USF-COM
Department of Family Medicine
Patient Education Information on...
Information for the Patient
with
DIVERTICULOSIS
by Hays Arnold, Class of 1999
Index of
Patient Education Topics
What
is diverticulosis and who get it ?
Diverticulosis is a condition of the intestinal tract in
which parts of the inner intestinal layer bulge through weak spots in the
muscular outer wall of the intestine. You might compare this to an old
bicycle tire where the inner tube bulges out through worn spots on the
tire. Usually these bulges, or diverticula, occur in the last portion of
the large intestine called the colon. Typically, diverticulosis is found
in older persons. It is also more common in industrialized countries like
the United States and England where dietary fiber intake is low and meat
intake is high. It is so common in this country that it is thought to occur
in almost half of people over the age of 60 years and in 90-95% of people
over the age of 80 years.
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What causes diverticulosis
?
The exact cause(s) are not yet known but several factors
have been related to an increased chance for developing diverticulosis.
It is known that the muscular wall of the colon thickens as we age. Because
of this thickening it requires more effort and more "pressure" within the
colon to pass stool. Over time it is this increased pressure that pushes
the inner intestinal lining through weak spots in the muscular wall. Long
periods of constipation or long term use of strong laxatives can also increase
your chances of developing diverticulosis. Some scientists even believe
that tension and physical or emotional stress can also increase your likelihood
of developing diverticula (small pouches).
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What kind of problems can
diverticulosis cause for me ?
For most people, diverticulosis causes few or no problems.
In fact, only about one person in five with diverticulosis will develop
symptoms. When a patient does have problems, they can include abdominal
cramping, constipation, diarrhea and bloating. If the diverticula are close
to blood vessels then a patient may sometimes notice small amounts of blood
in the stool, but this is not common and is usually very mild. However,
in a small number of patients with bleeding diverticulosis, the loss of
blood can be heavy. Because of the chance for heavy blood loss, you should
call your doctor quickly or go to the nearest emergency room if you ever
see blood in your stools.
Some patients may develop infection and inflammation in
the diverticula, a condition called diverticulitis. These patients often
complain of fever, nausea, vomiting, severe abdominal pain and constipation
mixed with episodes of diarrhea. If the inflammation is severe enough a
diverticulum can even burst open allowing the infection to spread to other
organs in the belly. If a patient gets many attacks of diverticulitis then
scar tissue can form creating a partial or even complete blockage inside
the colon. Luckily, less than one person in five with diverticulosis will
ever develop diverticulitis.
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What can my docotor do to
find out if I have diverticulosis ?
Usually your family physician will suspect diverticulosis
based on information that you provide to him/her about your diet, bowel
habits and belly pain. The exam in the doctor’s office usually also requires
a rectal exam in which your doctor inserts a gloved, lubricated finger
into the rectum to detect any blockages, tender spots or blood. Further
tests to confirm the suspicion include barium x-rays, sigmoidoscopy and
colonoscopy. If diverticulitis is suspected (remember that diverticulitis
is diverticulosis with inflammation), then Computerized Tomography scans
("CAT" scan) or ultrasound can be used to see any diverticula that might
be filled with pus. Another special type of x-ray, called angiography,
traces dye injected into the blood stream to locate bleeding diverticula.
In many cases the diagnosis of diverticulosis is made accidentally when
the doctor is performing tests for other illnesses!
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What can I do to help myself
?
The best thing that you can do is to watch your diet and
increase the amount of fiber that you eat. Fiber helps to soften your stools
and lowers the pressure in the colon so that the stools pass more easily.
Foods like fruits, vegetables and grain products have varying amounts of
fiber in them but are usually good sources. If you have a tough time eating
enough of these foods you can also try products like Citrucel or Metamucil
once a day. Try to count how many grams of fiber you eat every day by adding
up the totals from the "Nutrition Facts" label on your foods. You should
try and take in at least 20 grams of fiber per day, but 40-50 grams is
preferred. Also remember to drink plenty of water (at least 8 glasses a
day) since this helps soften your stools as well. Avoid using enemas or
laxatives frequently since this can actually make your diverticulosis worse.
Some doctors also believe that foods with small seeds (strawberries, grapes,
raspberries), nuts and popcorn can worsen diverticulosis by becoming stuck
in the small pouches and causing inflammation (diverticulitis), but studies
have not been able to prove this idea yet.
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What can my doctor do for
me ?
The best method of treatment for diverticulosis is a high
fiber diet and that depends mainly on you, the patient. Sometimes, though,
this is not enough and a visit to the doctor’s office, or even hospital,
is needed. Painful diverticulosis can result when the intestines undergo
painful cramps or spasms. Usually Tylenol or aspirin will help with this
pain, but sometimes stronger pain medicines or even muscle relaxants for
the intestines are necessary (Donnotal, Dicyclomine, and Hyoscyamine, are
examples of intestinal muscle relaxants). Unfortunately, the stronger medicines
can also have increasing number of side effects like dry mouth, dry eyes
and rapid heartbeat. If diverticulitis develops then you may have to take
a course of antibiotics and decrease the amount of fiber in your diet until
the symptoms clear up. If the diverticulitis is severe enough then your
doctor may recommend hospitalization with bed rest and a liquid diet to
help "rest" your colon. If you continue to have frequent or severe attacks,
then surgery may be advised. This surgery may also be required if the diverticulum
bleeds persistently, if the inflamed diverticulum ruptures, if infection
spreads to surrounding organs in the abdomen or if excess scar tissue either
partially or completely blocks emptying of the colon.
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Where can I find more
information about diverticulosis ?
You can ask your family physician if you have specific questions
about diverticulosis or you can visit your local library for more information.
If you have access to a computer that can search the "Internet" then you
might try visiting one or more of the following sites:
Type http:// in front of any of the following electronic
addresses to reach that site.
Additional References
-
Bennett WG, Cerda JJ. Benefits of dietary fiber. Myth or
medicine? Postgraduate Medicine 1996;99(2):153-56.
-
Freeman SR, McNally PR. Diverticulitis. Medical Clinics
of North America 1993;77(5):1149-67.
-
Jones DJ. ABC of colorectal diseases. Diverticular disease.
BMJ
1992;304(6839):1435-7.
-
McIntyre PB, Pemberton JH. Pathophysiology of colonic motility
disorders. Surgical clinics of North America 1993;73(6):1225-43.
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