Diverticulosis and diverticulitis: What are its causes and symptoms? + Treatment

Diverticulosis is a disease in which a bulge of the intestinal wall or other hollow organ or part of the intestine is present in the large intestine. This is called a diverticulum.

One or more diverticula can form in the intestine. They can develop in any part. However, it is most often in the large intestine and its left part, before the transition to the rectum, ie in the sigmoidal process.

The diverticulum is divided into:

• right diverticulum, which contains all the layers of the intestinal wall
• false or even a pseudodiverticulum that forms only some of the layers of the intestinal wall

The right diverticulum is rare. In most cases, it is false, ie pseudodiverticulum. Taking part of the wall of the large intestine arches through the weakened muscle layer.

Another designation for this disease is diverticular disease or diverticulosis of the colon, ie the large intestine. The disease has various stages. For example, the asymptomatic phase, ie asymptomatic. It is also referred to as uncomplicated asymptomatic diverticulosis.

Another example is complicated symptomatic diverticulosis. The first mentioned diverticulosis can in most cases be detected accidentally during an intestinal examination. Complications of diverticulosis can include a variety of conditions, such as:

• long-term abdominal pain, especially in the left mine quadrant
• bleeding
• acute diverticulitis
• emptying disorders
• increase in body temperature
• vomiting

The complication of diverticulosis, in this case, is acute left-sided diverticulitis. Uncomplicated diverticulitis is characterized by inflammation of the diverticulum when it is not perforated, ie ruptured. Complicated diverticulitis is accompanied by perforation, ie rupture of the intestinal wall.

An abscess or fistula ensues.

The abscess is a bounded inflammatory deposit. A fistula is a pathological connection of the intestine to another, adjacent organ, often establishing an association of the intestine with the bladder. With repeated inflammation, stenosis can occur, ie narrowing to obstruction, ie obstruction of the intestine.

People under the age of 30 are more likely to encounter diverticulosis. Its incidence after the age of 40 is about 10%, while in people over 60 years of age 50%. At the age of over 80, its incidence is close to 100 percent. And regardless of gender. The diverticulum can develop in the esophagus, stomach, or small intestine. Most often, however, in the large intestine and its sigmoid part.

Approximately 25% of cases of diverticulosis are reported to be complicated by acute diverticulitis.

Colon and its parts

The large intestine is technically referred to by the Latin name, and thus intestinal crissum or even colon. It continues from the small intestine and can be about 1.5 meters long. There is no production, ie the formation of new substances, in the mucosa of the large intestine. It serves mainly for re-absorption, ie absorption of water.

The width of the large intestine is in the range of approximately 4 - 8 cm.

Undigested food residues, bile pigments, exfoliated cells from the higher parts of the tract, but also water advance here from the small intestine. Subsequently, this content (chymus) is affected by intestinal fermenting and putrefactive bacteria. It further decomposes until it turns into feces.

This process produces intestinal gases such as methane, carbon dioxide, ammonia, and, for example, phenol.

The table shows the parts of the colon as they progress

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The diverticulum is a hollow in the wall of the intestine. While the most commonly arches accordingly part of the intestinal wall, and through the weakened muscle. This happens especially in the S-shaped handle. Why these bulges are formed is not fully understood.

The main cause is thought to be a weakened intestinal layer and increased pressure in it. This includes, for example, the area of ​​entry of blood vessels through the intestinal wall, but also the space between the muscle bundles. Risk factors for diverticula include:

• increased pressure in the intestine due to strenuous stools or constipation
• weakening of the intestinal wall, especially its muscle layer
• older age, over 40 years
• lack of fiber in the diet, and thus difficult bowel movements

Diverticulosis often, in 25 percent, rolls into acute diverticulitis. This is the inflammation of the arch. This can take place uncomplicated as long as the intestinal wall is not damaged. However, in a more severe case, it is complicated diverticulitis.

It is characterized by perforation (breach) of the intestinal wall.

In addition to perforation of the intestine, an abscess or fistula may occur. Stenosis (narrowing) to obstruction (obstruction) of the intestine is the result of recurrent inflammation. The cause of the inflammatory complication is not exactly clear. In the first place, it is explained as an interplay:

1. abnormal intestinal wall
2. reduced motility, ie bowel motility
3. increased intestinal pressure
4. disturbance of the intestinal microflora 

The development of diverticulosis and diverticulitis is further influenced by:

• lifestyle, lack of exercise
• smoking
• alcohol
• obesity
• baby
• drugs such as corticoids, chemotherapeutics, non-steroidal anti-inflammatory drugs

In developed countries, the higher incidence of diverticulosis is mainly attributed to incorrect dietary composition. While it contains less vegetables, fruits, cereals, and more meat. So a low fiber content. As a result, constipation occurs, but also difficult and difficult bowel movements.

