Anorectal disorders occur at the junction of the anal canal and the rectum. Often times treatment is available in an office setting, but occasionally require more complex treatments.
Learn what diverticulum are, what the symptoms are, your surgical options and more.
What is Diverticulitis?
Diverticulosis is the medical name for the presence of diverticulum. Diverticulum are small pouches that form in the wall of the colon (the large intestine) in areas where blood vessels go through the colon wall. The cause for development of these is not well understood, but may be related to relatively low amount of fiber in one's diet. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon. There also seems to be a genetic component (meaning it can run in families).
When the diverticulum are present but not causing problems, this is called Diverticulosis. This is often found with a test done for other reasons, such as flexible sigmoidoscopy, colonoscopy, or barium enema. Many people with diverticulosis have no symptoms and will remain symptom free for the rest of their lives.
Diverticular disease is a common problem that affects men and women equally. The risk of disease increases with age. It occurs throughout the world but is seen more commonly in developed countries.
Reproduced with permission from: Young-Fadok T, Pemberton JH. Patient Information: Diverticular Disease (Beyond the Basics). In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA 2012. Copyright © 2012 UpToDate, Inc. For more information visit www.uptodate.com.
Diverticulitis happens when the diverticulum become inflammed. Particles of stool or undigested food can become stuck in the pouch; this creates inflammtion and infection in the wall of the colon due to the bacteria that lives in the colon normally. This causes increased pressure in the diverticulum, and in severe cases can cause the diverticulum to rupture, spilling stool and bacteria outside the colon, which could cause a severe wide spread infection throughout the abdomen.
Symptoms of Diverticulitis
The symptoms of diverticulitis depend upon the degree of inflammation and infection present. Symptoms can include:
- Abdominal pain, many times in the lower abdomen, more often on the left side, but can be present on the right side as well
- Fever and chills
- Diarrhea or constipation, can have blood or mucous in the stool
- Nausea with decreased appetite, sometimes with vomiting
- Blood from the rectum
- Pain in the pelvis area with urination (this is due to inflammation around your bladder, as the colon can sit very close to the bladder on the inside)
You should seek medical attention if you have any of these symptoms. Diverticulitis can progress into a severe, wide-spread infection if left untreated.
Testing for Diverticulitis
The doctor will assess your symptoms and do an examination of your abdomen, as well as the rest of your body. You will need tests to determine if you have diverticulitis, or if your symptoms are related to other conditions.
- Blood tests to look for signs of infection or inflammtion, evaluate your kidney and liver functions
- Urine test to look for infection in the urinary tract
- Most likely you will need a CT scan; this is the best test to create an image of the organs inside the abdomen, to look for diverticulitis, as well as complications from the diverticulitis, as well as other disease processes that may cause similar symptoms.
Complications Associated with Diverticulitis
Simple diverticulitis, meaning without any of the following complications, accounts for 75 percent of cases. These cases can generally be treated at home with antibiotics, and do not generally require hospitalization.
Complicated diverticulitis is a more severe form of diverticulitis and generally occurs in about 25 percent of cases. In most cases, they will require hospitalization and surgery. Complications associated with diverticulitis can include the following:
- Recurrence — After a person has one episode of diverticulitis, even if it is uncomplicated, they are at higher risk of having recurrent episodes, which can become more severe. About 1/3 of patients that have one episode of diverticulitis will have future episode(s).
- Abscess — an abscess is a localized collection of pus adjacent to the inflamed colon. This is usually caused by a “microperforation” which is a very small hole in the diverticulum which allows bacteria to escape from the colon into the abdomen. The body is able to contain the infection to a small area by “walling off” the infection and forming an abscess.
- Fistula — an abnormal tract between two areas that are not normally connected (eg, a hole is formed between the colon and the bladder or between the colon and another part of the intestines) due to inflammation of surrounding tissues and organs.
- Obstruction — a blockage of the colon due to the wall of the colon being inflamed and thickened so that the stool is not able to pass through normally.
- Peritonitis — wide spread infection of the abdominal cavity and the space around the abdominal organ caused by a larger hole in the colon, in which the body is not able to contain the infection (such as with an abscess).
- Sepsis — overwhelming body-wide infection that can lead to failure of multiple organs.
- Diverticular bleeding — Diverticular bleeding occurs when a small artery located within the diverticulum breaks through the colon lining into the colon. This can happen with diverticulosis and diverticulitis. Diverticular bleeding usually causes painless bleeding from the rectum. In about 50 percent of cases, the person will see maroon or bright red blood with bowel movements. Bleeding with bowel movements is not normal and you should seek medical attention if you notice this. Most cases of diverticular bleeding resolve on their own. However, some people will need further testing or treatment to stop bleeding, which may include a colonoscopy, angiography (a treatment that blocks off the bleeding artery), or surgery.
Treatment of Diverticulitis
Treatment of Diverticulitis depends upon how severe your symptoms and disease are. People with diverticulosis who do not have symptoms do not require treatment.
- Increase fiber to add bulk to the stool — Fruits and vegetables are a good source of fiber. The fiber content of packaged foods can be calculated by reading the nutrition label. You can also take fiber supplements such as Metamucil, Citrucel, or Benefiber or other over-the-counter fiber supplements. Fiber can help to bulk the stools and possibly prevent the development of new diverticula, diverticulitis, or diverticular bleeding. However, fiber is not proven to prevent these conditions or get rid of diverticuli that are already present.
- Seeds and nuts — Patients with diverticular disease have historically been advised to avoid whole pieces of fiber (such as seeds, corn, and nuts) because of concern that these foods could cause an episode of diverticulitis. However, this belief is completely unproven. We do not suggest that patients with diverticulosis avoid seeds, corn, or nuts.