Diverticular Disease

Diverticulosis is a condition whereby diverticula (small pouches) develop in the lining of the large intestine, extending into and through the muscular tissue surrounding the intestine. If these pouches become infected or inflamed, the condition becomes known as diverticulitis. Rarely, diverticula may also occur in the stomach or small intestine.

Diverticulosis used to be a rare disease and even today it is almost nonexistent in certain parts of the world. However, in developed countries like the United States over half of people over 60 have it and most of them are unaware of their condition. The disease usually remains dormant, with the pockets uninfected. Unfortunately, by the time most people realize they have it, it’s too late and the disease is established. The good news is that simple changes in the diet will prevent it from ever becoming a serious problem.

Diverticulosis is a “lifestyle disease” that is easily prevented through dietary modifications. Insufficient fiber in the diet is the chief cause as the large intestine must work overtime to produce small, hard stools that ultimately stress the colon beyond its endurance. In addition, increasing pressure in the colon is experienced when trying to evacuate the firmer stools. This pressure causes weak spots in the wall, forcing the tissue to bulge out.

In over 90% of cases, serious diverticulitis affects the sigmoid colon, in the lower left side of the abdomen. The diagnosis can be confirmed by a barium enema X-ray. If it is known that pockets are present, signs and symptoms alone are enough to make the diagnosis of diverticulitis, and further testing is not usually required.

Conventional treatment of minor diverticulitis can take place at home with rest, a liquid diet, and oral antibiotics. Symptoms usually subside rapidly. The diet transitions to soft low-roughage foods and a daily psyllium seed preparation. Eventually a high-roughage diet is resumed. If the patient has severe symptoms or complications such as peritonitis or obstruction, hospitalization is necessary. Overall, about 80% of patients can be treated successfully without surgery.

 


Signs, symptoms & indicators of Diverticular Disease

Symptoms - Bowel Movements  

Regular/occasional/frequent painful urge to defecate



 

Bowel movement changes



Symptoms - Gas-Int - General  

Severe/severe right/severe left lower abdominal pain



 

(Right/left) lower abdominal ache



 

Meal-related bloating



 

General flatulence



Counter Indicators
Symptoms - Gas-Int - General  

Absence of lower abdominal ache



Symptoms - Metabolic  

Mild/moderate unexplained fevers or unexplained fevers that hit hard or unexplained high fevers



 

Having a moderate/having a slight/having a high fever




Conditions that suggest Diverticular Disease

Digestion  


Lab Values  


Symptoms - Gas-Int - Conditions  

Absence of diverticular disease




Risk factors for Diverticular Disease

Autoimmune  


Digestion  


Environment / Toxicity  



Diverticular Disease suggests the following may be present

Digestion  



Diverticular Disease can lead to

Digestion  


Lab Values  



Recommendations for Diverticular Disease

Animal-based  

Probiotics / Fermented Foods

The use of probiotics can be helpful in maintaining a healthy bacterial population with uncomplicated diverticulitis. Probiotics, especially Bifidus bacteria, help reduce inflammation in inflammatory bowel disease and should provide benefit in diverticular disease by reducing pathogenic bacteria presence or overgrowth.



Botanical  


Diet  

Liquid Diet

The liquid diet should be used for a short time when symptoms are present, in order to give the colon a rest.



 

High/Increased Fiber Diet

A high fiber diet can help relieve symptoms for most people with diverticulosis. The suggested daily total should be 20-35gm. The fiber of choice for diverticulosis is supplemental psyllium, methylcellulose or polycarbophil. These are available over-the-counter in commercial products such as Metamucil (psyllium), Citrucel (methylcellulose) and Fibercon (polycarbophil), among others.

If you suspect that your diverticulosis has turned into diverticulitis, call your doctor and restrict fiber until instructed otherwise.

Oat bran is good for diverticulosis. It is hypoallergenic as compared to wheat containing products, and has additional health benefits. Two tablespoons per day is a reasonable dose and it can be mixed in with foods are added to baked products.



 

Therapeutic Fasting

Water or juice fasting can provide an opportunity for recovery during times of inflammation.



Drug  

Antibiotics

The infection causing diverticulitis often clears up after a few days of treatment with antibiotics. Diet then becomes the chief form of treatment to prevent further episodes.



Habits  

Aerobic Exercise

In one of the few studies that have been done, the most active men had a 37% lower risk of symptomatic diverticular disease than the least active men. Most of the protection against diverticulitis was due to vigorous activities such as jogging and running, rather than moderate activities like walking. [Gut 36:276, 1995]



Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Strongly counter-indicative
Very strongly or absolutely counter-indicative
May do some good
Likely to help
Highly recommended

Glossary

Diverticular Disease

Some people develop small pouches (diverticula) that bulge outward through weak spots in the colon. Diverticulosis is the condition of having these pouches; diverticulitis is an inflammation or infection in these pouches. The conditions diverticulosis and diverticulitis are both referred to as diverticular disease. Diverticulosis may not cause any symptoms but could include mild cramps, bloating and constipation - all of which are common to other conditions such as IBS or ulcers. The most common symptoms of diverticulitis are abdominal pain and tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping and constipation may also occur.

Stomach

A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.

Colon

The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.

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