Diverticulosis and diverticulitis:causes,symptoms,treatment

Diverticulosis and diverticulitis:causes,symptoms,treatment 1
Diverticulosis and diverticulitis are two intestinal diseases, mostly affecting the colon , very common especially in Western countries. The risk factors are many, including age and genetics, but a diet too full of animal fats and proteins, in particular meat, obesity and a life that is too sedentary, also play a decisive role.
If diverticulosis is often asymptomatic, diverticulitis is usually accompanied by disorders such as pain, constipation or diarrhea, nausea and vomiting.

Diverticulitis and diverticulosis: what they are and what is the difference

The diverticulitis is a condition of inflammation and / or infection that affects the diverticula , or protrusions, small sacs that make their way through the intestinal wall outward.
By diverticulosis, we mean intestinal disease (usually affecting the sigmoid colon to the left – in western countries) in which the increase in intra-luminal pressure leads to the appearance of diverticula. The term “diverticulosis” refers to the simple presence of diverticula .
Normally, only the innermost part of the intestinal wall (mucosa and submucosa) tends to prolapse through points of greater weakness of the muscular habit, therefore in the majority of cases we find ourselves in front of “false” diverticula. The “true” diverticula, where the musculature and the external serosa prolaps, are much more rare and usually congenital. Usually the points of weakness are those in which the blood vessels penetrate the muscular layer, thus creating natural holes between the muscle fibers. This condition, associated with chronically increased pressure in the intestinal lumen (as happens in cases of chronic constipation), causes the formation of diverticula.
In summary:
the diverticulosis is a condition characterized by the presence of diverticula ;

the diverticulitis is the condition in which these diverticula become inflamed and / or infected .
Historically, the difference between the two conditions is that there are no symptoms in the first one. Today in reality this dogma begins to be questioned, as we will see later.

Diverticulosis and diverticulitis: causes and risk factors

The chronic constipation and weakness of the connective tissue related to age are the main factors that lead to ‘ “herniationof the intestinal mucosa through the muscle vascular deficiencies, ie to the formation diverticula (diverticulosis).
All conditions that, like constipation, cause an increase in pressure in the intestinal lumen (for example, obesity) or that, like aging, cause a weakening of the intestinal tissues (connective diseases), can lead to training of diverticula.
The risk factors for diverticulosis , therefore, are:
 the increase in age (about 50% of people over the age of 70 have diverticulosis)

 chronic constipation

 genetic factors


 lack of exercise


diet rich in fat and red meat, low in fiber (the role of fibers is, as we will explain later, much debated).

These are risk factors that predispose to the formation of diverticula , but some of them also play a role in the inflammation of the diverticulis (diverticulitis).
About 20% of people with diverticulosis develop diverticulitis. Why?
Certainly the stagnation of feces and food in the diverticula, with compression of the blood vessels, causes the intestinal bacteria that cause inflammation to overproduce . So everything that leads to stool stool can be considered a risk factor for the development of an attack of acute diverticulitis: constipation , the habit of drinking little and eating very fatty foods and little fruit / vegetables . There is much debate about the role of fibers, which are important for counteracting constipation, but in some cases they irritate the colon causing the opposite effect to the desired one. Obviously the presence of many large diverticula increases the risk that I stagnated.

Diverticulosis and diverticulitis:causes,symptoms,treatment 2


The diverticulosis, as already mentioned, it is usually asymptomatic . In some cases there may be pain in the lower left abdomen and other non-specific abdominal disorders.
About 20% of patients develop symptoms (source: Sice – Italian Society of Endoscopic Surgery and New Technologies). In the presence of abdominal symptoms such as pain and meteorism, in the absence of other pathological conditions, we speak of  Symptomatic Uncomplicated Diverticular Disease (SUDD), an entity halfway between diverticulosis without symptoms and acute diverticulitis .
Clinically, diverticulosis is often noted only through the bleeding or inflammation of diverticula, or in the case of diverticulitis . Patients with this disease typically suffer from progressive abdominal pain (it can get to the acute abdomen), sometimes accompanied by feverish temperatures and changes in stool such as constipation or diarrhea, nausea, vomiting and flatulence . The diverticula can also bleed , resulting in visible anal bleeding and / or anemia.

Complications of diverticulitis

The most frequent manifestation (from 75 to 80% of cases) of diverticulitis is uncomplicated. Diverticulitis is rather complicated when it is associated, in fact, with a series of complications.
About 5% of patients with diverticula have blood loss . This can lead to a sharp drop in hemoglobin and therefore of anemia
A feared complication of diverticulitis is perforation . A perforation free with air or intestinal contents that escapes in the abdomen is an indication for an emergency surgical intervention.
Other possible complications include fistulas (an abnormal connection that connects two hollow organs or a hollow organ with the outside). These usually run from the colon to the bladder and often cause recurrent urinary tract infections. However, fistulas with the skin (between the colon and skin of the abdomen) or between the colon and vagina are also possible.
The inflammatory processes can also lead to stenosis (narrowing) of the intestine with the risk of a subsequent ileus (that is, of the temporary arrest of intestinal peristalsis, with nausea, vomiting, abdominal discomfort and difficulty in evacuation).
Among the other complications there is also the abscess , or a collection of pus embanked by an inflammatory “wall”: in this case, the pus collects in the peridiverticular tissue, where there is an inflammation of the diverticulum (diverticulitis) .

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Diverticulosis and diverticulitis: diagnosis

Diverticulosis is often diagnosed by chance during a colonoscopy for the prevention of colorectal cancer or during a CT abdomen , which allows the evaluation of all abdominal organs and the detection of abnormalities of the small intestine and colon.

In the case of diverticular bleeding, a colonoscopy may be indicated to look for the source of the bleeding and exclude a malignoma. In the event that colonoscopy cannot be performed, interventional radiology techniques are used.

