Diverticulum in the intestine are found particularly in the large intestine. If various diverticula have arisen in the large intestine, this clinical picture is also called Diverticulosis designated. Diverticula in the small intestine, on the other hand, rarely occur and the person concerned usually has no symptoms.
What are diverticula in the intestine?
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Diverticula in the intestine are protrusions of the intestinal wall, which occur particularly in the large intestine. In some cases they are innate. But they can also develop in the course of life. Medicine differentiates between real and fake diverticula. Real diverticula are protuberances in all areas of the intestinal wall.
Most of them are innate and only occasionally present. The so-called fake diverticula only protrude from the inner layers of the intestinal wall. They are not innate, they develop over time. These diverticula in the intestine arise at weak points in the intestinal wall, bulge outwards and cause diverticula to appear.
causes
The reasons for diverticula in the intestine are many. The exact development process is still not fully understood. Doctors suspect an interaction between increased pressure inside the intestine and debility of the intestinal wall.
In the muscle layer in the wall of the intestine, there are gaps in which the blood vessels run. With age, the breakdown of connective tissue increases, making the gaps more sensitive. If the pressure increases inside the intestine, the mucous membrane is pressed out through the weak points. Diverticula develop.
This appearance is favored by a low-fiber diet. The section in front of the rectum is most affected by the formation of diverticula. Diverticula in the intestine appear more frequently in this area because the causes weakness of the intestinal wall and pressure occur together in it.
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In most cases, diverticula do not cause discomfort in the intestine. However, if the diverticula become inflamed, abdominal pain occurs. Depending on the type of protuberance, the symptoms occur either in the left lower abdomen or in the right middle or lower abdomen. The pain usually subsides after a bowel movement. At the same time, digestive disorders can occur.
Many patients suffer from constipation, diarrhea, severe gas or bowel movement. Externally, this can be noticeable as a painful pressure-sensitive hardening in the abdomen. This so-called “roller” usually lasts for a few days to a week and then recedes by itself.The symptoms of diverticulosis are accompanied by a fever and a general feeling of illness.
If the disease is not treated, further symptoms can arise. Possible secondary diseases are, for example, intestinal rupture, peritonitis, narrowing of the intestine and the formation of abscesses. In addition, there may be bleeding into the intestines and the formation of fistulas. All of these complaints are associated with increasing malaise. As a rule, the person concerned is no longer productive and feels weak and exhausted. These clear signs can be used to quickly diagnose diverticulosis.
Diagnosis & course
Diverticula in the intestine (diverticulosis) require a thorough diagnostic procedure to make it possible to rule out malignant intestinal tower tumors. The diagnosis begins with an exact description of the symptoms.
Then, with the help of a colonoscopy and an X-ray contrast agent examination, other diseases such as irritable bowel syndrome or colon cancer can be eliminated. An inflammation of the diverticula shows up after a blood test. The number of white blood cells increases and the rate of lowering of the blood cells becomes noticeable.
If the inflammation has already been transmitted to the urinary bladder, white or red blood cells can be found in the urine. For a closer examination of the inflamed diverticulum, an ultrasound examination, computed tomography or magnetic resonance tomography is also used.
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Colonoscopy for diverticula in the intestine © Juan Gärtner - Fotolia.com
When should you go to the doctor?
If the diverticula in the intestine become inflamed, a doctor is recommended. Abdominal pain, which typically occurs in the left lower abdomen, indigestion and fever indicate such an inflammatory process - then it is essential to seek medical advice. If symptoms of peritonitis or an intestinal obstruction occur, the emergency doctor must be called in. Likewise, if blood is noticed in the stool or a rupture of the bowel occurs.
Because these complications are life threatening, they must be treated in hospital. There - if not already done - the diverticula in the intestine are also identified as the cause. After the diagnosis, the patient has to stay in the clinic for about one to three weeks. Depending on the severity of the inflammation, surgery may be necessary to close any wounds.
In order to avoid such a severe course, the risk groups in particular - including people who have a particularly high-fiber diet or are over 70 years old and patients with existing intestinal diseases - should arrange for a medical evaluation if they have initial symptoms of intestinal diverticula.
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Complications
Diverticula in the human intestine are mostly harmless in nature. In some cases, however, they can lead to sometimes serious complications. If there are a lot of diverticula in the bowel, it is called diverticulosis. In 80 percent of the cases, this disease occurs without symptoms.
However, in some cases, inflammatory processes occur. The result is what is known as diverticulitis. If such diverticulitis is suspected, a doctor should be consulted immediately. If left untreated, this type of inflammation can lead to serious complications. The inflamed diverticula can form fistulas and abscesses which can lead to further problems.
A particularly serious complication is the narrowing of the bowel. This can go so far that it comes to a complete closure of the intestine. In this case there is a so-called lleus. Another possible consequence is a perforation of the intestine. This must be treated immediately. If left untreated, this can be fatal.
