Weakening of muscle of the walls of the large intestine, allowing the formation of small stagnant pockets.

 

Causes of Diverticular disease

This appears to be a disease of the West, almost certainly caused by a lack of fibre in the diet. The theory is that high fibre leads to bulky, soft stools, which are expelled by the colon with little effort, whereas the small hard stools of a low-fibre diet require strong muscular effort for the same result.

The walls of the large intestine contain muscle which docs the propelling and churning of the faecal material, prior to defecation. Under pressure, the wall weakens and a pouch may form. It is more common in older people because the walls of the colon naturally weaken with age.

Most people over the age of 50 have a few of these pouches of just 1 cm/0.5 in diameter. In diverticulitis there are dozens if not hundreds. For much of the time these diverticular are asymptomatic. They are a potentially stagnant area – if faeces lodge in them it is only a matter of time before infection occurs, when symptoms and possible complications arise.

Symptoms of Diverticular disease

Few with diverticular disease have symptoms. Mild effects may be pains in the left lower abdomen of a colicky nature that come and go over a few hours, and there may be rectal bleeding. These symptoms are from mild irritation of diverticulae. If there is a serious infection, then there is much more pain plus fever. The lower left side of the abdomen is tender.

Considering how common the condition is complications are rare. One is peritonitis with very severe stomach pains and collapse. This only happens if one of the diverticular has burst (perforated), allowing faeces to spill into the abdomen, and is
a surgical emergency. The other complication is obstruction with colicky pains, vomiting and loss of bowel action.

A barium enema shows up the diverticular; symptoms should also be investigated by sigmoidoscopy and colonoscopy (see page 355) as this is the same age group risk as lor bowel cancer and the symptoms can be very similar.

Treatment of Diverticular disease

Mild attacks need only painkillers and an antibiotic. Once the diagnosis is established, doctors recommend a high-fibre diet and an antispasmodic such as mebeverine to relieve any occasional colicky pains. Usually nothing more is necessary. Only in patients with severe and persistent problems is it necessary to remove the diseased portion of colon – a colectomy.

In cases of sudden severe pain hospital admission may be necessary for intravenous antibiotics and to exclude obstruction or the dangerous complication of perforation and peritonitis, needing emergency surgery.

QUESTIONS

Diverticulitis/diverticular disease – what are they?

Diverticular disease means simply having multiple diverticular, hut without experiencing symptoms, the condition being discovered while investigating other abdominal symptoms such as rectal bleeding. Diverticulitis is inflammation of one of those diverticular, giving rise to symptoms as above.

What are the risks?

It is estimated that of the 50% of over 50s who have it, only 10% will get any symptoms at all and only 1% will run into serious complications requiring surgery or intensive treatment. Asymptomatic disease is best left alone.

Complementary Treatment

Diet – consult a nutritional therapist or naturopath. Useful acupuncture points are Stomach 25, on the abdomen, and Stomach 36, below the knee. Chinese herbalism remedies include Dang Shen and Bai Zhu. If the condition is accompanied by low back pain, chiropractic can help. Ayurveda – panchakarma detoxification, oil laxatives and enemas are used, often with oral medicines. Other therapies to try: chakra balancing; Western herbalism; homoeopathy.

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