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Diverticulitis: Symptoms, Causes, Diagnosis and More

Written by Resurchify | Updated on: February 13, 2023

Diverticulitis: Symptoms, Causes, Diagnosis and More

Let us read about Diverticulitis, its causes, symptoms and treatment options.

Before we understand diverticulitis, let's look at the anatomy of the colon. 

Anatomy Of The Colon

The colon is the large intestine. It is the last part of the digestive system. Here the water and electrolytes are absorbed from the waste that is to be excreted from the body. It is around 5 feet in length. It is arched and surrounds the small intestine. It is attached to the end of the small intestine with assistance from a small structure called the cecum. It is divided anatomically into four parts. These are as follows: 

Ascending Colon

It begins from the cecum and moves upward, and thus, is called ascending colon. It makes a tune when it hits the lower lobe of the liver. This turn is called the right colic flexure (or hepatic flexure). 

Transverse Colon

It is a horizontal part of the intestine. It goes from the right side of the abdomen to the left side. It takes a turn when it is near the diaphragm end on the left end. There it turns in a downward direction. The left turn is called left colic flexure (or splenic flexure). 

Descending Colon

From the left colic flexure, the intestine moves in a downward direction. It is the descending colon. Towards the lower left side of the abdomen, the intestine turns a little toward the medial line of the body. 

Sigmoid Colon

The sigmoid colon is the second last passage point for the waste. It is 40 cm long and in an S shape. It meets the rectum, where all the waste is stored before it is excreted from the anus. Most diverticulitis cases are seen in the sigmoid colon. Yet, in Asian and African countries, diverticulitis is seen in the ascending colon.

Why Is The Function Of A Colon Important?

The digestion of the food finishes in the small intestine. The majority of the absorption of nutrients from food happens in the small intestine. After it, the waste is pushed forward to the large intestine through the cecum.  

The feces still has a lot of water and electrolytes that are not absorbed by the small intestine. These are essential for the body. Thus the tiny projections present in the walls of the large intestine absorb the excess water from the waste. Thus when the feces reaches the end of the large intestine, all the required things are absorbed from it. All that remains is waste that is toxic to the body. It is excreted out of the body through the anus. 

Thus, maintaining healthy and hydrated body function of the colon is crucial. 

Diverticulitis

It is one of the diverticular diseases. It is an infection and inflammation caused to the diverticula on the walls of the intestine.

What Are Diverticula?

Diverticula are when the part of the wall of the colon deforms in the shape of punches on the outer side. These pouches can form in anyone's body, it might not even be noticeable. These diverticula are more common as you age. Let's understand some terms here.

Diverticulum: it is the signal unit of the pouch. That one pouch is known as a diverticulum.

Diverticula: a group of pouches on the colon walls is called diverticula. It is a common situation among old aged people. It is not that harmful unless it gets inflated or catches an infection. Sometimes it can also cause blooded stool. The expert should be consulted when facing this condition. 

Diverticulosis: This situation is where there are more than just a few pouches present in the wall of the colon. It can be a severe condition as it leads to more chances of you getting the diverticular disease.

Diverticular Disease

These are diseases caused in the colon walls due to the presence of the diverticulum or diverticula. There are three diverticular diseases. These three diseases are as mentioned below: 

Diverticulosis

It is when there is the formation of many pouches on the colon wall. The size of this pouch may vary. The wall affected by these pouches keeps getting weaker. It can be because it is performing bowel movements, which puts strain on it. This friction and strain on the walls can make the situation worse. 

Diverticulitis

It is inflammation and infection in the diverticula. This infection is caused when the diverticula are blocked by waste that gets stuck in it. It causes inflammation and even bacterial infection here. It can cause chronic pain in the affected part and problems in bowel movements. 

Diverticular Bleeding

As the walls of the intestine form the pouches, the blood capillaries in the wall are strained. It can cause the bursting of the capillaries. It leads to the presence of blood in the stool. It is also known as 'western diseases. It is because it is diagnosed more in European and North American countries compared to African and Asian countries. 

