Diverticulosis. What causes it?

What causes diverticulosis and what causes it has not been fully proven, but the prevailing theory attributes the cause of diverticulosis to a low-fiber diet. The condition was first observed in the USA at the beginning of the 20th century. At the same time, processed foods were introduced into the American diet. Many of these foods contain processed, low-fiber flour. Unlike whole wheat flour, processed flour has no bran.

Diverticulosis is common in developed or industrialized countries – especially in the USA, England and Australia – where low- fiber diets are common. The disease is rare in countries such as Asia and Africa, where people consume high- fiber diets containing vegetables.

Fiber is those components of fruits, vegetables and grains that the body cannot digest. Some fiber dissolve easily in water (soluble fiber) and in the gut they take on a soft gel-like texture. Other fiber pass through the intestines almost unchanged (insoluble fiber). However, both types of fiber soften the stool and facilitate its elimination. They also prevent constipation.

Constipation makes the muscles strain to move stools that are too hard. That is why it is the main cause of increased pressure on the colon. This excessive pressure can be the cause of weak spots in the colon that protrude and become diverticula.

Diverticulitis occurs when the diverticula become infected or irritated. Doctors are not sure of the cause of the infection. It can start when feces or bacteria become trapped in the diverticula. An episode of diverticulitis can occur suddenly and without warning.

What are the symptoms of diverticulitis?

Most people who have diverticulopathy do not experience discomfort or symptoms. Symptoms, however, may include mild cramping, bloating and constipation. Other conditions such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so these symptoms do not always indicate that a person has diverticulopathy. For this reason, it is recommended that you visit your doctor if you have bothersome symptoms.

The most common symptom of diverticulitis is abdominal pain, and the most common indication is tenderness around the left side of the lower abdominal area. If the cause is infection, symptoms such as fever, nausea, vomiting, chills and constipation may occur. The severity of symptoms depends on the extent of the infection and complications.

Are there any complications?
Diverticulitis can lead to complications such as infections, perforation, tears, blockage or bleeding. These complications always require treatment to prevent them from progressing and causing serious illness.

a) Bleeding
Bleeding from the Diverticula is a rare complication. When the Diverticula bleeds, blood may appear in your toilet or stool. The bleeding may be severe, but it may stop on its own and not need treatment. Doctors believe that bleeding diverticula are caused by a small blood vessel inside the diverticulum, which weakens and eventually breaks. If you are bleeding from the anus, it is recommended that you visit your doctor immediately. If the bleeding does not stop, surgery may be necessary.

b) Abscess, Perforation and Peritonitis
The infection caused by diverticulitis often recovers after a few days of treatment with antibiotics. If the condition worsens, an abscess forms in the colon.

The abscess is a pus-infected area that can cause swelling and destroy tissue. Sometimes, the infected abscess can develop small holes, called perforations. These perforations allow pus to leak out of the colon and then into the abdominal area. If the abscess is small and remains inside the colon, it can clear up after treatment with antibiotics. If the abscess does not clear with antibiotics, then the doctor may need to drain it.

To drain the abscess, the doctor uses a needle and a small tube called a catheter. The doctor inserts the needle through the skin and drains the fluid through the catheter. This procedure is called percutaneous drainage. Sometimes, however, surgery is needed to clear the abscess and, if necessary, remove part of the colon.

A large abscess can become a serious problem if the infection leaks out and infects other areas outside the colon. An infection that spreads into the abdominal cavity is called peritonitis. Peritonitis requires immediate surgery to clean out the abdominal cavity and remove part of the damaged colon. Without surgery, peritonitis can become fatal.

c) Fistula
A fistula is an abnormal tissue connection or abnormal communication between two organs or between an organ and the skin. When damaged tissues come in contact with each other during infection, they sometimes stick to each other. If they heal in this way, a fistula is formed. When the ectopic-associated infection spreads outside the colon, the colon tissue can stick to neighboring tissues. The organs usually involved are the bladder, small intestine and skin.

The most common type of fistula occurs between the bladder and the colon. It affects men more than women. This type of fistula can cause severe and prolonged infection in the urinary tract. The problem can be corrected by surgery to remove the fistula and the infected part of the colon

d) Intestinal Obstruction
Scarring caused by infection can cause partial or complete obstruction of the colon. When this occurs, the colon is unable to move the contents of the bowel normally. When the obstruction completely blocks the bowel, emergency surgery becomes necessary. Partial obstruction is not an emergency condition, so surgery can be scheduled.

How does the doctor diagnose diverticulosis?

To diagnose diverticulopathy, the doctor first takes a medical history, performs a physical-clinical examination and may do one or more diagnostic tests. Because most people do not show symptoms, Diverticulopathy is often detected through tests prescribed by the doctor for another disease.

During the medical history taking, the doctor may ask about your bowel habits, symptoms, pain, diet and medications. The physical examination usually includes a finger rectal examination. To perform this examination, the doctor, having worn gloves and lubricated his or her finger, inserts it into the rectum to detect tenderness, palpable tumor, obstruction or blood. The doctor may check the stool for signs of bleeding and examine the blood for signs of infection. He or she may also ask for further X-rays or other tests.