In case of clinical suspicion of diverticulitis, a blood test for general inflammatory parameters is useful. Imaging is important. The method of choice if diverticulitis of the descending colon / sigma is suspected is ultrasound . In this case the direct detection of inflamed diverticula with a thickening of the intestinal wall greater than 5 mm is often effective. Furthermore, it is possible to detect free fluid in the abdomen as a sign of an inflammatory reaction.

In heavily overweight patients, CT is often more effective than ultrasound. The patient is given the contrast medium orally, anal and intravenously to determine the exact position of the diverticulitis.

Due to the high risk of perforation, a colonoscopy should be avoided in urgency and should only be performed after the end of inflammation to rule out complications such as stenosis or malignant tumors.

Cure: the right diet

There is no possibility of therapy for the regression of diverticula . It is advisable to reduce the consumption of fatty foods and red meats to prevent the appearance and slow down the progression of diverticulosis .

The evidence, especially regarding the recommendation to follow a diet rich in fiber , is not clear. The fibers seem important in counteracting chronic constipation (as well as taking plenty of fluids and making regular meals), so to prevent diverticulosis and avert the risk that it develops in diverticulitis, but if taken in large quantities when diverticula are already present they can cause discomfort . There is no evidence to show that avoiding taking food with seeds or nuts leads to a benefit. It is therefore possible to eat foods such as tomatoes and kiwi, without removing the seeds.

These recommendations apply especially in the case of diverticulosis with “silent” symptoms, or almost, but they also apply to cases of uncomplicated acute diverticulitis: in this case the diet will vary from patient to patient, based on the intensity of the acute attack and to the foods that cause the most symptoms (for example, too many fibers can irritate the colon even more, so they are often excluded from the diet). Each patient should then individually discuss their dietary plan with the gastroenterologist based on their own discomfort.

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In the case of complicated diverticulitis , strict fasting is recommended instead .

The most effective drugs for the treatment of diverticulitis

In the case of diverticulosis without symptoms, it is not necessary to take drugs . Instead it is important to follow a diet rich in fiber to prevent the appearance of disorders.

In the case of diverticulosis with vaghi symptoms (swelling, abdominal discomfort, sometimes true pain) it is useful to follow a diet rich in fiber, to be associated with probiotics and anti-inflammatories (eg Mesalazine), in some cases with antibiotics.

The use of antibiotics in case of diverticular disease with symptoms or after one or more acute episodes will have to be personalized , usually with effective intestinal drugs (eg Rifaximin) administered in cycles, followed by probiotics to restore the blood balance of bacterial flora.

The complicated diverticulitis is treated in hospital : is scheduled fasting, associated with administration of liquid for vein.

The diverticulitis uncomplicated can also be managed at home: in case of acute attack without fact, complications are not required hospitalization and antibiotic use, but you can discuss home treatment, except in elderly patients with major diseases or .

Natural remedies

Along with probiotics, which are eventually prescribed in combination with antibiotic cycles to restore the bacterial flora, there are natural remedies that can be taken, on the advice of the herbalist, to alleviate the symptoms of diverticulitis. The herbalist , recommends 3 of them.

Vaccinium Vitis Idaea (cranberry) bud-derived . The glycerine macerate has an anti-inflammatory, antispastic action and relaxes the intestinal muscles. Indicated in irritable bowel syndrome, meteorism, dysbiosis, diverticulitis. How to use: 50 drops in a little water 2 times a day before the main meals for 2 months.

Mallow flowers and leaves . Mallow has emollient and calming properties, especially to relieve inflammation of intestinal mucosa. The flowers and in particular the leaves of the mallow are rich in mucilage able to ignite the colon and gently purify the intestine. How to use: bring about 200 ml of water to the boil, add a spoonful of mallow, prolonging boiling for a few moments. Turn off and leave to infuse for 15/20 minutes (stirring occasionally), strain and drink 1 to 3 cups a day, preferably between meals.

Lemon balm leaves in herbal tea . Lemon balm leaves contain essential oil, mucilage, useful tannins against painful spasms and help eliminate gas accumulations in the digestive tract. How to use: bring about 200 ml of water to the boil, pour a tablespoon full of lemon balm, turn off and leave to infuse (stirring occasionally). Strain and drink 1 to 3 cups a day.

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When is surgery necessary and what does it consist of?

Surgery is usually only necessary in case of complications, such as perforation, stenosis, fistulae . It almost always intervenes in an emergency condition and almost never in prophylaxis. The intervention consists of a resection of the colonic tract involved with anastomosis (which consists in attacking the two stumps). Often for small abscesses without perforation, drainage and antibiotics are enough.

How to prevent diverticulosis and diverticulitis

As mentioned above, nutrition plays an essential role in preventing the onset and progression of diverticulosis. It is important, in particular, to reduce the consumption of fatty foods and red meats .

Even following a diet rich in fiber helps to combat constipation and thus prevent diverticulosis, as well as always ensuring the right hydration , either by drinking at least 1.5 / 2 liters of water a day, or by bringing food to the table. If diverticulosis is already present, the fibers are still important for preventing constipation and the development of diverticulitis. But be careful, in some cases too many fibers can also cause the opposite effect and give symptoms.

Regarding diverticulitis , recent studies have identified a direct link between consumption of red meat and the incidence of the disease , so it is advisable to limit the intake of meat, especially if you are at risk.

An abundant consumption of fruit and vegetables helps to reduce the risk of diverticulitis.

It is also important to have an active life to combat overweight and obesity, risk factors for the appearance of diverticolos : it is useful to practice sport consistently or, if this is not possible, to try to stay active, taking a brisk half-hour walk every day or using the stairs instead of the elevator.

Article written in collaboration with specialist medical personnel

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