The exact cause of these diseases is still not clear. But it is said to be because of a low-fiber diet and genetics. If you see any of these symptoms, consult the doctor to get them diagnosed. 

Causes of Diverticulitis

The stool gets stuck into the diverticula of the intestinal walls. It blocks the pouch, and bacteria grow a lot and cause infection. It leads to inflammation of the diverticula. 

Symptoms

The symptoms one may experience when they have diverticulitis are as follows:

Unreasonable Pain

There is pain in your lower left side of the abdomen. It could be mild or severe, depending on your condition. This pain is more when you eat or sometime after you eat. It is because of the strain and friction experienced by the affected diverticula. It subsidizes a little once you pass the waste. 

You may feel slight pain throughout the day as it gets friction due to your movement. The inflammation is also responsible for the pain. 

Fever

It is a very general symptom when you have got inflammation in any part of the body. It can be a mild or severe fever, depending upon the condition of the patient. 

Nausea

One might experience nausea and vomiting without any reason. It can be one of the symptoms of the disease. 

Diarrhea

It could be because of a problem with the movement of the walls of the colon. It leads to improper digestion and absorption of food. As the bowel moment are affected, it can lead to severe diarrhea. Severe cases can cause damage to the patient. 

Tiredness

Inflammation and infection weaken the body, and thus one might experience tiredness often.

Risk Factors

There are certain rik factors that may make you more prone to be affected with diverticulitis. They are as mentioned below:

Age

As we age, our intestinal walls become weaker. It can cause pouches to form on the walls, which increases the chances of getting diverticulitis. We have no control over this as this is a natural irreversible condition.

Low Fiber Intake

Fiber feeds our intestinal walls, especially the large intestine. It facilitates the movement of walls to push the food/water forward. If you have low fiber intake, the pressure on the walls to push increases. It also gets weaker as they depend on fiber for cell energy. Due to all this, these pouches can form. The more pouches, the more chances you get diverticulitis.

Fluid Intake

Fluid is essential in the body. It ensures that the various function of the body is running smoothly. Low fluid intake leads to less water in the waste. It will lead to the hardening of the feces. It puts pressure on walls to push the hard waste forward. As there is low water, the cells may also get affected.

All these factors can worsen the diverticula, leading to infection in inflammation.

Smoking

Cigarettes have many harmful chemicals. One of them is nicotine. Nicotine affects the contraction of the intestinal walls. It leads to the slow movement of waste and affects the diverticula. It increases the chances of you getting diverticulitis.

When You Have Diverticulosis?

The more diverticula in the intestinal walls, the higher your chances of diverticulitis. The chance of substances getting stuck in the diverticula is high. It also increases the chances of bleeding as waste passes through the intestine.

Overweight

High body mass index is found to be affecting the working of the intestinal walls. It puts pressure on them that could be risky in long run.

No Exercising

Exercise helps you relieve the pressure on the bowel walls. When you don't exercise, in long run this will affect your body and intestinal walls. Exercise can also facilitate digestion which facilitates the intestinal walls working.

Some Medications

Nonsteroidal anti-inflammatory drugs (NSAIDS).

These are painkillers. When taken in access amount for a longer period it causes diverticulitis as it affects the cell wall and its function.

Complications

There are rare chances that diverticulitis is affected by some other complications that could harm the patient. Some of these complications are as mentioned below: 

Abscess

It is a condition where the puss is formed inside the intestinal walls. An abscess occurs when there is an infection. It is the result of your body's defense against the infection. They are liquid, and that liquid is the dead cells, usually the WBC. 

This puss grows and puts pressure on the surrounding surface, which also causes inflammation. This pressure and inflammation result in pain. People with low immune systems or suffering from other diseases are at more risk of getting the abscess. 

