Diverticula

Diverticula are a pea- to cherry-sized protrusions of the intestinal mucosa acquired during life. They are formed by holes in the muscles of the intestinal wall. They can thus protrude from the lumen of the intestine into the abdominal cavity. Mainly the left colon area is affected.

Men and women are affected at roughly equal rates. Many older people have such diverticula, but most people with this disorder have no complaints. Thus in persons under 40 years only 10% are found to have diverticula, in those over 70 years more than 40%. About 80% of all persons with diverticula stay free of noticeable symptoms.

As long as the diverticula are not inflamed, the affected persons often do not even notice that they have diverticula.

Symptoms occur only when the diverticula become inflamed. This is then called diverticulitis or diverticulosis.

In the course of diverticulitis also fistulas may form, for example to other intestinal parts, to the bladder or the vagina.

Causes

The precise genesis of the disease is still not understood. Low-fibre and low-roughage diet, increased pressures in the intestines (such as in constipation) and age-related changes in the intestinal wall are considered as causes of the formation of diverticula.

Since this occurs much more frequently in countries with so-called "high standards of living", one can indeed speak of a lifestyle disease. In countries with a high fibre content of the diet, diverticulosis is rare. The following factors may favour the occurren:

  • Connective tissue weakness
  • Chronic constipation
  • Overweight
  • Age
  • Genetic factors
  • Low-fibre diet

Symptoms

Diverticular disease is typically characterized by the following symptoms:

  • Diarrhoea or constipation
  • Fever and a palpable induration ("roll") in the left lower abdomen
  • Bloating, intestinal bleeding or excretion of mucus
  • Abdominal pain in the left lower abdomen subsiding upon defecation
  • Rarely: Intestinal stenosis, intestinal obstruction and as a serious complication intestinal wall perforations
  • In very extreme cases, the bowels empty into the abdominal cavity and trigger a strong peritonitis. This is an extremely dangerous, potentially life-threatening situation.

Therapy

olonoscopy, x-ray imaging with contrast medium and computed tomography allow diverticula to be identified.

The acute inflammatory episode can be treated by fasting, infusion therapy and antibiotics. After the acute inflammation has subsided, slow re-accommodation of food intake and later high-fibre diet follow. In case of recurring bouts of diverticulitis, surgical treatment is indicated.

Today a temporary colostomy is only very rarely required if surgery is performed in due time.

If there are no complications, the patient may be discharged as early as ten days after surgery.

If diverticula are known, the following measures should be considered:

  • Diet rich in roughage: Whole grains, salads, fruits, vegetables
  • Drinking sufficient quantities (1.5 – 2.5 litres of liquid per day)
  • In addition, wheat bran or flaxseed can also be used.
  • Tea, cocoa and red wine are to be eschewed, since they have constipating effects, whereas table water, juices, and coffee stimulate the intestine
  • For minor complaints, damp heat on the stomach, associated with antispasmodic medication, can help
  • Painkillers are rather to be avoided since they prevent noting a possible aggravation of symptoms