If the inflammation moves further up, infiltration of the peritoneum is possible. The ileus as well as the inflammation of the peritoneum can lead to a life-threatening state of shock. Other possible complications relate to the treatment of these diseases. Operations on the intestine or peritoneum can lead to fistula formation, accumulation of pus, tissue damage and infections.
Treatment & Therapy
Treatment of diverticula in the intestine depends on the potential discomfort and the degree of inflammation of the protuberances. If the clinical picture is symptom-free, no special treatment is necessary. However, if the person has physical symptoms, measures to regulate the stool can improve the symptoms.
A combined treatment consisting of a diet high in fiber, sufficient fluid intake and daily physical activity is particularly suitable for this. However, if there are complications such as inflammation, the treatment methods are different. In the case of a slight inflammation of the diverticula, conservative therapy consists of taking antibiotics and antispasmodic drugs. If the inflammation is very severe, the treatment is inpatient. Only in this way can the disease be fully examined and treated.
Surgical intervention is also possible as therapy. This is recommended if the inflammation has caused a ruptured intestine or if excessive diverticular bleeding cannot be controlled. To do this, it may be necessary to remove the entire affected section of the intestine by means of an operation. Such an operation if diverticula in the intestine is suspected also helps to rule out the presence of colon cancer.
Outlook & forecast
Those affected often remain symptom-free for a long time. The course of the disease depends very much on how much the bowel has changed. If inflammation has not yet developed, the prognosis is favorable, but even milder inflammations can be treated relatively well in most cases.
It becomes more difficult with a more extensive inflammation of the diverticula. This can affect the intestinal wall and make it thinner. Then there is the risk that the intestinal wall will tear and foci of pus will form in the abdomen. If this causes intestinal bacteria to spread in the abdominal cavity, there is a risk of life-threatening peritonitis.
In addition, chronic inflammation in the context of diverticulosis can compress the intestine in such a way that a bottleneck arises inside, which favors an intestinal obstruction if the transport of the intestinal contents is blocked through the narrow point. Another risk is that the disease can form connections between other parts of the intestine, bladder, and vagina called fistulas, which are uncomfortable and difficult to treat for those affected.
After the inflammation has been successfully treated, there is a risk of approx. 30% that intestinal diverticula will occur again. If diverticulosis develops at a young age, it usually has to be treated surgically at a later age.
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So far, the exact causes of diverticula in the intestine are unknown. Currently, however, medical professionals assume that a high-fiber diet can prevent the protrusions. Adequate fluid intake and regular exercise can also have a positive effect on the functioning of the bowel. No more preventive measures for diverticula in the intestine are known.
Aftercare
Follow-up care for diverticula in the intestine (diverticulosis) is carried out with the internist or gastroenterologist, sometimes in cooperation with the family doctor. Immediately after therapy, it is important to eat bland foods that do not put additional strain on the patient's bowel. Consult your doctor in the event of bleeding or similar unusual events.
The diet is coordinated with the doctor, but nutritionists or dietitians can also provide valuable help in this regard. In many cases, a high-fiber diet combined with a sufficient amount of water is the optimal composition. Fruits and vegetables are advisable. Flatulent or spicy foods and alcohol, on the other hand, are something that those affected should avoid in order to supplement the treatment after diverticulosis with targeted follow-up care.
Diverticula can be promoted in their formation by strong pressing and constipation. Therefore, the chair should ideally be kept soft and voluminous. If this cannot be achieved with a purely high-fiber diet, flea seed products are often helpful. However, especially in the context of aftercare, it is important to discuss the intake in advance with the treating doctor.
The colonoscopy (colonoscopy) is both aftercare and prevention at the same time. Your doctor will also determine their frequency. It discovers at an early stage whether new diverticula are emerging and can thus enable early treatment.
You can do that yourself
Diverticula in the intestine (diverticulosis) are a form of the disease that, in addition to classic medical therapies, also offers those affected a lot of opportunities for self-help in everyday life. This is because the disease is often associated with or caused by chronic constipation. To alleviate these or, ideally, to eliminate them completely, is one of the important therapeutic strategies that also require the active and above all consistent cooperation of the patient for success.
An important factor in this context is a sufficient amount of fluids. It ensures that there is sufficient fluid in the intestine and can help prevent stool residues from settling in the diverticula and causing inflammation (diverticulitis) there. A diet rich in fiber has the same effect. It can be made even more effective with home remedies such as ingesting psyllium husks. It often helps to switch from a few large meals to eating smaller portions more often during the day.
Sufficient exercise as part of a conscious diet can also improve the symptoms caused by diverticula in the intestine. Regular exercise and other exercise-intensive activities also increase mobility in the intestines. The chyme can be transported more efficiently and a deposit in existing diverticula can often be prevented. Endurance sports such as swimming, walking or cycling are particularly effective.
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