Antibiotics alone may not be enough to deal with the puss. The doctors may need to remove it to relieve the pain and better the situation. For this, the doctor may insert a small needle through your abdomen to remove the puss. Anesthesia is used to make the process easier. 

Fistula

It is an abnormal connection between the body parts. This connection is caused by injury, surgery, infection, or inflammation. It is also seen that it can be formed when one has an abscess. When one has a fistula in their body they may experience pain, puss, bleeding, weakness, and fever. 

There are many types of fistula. The ones that are related to the intestine are as follows: 

  • Enterocutaneous: A connection is formed between the intestinal walls and skin.
  • Enteroenteric: A connection is formed between the large intestine and small intestine. 
  • Enterovesicular: A connection between the colon and urinary bladder. This often leads to a gas passage from the urinary bladder when you urinate. 

Peritonitis

It is a condition where your peritoneum has inflammation and is infected. The peritoneum is the thin membrane that lines the inner walls of the abdomen and it also covers the organs in the abdomen. In diverticulitis, there are chances that the wall of the pouch will burst open. This can lead to the infection spreading in the related area. One of these infections is an infection in the peritoneum. 

Symptoms of peritonitis include:

  • Mild to severe pain in the abdomen
  • Swelling of the abdomen 
  • The problem in the bowel moment
  • Fever
  • Nausea

Tests

When one suffers from any of these symptoms, they should consult a doctor. It is critical to diagnose as these symptoms overlap with other conditions. Thus, your doctor may ask you some questions about the issue, your digestive health, and any related topic. Based on that they will take action. 

Some of the most common options that the expert may choose to diagnose the disease are as mentioned below: 

Blood Test

The very first thing the doctors suggest is a blood test. It helps them identify if there is any inflammation in the body, which can be identified due to the high presence of white blood cells (WBC). Though this is not the most accurate result showing the test, it can provide enough guidance. 

Barium Enema

It is also known as a colon X-ray. It is different from the normal x-ray. Generally, barium sulfate is used in this process. Here the x-ray absorber barium is inserted in the colon through the rectum. When the x-rays pass, the barium glows white and thus giving a better view of the colon walls. It is used to point to the diverticula, inflammation, tumor, and even abnormalities in the intensive (colon). 

Identifying the inflammation causing diverticulitis becomes easier using this method. 

CT Scan

It is an advanced type of x-ray. It is used to derive detailed cross-sectional images of the area to be diagnosed. In this process, the patient is injected with barium or iodine solution. It is done orally or with an IV. It leads to a clear and highlighted view of the affected area. 

CT scans are used to get a clear image of the colon. It helps them to identify the problem area more smoothly and accurately. 

Colonoscopy

In case of severe bleeding or pain, the doctor might suggest a colonoscopy to identify the source of the problem. In this process, a tiny tube with a small camera in the tip is inserted into the colon through the rectum. It gives the expert a clear view of the inner walls of the colon. It is easy to identify the problem area. 

While this process may not hurt you, it can be uncomfortable, and thus experts may provide you with pain delivers or sedatives in advance.

Treatment

Treatment of once diverticulitis depends on many factors and the level of diverticulitis. The condition may be simple to mild diverticulitis or can be a severe condition with complications. It is not a very dangerous disease in the mild stage and thus can be treated at home. But, if the condition is severe and very prone to complications, one must be treated at the hospital. 

Antibiotics and Painkillers

At home: the doctor will prescribe some antibiotics and painkillers like paracetamol. They will not suggest other painkillers like aspirin and ibuprofen as they can worsen the condition. At the hospital: one is admitted to hospital when they are not able to take the antibiotics and painkiller, or they are not effective on them. In such cases, the doctor asks them to stay at the hospital to ensure recovery. 

Diet

You have to increase your fiber intake if it's low. It helps the intestine walls to regain their energy and function properly. It can also help you avoid server diverticulosis. Good sources of fiber are fruits, vegetables, pulses, nuts, dried fruits, and starchy food. Fluid intake is important. Whether it is water or other fluids, make sure to consume enough fluid. It could be tremendously helpful to your body.