Diverticulosis is asymptomatic in most cases. And so he has no manifestations. This is referred to as uncomplicated asymptomatic diverticulosis. 

However, approximately 25% of cases progress to complicated symptomatic diverticulosis.

The complication is acute left-sided diverticulitis. It is further divided into uncomplicated and complicated. And there are other symptoms accordingly. When uncomplicated, inflammation of one or more diverticula occurs.

And the intestinal wall is not damaged.

The complicated form is characterized by disruption, i.e. perforation of the intestinal wall. In another case, an abscess or fistula occurs. After healing and clearing, there are also recurrent inflammations that can cause narrowing (stenosis) or even intestinal obstruction.

This results in an acute abdominal event.

Among the symptoms are classified:

• feeling stiff belly
• cramping abdominal pain, especially in the lower left, may radiate to the groin or back
• aggravation of pain when moving
• increased sensitivity during palpation
• emptying disorder, which can cause constipation or even diarrhea
• feeling fullness
• flatulence
• increase in body temperature, shivering and therefore chills
• vomiting
• bleeding, and finding fresh blood in the stool, is called enterorrhea
• difficulties are significantly worsened when the diverticulum ruptures and the contents of the intestine are emptied into the abdominal cavity
• risk of peritonitis - a threat to human health and life
  • severe abdominal pain
  • hard, plate-like abdomen
  • gas exit stop
  • cold sweat
  • fever
  • accelerated heart and  respiratory rate
  • reduction of blood pressure and development of shock
  • risk of death

The incidence of diverticulitis is reported to be from 10 to 30 percent of diverticulosis cases . Very often a fistula is found, ie a pathological connection of the intestine with another organ. And in 4 - 20% of cases. The wall of the intestine into the adjacent organ is broken, most often into the bladder.

65% of the fistulas are between the intestine and the bladder
25% are the connection of the intestine with the vagina
3% with the uterus
and rare, and thus about 1% represent the fistula of the intestine with the skin

Diagnosis depends on the symptoms present. Due to the fact that diverticulosis is asymptomatic, its diagnosis is usually random during the intestinal examination. In the case of acute diverticulitis, the diagnosis relies on the clinical picture, physical examination, and also a history.

Subsequently, laboratory blood tests are also performed. The level of white blood cells and also CRP increases. The serum CRP level is higher than 50 mg/liter. Among imaging methods is classified as ultrasound, CT, or MRI. Colonoscopy is not recommended in the acute phase of diverticulitis, especially due to the risk of complications.

Of course, the occurrence of symptoms and the severity of the problem are influenced by the occurrence of complications. It is important to rule out other inflammatory bowel diseases that may have similar symptoms. In any case, professional examination and early diagnosis of diverticulitis are very important.

The presence of a diverticulum need not be externally proven. In case of complication, there is a feeling of hardening to abdominal pain. From the beginning, there is also a feeling of fullness and flatulence.

The most common locality for the occurrence of diverticula is the sigmoid loop of the large intestine, which is located in the lower-left quadrant of the abdomen. And from that also the area where there is pain or irritation to the touch.

The pain is convulsive, intense. Her movement makes it worse. Difficulties are accompanied by an emptying disorder, in the form of constipation or diarrhea. Difficulties in diverticulitis also depend on its extent. Pain and other symptoms increase with the rupture of the diverticulum. Subsequently, peritonitis and an acute abdominal event may occur.

Alternatively, an abscess is formed, which is a bounded inflammatory deposit that may be palpable on the outside. Another type of complication is the pathological connection of adjacent organs with the intestine.

This in turn results in associated complications. Bleeding into the intestines also occurs in this disease. This is characterized by the presence of fresh blood in the stool.

In case of frequent recurrences, recurrences, inflammations, narrowing of the intestine to its obstruction may occur. Of course, if the difficulties persist, seeking professional help and timely treatment is extremely important.

What is recommended for diverticulosis?

Prevention of difficulties, as well as recurrent inflammation, is also important in this disease. The change is a change in lifestyle, physical activity, and a change in eating habits, of course, with a change in the content of the menu.

Recommendations for diverticulosis in a clear table