Diverticulitis is inflammation or infection of the diverticula, which are pouches that form along the digestive tract, especially in the large intestine (colon). Diverticula are not organs that are present from birth. Diverticula generally form in people aged 40 years and over, because the intestinal wall has weakened. This condition is also prone to occur in people who rarely eat fibrous foods, such as vegetables and fruit.
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| Diverticulitis, Causes, Diagnosis, Treatment, Prevention, Complications |
The formation of diverticula in the colon wall is called diverticulosis. This condition is generally harmless and in most cases does not cause symptoms.
Unlike diverticulosis, diverticulitis is usually accompanied by symptoms such as severe abdominal pain, nausea, fever, and changes in bowel habits. In some cases, diverticulitis can even cause serious complications.
Causes of Diverticulitis
The exact cause of the formation of diverticula sacs is not known. However, a low-fiber diet and constipation are thought to be associated with the formation of diverticula in the large intestine.
Because the reasons for the formation of diverticula are not clear, it is also not known what causes diverticulitis. However, this condition is thought to occur when faeces or food are not digested properly so that they get trapped in the diverticula and cause the diverticula to become blocked.
The blockage causes the diverticula to swell and causes small tears in the wall of the colon, allowing bacteria from the colon to enter the diverticula. This is what is thought to result in inflammation or infection of the diverticula.
Several factors that can increase a person's risk of developing diverticulitis are:
- Aging
- Diet low in fiber
- Use of certain drugs, such as aspirin and non-steroidal anti-inflammatory drugs
- Smoking habit
- Overweight or obesity
- Rarely exercise
Symptoms of Diverticulitis
The large intestine (colon) is a tube-shaped organ measuring about 1.8 meters that functions to absorb fluids and process food waste resulting from digestion in the small intestine.
When diverticula form in the colon wall, sufferers generally will not feel any symptoms. However, in certain cases, symptoms may occur in the form of:
- Abdominal pain that gets worse right after eating or when moving
- Constipation, diarrhea, or both
- Flatulence or stomach feels full of gas
- The stool contains blood
If the diverticula are already inflamed or infected, sufferers can experience symptoms of diverticulitis, such as:
- Abdominal pain that gets worse and continues
- Fever and chills
- Nausea and vomiting
- The stool contains blood and mucus
These symptoms can be different for each patient and can appear suddenly or gradually over several days.
When to see a doctor
Check with your doctor if you experience the symptoms above. The symptoms of both conditions can mimic those of other, more serious conditions. Therefore, it is advisable to get checked out as early as possible to confirm the diagnosis.
Diagnosis of Diverticulitis
First of all, the doctor will ask about your medical history, symptoms you are experiencing, habits of consuming certain foods, and types of medicines you are currently taking.
After that, the doctor will carry out a physical examination, especially by examining the patient's abdomen to detect the location of inflammation or infection in the abdominal cavity. The location of inflammation can be detected by the appearance of pain when the stomach is pressed.
The doctor will also do a digital rectal examination, to see if there is bleeding, pain, lumps, or other disturbances in the rectum. Furthermore, the doctor can carry out supporting examinations so that the diagnosis obtained is more accurate, such as:
- Blood test
Blood tests are done to detect infection or bleeding in the colon, and check liver function to find out if the abdominal pain is caused by a liver disorder.
- Urine test
A urine test is done to rule out the possibility of abdominal pain caused by an infection in the urinary tract.
- Pregnancy test
A pregnancy test is done to ensure that the abdominal pain experienced by female patients is not caused by pregnancy.
- Stool examination
Stool examination is done to check the content of blood in the stool. Doctors can also find out if symptoms are caused by other conditions, such as irritable bowel syndrome.
- CT scans
A CT scan is done to find out in detail which sacs are inflamed or infected and confirm the diagnosis. This test can also show the severity of diverticulitis.
Please note, the doctor will not do a colonoscopy if the diverticula is inflamed, because it risks causing the diverticula to tear or rupture. Colonoscopy is only done when the diverticula are not inflamed, or if the doctor suspects that there is cancer in the colon.
Diverticulitis Treatment
The treatment given by the doctor will be adjusted to the severity of the diverticulitis experienced by the patient. If the patient has mild symptoms and there are no signs of complications, the treatment given by the doctor may include:
- Drugs
Doctors can give painkillers, such as paracetamol. If needed, the doctor can also prescribe antibiotics to treat the infection.
- A high-fluid or low-fiber diet
This diet is done to reduce the intestinal workload for several days until the pain disappears. When the pain is gone, solid foods will slowly be added to the diet.
If the symptoms are getting worse or diverticulitis has caused complications, the patient needs to be hospitalized. Treatments that doctors can give include:
1. Infusion of fluids and nutrients
Nutrition and fluids will be given through an IV to rest the intestines.
2. Injectable antibiotics
To treat infections, doctors can give injectable antibiotics. Several types of antibiotics are often used to treat diverticulitis, namely metronidazole, ceftriaxone, cefotaxime, ciprofloxacin, or levofloxacine.
3. Installation of a tube into the stomach
Inserting a tube into the stomach (NGT) is done to empty the patient's stomach contents.
4. Drainage with a needle
If an abscess has formed in the diverticula, a special needle will be inserted into the abdomen with the help of a CT scan or endoscopy. The goal is to drain the pus (abscess) from within the diverticula.
5. Operation
Surgical procedures are performed by doctors on patients who have impaired immune systems, have recurrent diverticulitis, or have complications. There are two types of surgical procedures to treat diverticulitis, namely:
- Bowel resection and anastomosis
This procedure is done by removing the inflamed part of the intestine and reconnecting it with the healthy part of the intestine (anastomosis).
- Bowel resection with colostomy
If the area of inflammation is large enough, it will be difficult to connect the large intestine and rectum, so the doctor will perform a colostomy procedure. After removing the inflamed intestine, the doctor will make a hole (stoma) in the abdominal wall as a temporary disposal site for feces.
Diverticulitis complications
Diverticulitis can cause serious, life-threatening complications. Several types of complications that may arise are:
- Abscesses and phlegmon, which are collections of pus that form in the diverticula
- Fistula, which is an abnormal channel that forms between the large intestine and the bladder, vagina, or small intestine
- Intestinal obstruction, namely narrowing that occurs in the large intestine
- Intestinal perforation, namely leakage due to the formation of a hole in the wall of the large intestine
- Peritonitis, which is inflammation or infection within the abdominal cavity (peritoneum)
- Continued rectal bleeding due to rupture of the small blood vessels around the diverticula
Diverticulitis Prevention
Not yet known with certainty how to prevent diverticulitis completely. However, there are several efforts that can be made to reduce the risk of developing this condition, including:
- Eat high-fiber foods to make bowel movements easier and maintain colon health.
- Drink plenty of water to prevent constipation or constipation.
- Exercise regularly for 30 minutes each day to help maintain bowel function and reduce pressure in the colon.
- Avoid smoking habits, because it can increase the risk of developing diverticulitis and various other health problems.
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