In mild cases, the doctor may suggest starting with low fiber intake to avoid pressuring the walls of the colon. This intake should be increased slowly till it is at intake at the best level. In severe cases, the expert may ask you to stick to a liquid diet to lower the working of the intestine wall. And maintain the body's nutrients. 

IV Fluids

In case the patient is very weak or has trouble taking medicines and food they are admitted to the hospital. There they are given nutrients and medication with the help of an IV. 

Rest

One is suggested to take a small break from work and proper rest. It will reduce the stress on the colon and promote healing faster.

Surgery

Surgery is avoided as it has many risks attached along with the benefits. Yet, to avoid any fatal complications, surgery might be performed. There are two parts of surgery:

Colectomy

It is a procedure in which the affected part of your colon is removed entirely through surgery. It is done by either open colectomy or laparoscopic colectomy. In open colectomy, a large cut is made on the abdomen to remove the part. In laparoscopic colectomy, a small cut is made and with help of advanced devices, the colon part is removed. 

Stoma

Your colon may need some time to heal before it is reattached and ready to function again. Thus, to excrete the waste out of the system doctors will attach a bag to your abdomen. This bag will collect all the waste excreted from the digestion of food. Once the colon is healed, the stoma is removed and the colon takes over its regular function. 

There are two ways to attach a stoma: 

  • Ileostomy: it is attached to the right side of the abdomen. It is attached where the small intestine ends and transfers the waste to the large intestine (colon). A small cut is made to attach the passage to the stoma to excrete the waste. 
  • Colostomy: it is attached to the part of the large intestine. A cut is made in the abdomen, and the part of the large intestine which is not affected is attached to the stoma. 

Once the colon is completely healed it is reattached and the stoma is removed.

Summary

The large intestine or colon of the body is one of the most important parts of the body. It helps to reabsorb the excess water and important electrolytes from the feces. Another major function is to remove the remaining toxic waste from the body. This process is done by the contraction of the wall of the intestine. It pushes the waste forward towards the rectum, which excretes the waste out of the body through the anus. 

Often time due to many reasons pouches forms on the outer side of the walls of the intestine. This individual pouch is called a diverticulum. The presence of few diverticula are called diverticula. They are not very harmful. Some may have it and don't feel anything about it. These are mostly present in the sigmoid colon. But, it is seen that in Asian and African countries it is also found in the ascending colon. 

These diverticula can cause some diseases, which are called diverticular diseases. They are diverticulosis (the presence of many diverticula), diverticular bleeding (caused by the bursting of blood capillaries of the wall of pouches), and diverticulitis. 

Diverticulitis is the condition where waste gets stuck in the pouch. This leads to inflammation and infection in the pouches. This shows symptoms such as pain in the lower abdomen, fever, nausea, and diarrhea. In mild cases of diverticulitis rest, antibiotics and a balanced diet are enough to solve the issue. But, in severe cases patient might be admitted to the hospital. If the case is worse, then they may need to perform surgery to remove the part of the intestine. This common condition in aged people. However, if you smoke, are overweight, don't exercise, and have a poor low-fiber diet you could also be affected by this. 

Certain complication such as puss formation, and infection spreading to other parts of the body needs immediate attention. Tests such as blood tests, barium enema, CT scans, and colonoscopies could be used to identify the type of issue in diverticulitis. 

This might not be the most fatal disease but left untreated or taken for granted can cause fatal situations. Thus, proper care should be taken.

References

  • “Diverticular disease and diverticulitis” by NHS inform
  • “Diverticular Disease” by WebMD
  • “Barium Enema” by Johns Hopkins medicine
  • “Abscess” by WebMD
  • “What is a fistula” by verywellmind
  • “Peritonitis” by Cleveland clinic
  • “The colon” by Teach me anatomy

         

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