of plant fiber in the diet, which provokes chronic constipation;
• lack of physical activity, as a result of which intestinal motility worsens;
• excess weight.

Other diseases can also affect the intestinal walls, however, their nature is often associated with the above phenomena. For a diverticulum to form, weakening of the muscles and connective tissues of the intestines is not enough.

They are formed only against the background of increasing intraintestinal pressure and resistance to the movement of too thick feces. In the presence of even small defects in the walls, protrusion of the mucous membrane occurs through the muscular layer of the intestine.

Residents of Canada and the USA are considered to be the record holders for the incidence of diverticulosis, and the smallest number of patients with this pathology was recorded in Asian countries and Japan.

Are diverticulum and diverticulitis the same thing?

No, diverticulitis is inflammation of the wall of an existing diverticulum. It (inflammation) may or may not occur. Some studies have found that the risks of diverticulum suppuration are low—only in a few cases out of 100.

However, if inflammation does appear, it can lead to very serious complications:

• cellulitis or abscess of the intestinal wall;
• perforation is the appearance of a defect, a hole in the wall of the intestine, it opens into the abdominal cavity. The release of intestinal contents through a perforation into the abdominal cavity leads to peritonitis;
• fistula. A hole appears in the diverticulum, and it opens into some hollow organ located nearby - for example, the area of ​​​​the intestine or vagina adjacent to the diverticulum;
• intestinal obstruction;
• bleeding.

With diverticulosis, several rounded protrusions (diverticula) often form in the intestinal walls. More than 70% of people with colon diverticula have no signs of disease. That is, it is asymptomatic. And only the remaining third have nonspecific signs of diverticulosis.

Indications for colonoscopy

Colonoscopy is performed if there is a suspicion of cancer, ulcer or diverticulitis. Diagnostic testing also helps to diagnose the cause of internal intestinal bleeding, gastrointestinal disorders, and inflammation of the colon.

Colonoscopy is performed to detect deformation of the mouth of the diverticulum, an inflammatory or infectious process. The screen clearly demonstrates the presence of redness, swelling, and dilated blood vessels. The procedure determines the location of bleeding and determines the intensity.

X-ray contrast examination of the intestines

Irrigoscopy or X-ray contrast examination of the intestine allows you to take an X-ray and see the outline of the large intestine. It is carried out in equipped diagnostic rooms. In order to see the outlines of the internal organs, the patient is injected with a contrast liquid. We are talking about a solution of barium sulfate. As a rule, the contrast agent is administered through an enema or by ingestion.

The endoscopist takes pictures in a lying and standing position to observe the functioning of the internal organs in different situations.

Indications for irrigoscopy

The following indications for irrigoscopy are distinguished:

• bleeding from the anus;
• pain in the intestines;
• mucous or purulent discharge from the intestines;
• problems with bowel movements;

It is recommended to perform irrigoscopy if colonoscopy does not give accurate results. X-ray diagnostics reveal various symptoms of diverticulitis. The size of the formations in diameter does not exceed 10 centimeters. If the protrusions are single, it is much easier to cure the pathology. Multiple protrusions extend beyond the contour of the intestine. In the presence of inflammation, the edges of the diverticula have irregularities.

When a diverticulum ruptures, a fistula forms on the surface of the intestine. This complication is demonstrated both during irrigoscopy and colonoscopy. Often, during inflammation, adhesions form from the connective tissue, which affect the narrowing of the intestines.