Diverticula are dilatations (like small pouches) that form in the wall of any area of the digestive tract. The most frequent are located in the colon (large intestine) and preferentially in the descending colon and sigma.
What is the importance of colonic diverticula?
Although in most cases, people who have diverticula do not feel sick, sometimes these diverticula cause abdominal pain and altered bowel movements. In this case we speak of diverticular disease of the colon.
What are the reasons why diverticula can cause disease?
To explain it we have to imagine what a diverticulum is, a small pouch in the wall of the colon that communicates with the intestinal lumen. As you will understand, feces can be retained in these pouches and produce a bacterial overgrowth, which would be the first step in the infection of a segment of the intestinal wall. We call this infection diverticulitis.
What are the symptoms like?
The symptoms depend on the degree of existing complication. Basically we can say that there are four stages of colon diverticula:
- Asymptomatic diverticula (silent) up to 80% of diverticula carriers never have symptoms or become complicated.
- Symptomatic diverticular disease. No infection but diarrhea, or constipation or both alternatively, with sensation of incomplete evacuations and also pain of spasmodic type (that comes and goes) like cramps.
- Acute or subacute diverticulitis. Infection of one or more diverticula (as if a phlegmon formed). This produces continuous pain, usually in the lower abdomen, more to the left. The pain increases with the patient’s movements. There may be fever and loss of appetite. In these cases, the physician should be notified urgently.
- There is a fourth stage that can develop after an acute episode of diverticulitis, which is segmental colitis. Part of the colon wall becomes thickened, with chronic inflammation and discomfort, not as acute as in acute diverticulitis but more persistent.
Is acute diverticulitis serious?
It can be. As we have said, it is an infection of the intestinal wall. The body, in response, forms a phlegmon or abscess (pocket of pus). This abscess, without diagnosis and treatment can spread and cause peritonitis, or a perforation of the colon wall looking for an exit to a neighboring intestine, to the urine bladder or to the abdominal wall itself. More or less intense bleeding from the anus may also occur.
How is acute diverticulitis diagnosed?
The main thing is clinical suspicion and physical examination. Blood tests, abdominal CT scan and colonoscopy (especially after a crisis) are the most common diagnostic tools.
Diverticular disease can be prevented
Once diagnosed, advice can be given to avoid complications. This advice is along the lines of a diet rich in fiber. A model diet would be the Mediterranean diet.
However, once they have formed, diverticula do not disappear. They are an alteration of the structure of the wall that remains.
Why do diverticula form?
There are some known reasons:
- The colon wall has areas of low resistance to pressure where small nutrient vessels pass through it. Diverticula can form at these points.
- Diets low in residual non-digestible fiber (typical of Western societies) favor slow intestinal transit and increased intraluminal pressure.
- Advanced age, sedentary lifestyle, and obesity are favoring factors.