Many times, people will say they have diverticulitis,a dangerous condition, when they have the more benign and common diverticulosis. Diverticulitis is a serious infection and inflammation of the bowel wall. It requires treatment with antibiotics, and often leads to hospitalization and surgery. People with diverticulosis have large intestinal pockets called diverticula. From the inside of the colon with the colonoscope,these can resemble Swiss cheese holes.
So how can you remember which term is which? “Itis” is an inflammation, as in such conditions as dermatitis, bronchitis, or sinusitis. Diverticulitis is like appendicitis, a serious condition often life threatening and requiring hospitalization and surgery. Diverticulitis is much like appendicitis. You don’t want it to burst and cause life threatening peritonitis.
In the colon or large bowel, diverticulosis will be seen as multiple pockets or holes. They are not true holes as they have a thin lining so that stool and bacteria do not leak out. The lining is thin so that if a great pressure is exerted on the diverticulum, the pocket bursts and the wall of the bowel becomes infected with the stool filled with many bacteria, causing diverticulitis. That may even lead to a walled off infection filled with pus and bacteria called an abscess. The infection may invade adjacent organs such as bladder, ovaries and uterus. This can create a hole in the bladder called a fistula. Patients may experience passing bubbles of air in the urine. Surgery when there is an abscess is thus much more complicated as the adjacent structures are involved.
Prior to the twentieth century, diverticulosis was unusual. Now the disorder called diverticular diseases is seen in two-thirds of elderly people. The most common symptom is no symptoms, so do you need to be concerned? After all if diverticulosis is common and without symptoms, why should you be concerned?
Diverticular disease symptoms range from asymptomatic (no symptoms) to constipation to bouts of pain and spasm, to diverticulitis with fever, pain, and tenderness. There tends to be a progression over many years. Diverticulosis does not resolve or improve over time. So all we can do is prevent progression. So how do we do that?
To begin, you need to understand that symptoms of diverticulosis has nothing to do with the pockets. What? That sounds likes heresy! The pockets of diverticulosis are not the problem. The real problem is high pressure zones caused by markedly thickened muscles called mychosis (not to be confused with the similarly named fungal infection mycosis). This thickening is generally segmental often in the sigmoid colon on the left lower abdomen. Therefore it is not surprising that diverticulitis most often occurs in the sigmoid colon. When we do colonoscopy at Progressive Gastroenterology in patients with advanced diverticulosis we see a narrow colon with thickened muscles called muscular hypertrophy. Think of the muscles on a jacked body builder, thick and brawny. Very powerful. In the colon this not only causes narrowing, but also strikingly high pressures. Those muscles contracting will cause diverticular pain. Worse yet, high pressures on those thin walled diverticula may pop one and cause the infection we call acute diverticulitis. You had heard that diverticulitis was caused by nuts or popcorn getting stuck in those pockets. Think again! Things go in and out of diverticula all the time. We see it in colonoscopy. Those old wives’ tales fail to understand the role of segmental high pressure zones and sigmoid muscular hypertrophy and narrowing.
So what is to be done to decrease the pressure in the colon? As I said before this is a disease of the twentieth century. We do not eat the dirt of our great-grandparents. Our high fat diets rich in meats and poor in fiber are very likely the culprit. So eat your oatmeal, and beans to your salad, chose whole grain breads rather than white breads, and add a fiber supplement such as Nutri-fi to your foods. Nutri-fi has an excellent balance of water soluble and insoluble fibers, benefitting not only diverticular disease, hemorrhoids and constipation but also decreasing cholesterol, stabilizing blood sugar and clearing carcinogens (cancer forming substances) from the intestines.