What Is Diverticulosis?
Diverticulosis is the common condition of small, sac-like pouches forming and pushing outward along the inside of the colon, called diverticula . With diverticulosis, there may be changes in bowel movement patterns as well as severe abdominal pain, bloating, constipation, diarrhea, or rectal bleeding .
These symptoms should prompt a visit to a medical provider, since diverticulosis can lead to diverticulitis an inflammation of the pouches that can have serious complications.
Treatment involves a high-fiber diet, medicines to ease bloating and other symptoms, probiotics and sometimes antibiotics . Procedures to stop bleeding may be necessary as well as surgery to remove the problematic area of the colon.
You can treat this at home through eating more fiber and a mild pain reliever (Advil, for example). Diagnosis is typically done through a colonoscopy, which many at this age should be getting anyways.
Diverticulosis generally does not cause any symptoms if there are no complications. However, in some cases, diverticula can bleed into the bowel . This generally occurs if the blood vessels that supply the colon wall are damaged from pressure and stretching.
Symptoms of diverticular bleeding
About five to 15 percent of people with diverticulosis will developing diverticular bleeding. This mainly includes bloody stools that can described as:
- Painless: This occurs in most people who have diverticulosis.
- Having bright red blood: This typically results from diverticulosis in the left side of the colon.
- Dark red or maroon-colored blood: This typically results from diverticulosis in the right side of the colon.
- Minor and self-resolving: This describes the majority of cases.
- Recurrent or severe: This can occur in some cases.
Other symptoms related to diverticular bleeding include:
The risk of developing diverticulosis increases with age, with more than half of the population developing diverticulosis by age 60 . Causes include increased pressure and abnormal colon activity as well as a variety of lifestyle factors.
Increased pressure and abnormal contraction of the colon
Normally, the colon contracts in a segmental pattern to move food through the bowel. In people with diverticulosis, the colon contracts in an exaggerated fashion, causing increased pressure at specific points that leads to the development of diverticula. Injury to the colon wall at these sites is what causes diverticular bleeding, one of the symptoms of diverticulosis.
Certain lifestyle factors can be associated with an increased risk of developing diverticulosis, such as:
- A diet low in fiber and high in fat and red meat: The reason for this is unclear but may be because such a diet can increase inflammation in the gut and change the gut bacteria to predispose to the development of diverticulosis .
- Lack of physical activity: Rigorous physical activity such as jogging or running appears to be the most effective for reducing the risk of developing diverticulosis .
- Being overweight or obese: The reason for this association is unclear but may have to do with increased levels of inflammation in the body .
- Taking certain medications: These include non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) , steroids such as prednisone (Deltasone), and opioid medications such as morphine sulfate (MS Contin), hydrocodone/acetaminophen (Vicodin), or oxycodone (OxyContin) .
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Treatment Options and Prevention for Diverticulosis
Diagnostic methods may be thorough in order to distinguish from other disorders with similar symptoms, such as irritable bowel syndrome. Diagnostic methods include patient history; physical examination, which may include a rectal exam; blood tests; and CT scan. In some cases, a colonoscopy will be performed.
People who have diverticulosis without bleeding or other complications generally do not require any treatment. Preventative methods are listed first, as they are important for any chance of remaining asymptomatic.
Medical treatment is recommended for those who are actively bleeding, or who have experienced multiple episodes of bleeding . Protocol to stop bleeding and make repairs usually involves IV fluids or blood products first, followed by a colonoscopy and an angiography, and, if necessary, surgery to remove part of the colon.
Action can and should be taken in those who have diverticulosis who are asymptomatic to prevent the development of symptoms, including:
- A high-fiber diet
- Medications: Such as mesalazine (Asacol) or rifaximin (Xifaxan)
Intravenous fluids and/or blood products
People with diverticulosis who are bleeding will be treated to make sure they are stabilized. This involves receiving intravenous fluids and, potentially, blood products, such as blood transfusions, to make sure they are not dehydrated or low on blood.
Once stabilized, the next step of treatment usually involves using colonoscopy, or a scope inserted into the colon. The scope has a camera that allows the physician to identify the diverticula that are bleeding. Once the bleeding diverticula are identified, the physician can treat the diverticula and prevent further bleeding. Options at this stage include:
- Injection: A medicine called epinephrine will be injected into the diverticula to constrict the blood vessels.
- Heat: This may be concentrated and used to seal off the bleeding.
- Endoscopic band ligation: A band will be wrapped around the diverticula to stop the bleeding.
In an angiography, a catheter is threaded through a blood vessel to the site of the bleeding diverticula. Once at the site, the bleeding can be stopped by either delivering a medication to constrict the blood vessels or a substance, such as a small coil or glue, to physically stop the bleeding.
Surgery to remove a part of the colon
Surgery is generally required if there is too much bleeding, or if the bleeding cannot be stopped with another method.
- Details: The source of the bleeding is identified before or during surgery, and the segment of colon with the bleeding diverticula is removed.
- Prognosis: Surgery generally has a high rate of success in preventing subsequent bleeding episodes.
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When to Seek Further Consultation for Diverticulosis
If you develop any symptoms of diverticulosis, such as episodes of bloody stools, you should see your physician.
If you are actively experiencing a lot of bleeding
You should go to the emergency department or call an ambulance right away. The physician can order imaging studies or perform procedures to identify the source of the bleeding, and then offer the appropriate treatment.
Questions Your Doctor May Ask to Determine Diverticulosis
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- How long has your constipation been going on?
- How many times have you passed stool in the past week?
- Do you eat fruits and vegetables every day?
- Has your constipation gotten better or worse?
- Do your symptoms start or worsen when you are dehydrated?
If you've answered yes to one or more of these questions
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