#16) DIVERTICULOSIS

Diverticulosis is the condition of having outpouchings (diverticulae) of the colon develop as a result of chronic excess pressure on the colon wall. Three decades ago, it was virtually unheard of before age 40 or 50. Now although it is still more common with age, it’s seen occasionally in the 30’s. Symptoms include abdominal pain due to spasm (more common in the left lower abdomen), bloating, and changes in movements (both diarrhea and constipation can result). Any such symptoms would prompt a gastrointestinal work up to rule out more serious conditions. Occasionally bleeding can occur, and if the diverticulae become infected then diverticulitis results, which can lead to perforations and abscesses.

Risk factors for diverticulosis include increased age, chronic constipation, and a low fiber diet over decades. Fiber was first recognized in 1974 as being the most important factor in diverticulosis. Denis Burkitt was a general surgeon who practiced medicine in developing countries in Africa as part of missionary work. As a young doctor he expected to do a lot of abdominal surgery in these areas that didn’t have medical care prior to his arriving. For his entire career he operated on just a few people with appendicitis and diverticulitis, and those were Western workers who had only been in Africa for a brief time. In 1979 he published a book called “Don’t Forget Fiber in Your Diet,” and the rest is history; the major cause of diverticulosis was identified.

Definite diagnosis is relatively easy with the use of a CT scan or MRI, followed by a colonoscopy.

The recommended treatment depends on the symptoms. Many cases have minimal symptoms and require nothing more than a high-fiber diet. Fiber has been shown to reduce pressure in the colon. For decades the advice to avoid seeds in many vegetables and fruits was given; this was based on the theory that the seeds could get caught in the diverticula. This advice was never based on legitimate studies and now has been proven to be definitely erroneous; in fact these vegetables and fruits contain fiber that improves the condition. Recommended fiber sources include both insoluble fiber as in whole wheat products and vegetables, and soluble fiber as in fruits and oats. Don’t’ get tricked, many containers of food products mention fiber, but actually have an insignificant amount.

For acute flare-ups of abdominal pain, prescription anti-spasmotics and the old fashioned remedy of peppermint oil can be prescribed.

When infected, diverticulitis is treated with antibiotics and a low fiber diet (which puts the colon at rest). A liquid diet and antibiotics are used in outpatients. More serious cases require hospitalization, nothing by mouth, and intravenous antibiotics. In either case, two antibiotics are necessary to treat aerobic (requiring oxygen to multiply) and anaerobic (multiply without oxygen) bacteria. Augmentin and Cleocin are antibiotics commonly used in outpatients.

Absesses not cured by antibiotics, and uncontrolled bleeding are two indications requiring surgery to remove the affected area of the colon or drain the abscess. With stronger antibiotics available, surgery is required much less often than several decades ago.