Diverticular Disease

Diverticular disease is a digestive disorder that affects the colon—a part of the large intestine. The colon helps remove wastes from the body. Diverticular disease may either be diverticulosis or diverticulitis. When pouches, called diverticula, form in the colon, the diverticular disease is specifically called diverticulosis. Diverticula are most common in the lower portion of the large intestine, called the sigmoid colon. Diverticulitis occurs when the pouches that form become inflamed.

Diverticular disease is more common in people as they age. In fact, according to the National Digestive Diseases Information Clearinghouse (NDDIC), chances of getting it increases every 10 years when a person reaches the age of 40.

Causes

The actual cause of diverticular disease is not fully understood. However, experts believe that having a diet low in fiber causes diverticular disease. Fiber, which is obtained from many fruits and vegetables, is important for good bowel movement.

It is difficult for the body to digest fibers in food. But, even so, these fibers that travel in the colon absorb water, which makes bowel movements much easier to pass. People with diets low in fiber may experience constipation, which can occur when stools harden and makes it difficult to pass. When constipation occurs, it can cause straining of muscles while passing stool. Too much straining may cause formation of diverticula in the colon. When these pouches get infected with bacteria or stools are caught in the diverticula, diverticulitis can occur.

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Signs and Symptoms

The symptoms of diverticulosis and diverticulitis may differ from each other.

Diverticulosis may not cause symptoms in some people. However, others may experience cramping, bloating, and constipation. Some may also experience bleeding, inflammation, and fistulas—abnormal connection of tissues, either between two organs or between an organ and the skin. Rectal bleeding, which is bleeding that occurs in the rectum—the end of the colon that connects to the anus. Rectal bleeding may be painless, yet, it can be dangerous because it may be a symptom of a more serious problem. A consultation with a doctor is advised.

Diverticulitis can cause symptoms such as:

 Pain in the lower part of the abdomen

 Cramping

 Nausea and vomiting

 Fever

 Chills

 Feeling sick to your stomach

 Change in bowel movement

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Complications

Diverticulitis can lead to bleeding; infection, called peritonitis; small tears, called perforations; or blockages in the colon. These complications always require treatment to prevent them from progressing and causing serious illness.

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Tests and Diagnosis

In addition to learning about your signs and symptoms, medical history, and performing physical examination, your doctor may also recommend additional tests to help with the diagnosis and look for possible complications.

Tests for diverticular disease may include:

CT Scan. This imaging test is the most common test used. In this procedure, the doctor will inject a liquid in a vein in your arm, which better highlights your organs on x rays. An alternative to getting an injection is to drink a liquid called barium. After this, you are placed in a large doughnut-shaped machine that takes x rays.

Blood test. This test is used to help detect infections.

Stool analysis. This test can help show bleeding in the digestive tract.

Digital Rectal Exam. In this procedure, the doctor will insert a gloved finger into your rectum and check for pain, bleeding, or blockage.

Colonoscopy. This imaging test will make use of a small tube, which inserted through your anus. A tiny video camera is in the tube and will show if there are any pouches.

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Treatment of Diverticular Disease

Treatment of the condition depends on the type of diverticular disease and how serious the problem is. Most people get better by simply changing their diet. If you have rectal bleeding, you need to see your doctor immediately so she or he can find the part of your colon that is bleeding. Your doctor may prescribe a special drug that makes the bleeding stop. He or she may also decide to operate and remove the part of the colon that is bleeding.

For Diverticulosis

Eating high-fiber foods can help relieve symptoms. Sometimes mild pain medications also help.

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For Diverticulitis

The doctor may prescribe antibiotics, pain reliever, and recommend bed rest and following a liquid diet. Most people get better with this treatment. However, some people may need surgery and other treatments.

 Surgery. More serious problems from diverticulitis are treated with surgery. The surgeon can clean the abdomen after infections and remove bleeding pouches and fistulas.

 Colon resection. For recurring diverticulitis, your doctor might suggest removing the part of the colon with diverticula. The healthy sections can then be joined together. With the diverticula gone, you may avoid other infections.

 Emergency surgery. If you have severe problems, you may need emergency surgery to clear the infection and remove part of the colon. Later, a second surgery rejoins the healthy sections of the colon. The colon is separated for a brief time between surgeries, because rejoining the colon during the first surgery is not always safe.

A temporary colostomy is needed between the two surgeries. A colostomy is an opening made on the abdomen where a plastic bag is connected to collect stool after food is digested. The surgeon makes the opening, called a stoma, and connects it to the end of the colon.

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References:
National Digestive Diseases Information Clearinghouse (June 2007). What I need to know about Diverticular Disease (NIH Publication No. 07—5535). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://digestive.niddk.nih.gov/ddiseases/pubs/diverticular/index.htm. Accessed: December 18, 2008

National Digestive Diseases Information Clearinghouse (July 2008). Diverticulosis and Diverticulitis (NIH Publication No. 08—1163). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://digestive.niddk.nih.gov/ddiseases/pubs/diverticular/index.htm. Accessed: December 18, 2008

Image Credit: NIDDK

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Bleeding in the Digestive Tract

Bleeding in the digestive tract is a symptom of a disease rather than a disease itself. Bleeding can occur as the result of a number of different conditions, some of which are life threatening.

Most causes of bleeding are related to digestive disorders that can be cured or controlled, such as ulcers or hemorrhoids. The cause of bleeding may not be serious, but locating the source of bleeding is important.

The digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from one or more of these areas, that is, from a small area such as an ulcer on the lining of the stomach or from a large surface such as an inflammation of the colon. Bleeding can sometimes occur without the person noticing it. This type of bleeding is called occult or hidden. Fortunately, simple tests can detect occult blood in the stool.

What causes bleeding in the digestive tract?

Stomach acid can cause inflammation that may lead to bleeding at the lower end of the esophagus. This condition, usually associated with the symptom of heartburn, is called esophagitis or inflammation of the esophagus. Sometimes a muscle between the esophagus and stomach fails to close properly and allows the return of food and stomach juices into the esophagus, which can lead to esophagitis.

In another, unrelated condition, enlarged veins (varices) at the lower end of the esophagus may rupture and bleed massively. Cirrhosis of the liver is the most common cause of esophageal varices. Esophageal bleeding can be caused by a tear in the lining of the esophagus (Mallory-Weiss syndrome). Mallory-Weiss syndrome usually results from vomiting but may also be caused by increased pressure in the abdomen from coughing, hiatal hernia, or childbirth. Esophageal cancer can cause bleeding.

The stomach is a frequent site of bleeding. Infections with Helicobacter pylori (H. pylori), alcohol, aspirin, aspirin-containing medicines, and various other medicines (NSAIDs, particularly those used for arthritis) can cause stomach ulcers or inflammation (gastritis). The stomach is often the site of ulcer disease. Acute or chronic ulcers may enlarge and erode through a blood vessel, causing bleeding. Also, patients suffering from burns, shock, head injuries, cancer, or those who have undergone extensive surgery may develop stress ulcers.

Bleeding can also occur from benign tumors or cancer of the stomach, although these disorders usually do not cause massive bleeding.

A common source of bleeding from the upper digestive tract is ulcers in the duodenum (the upper small intestine). Duodenal ulcers are most commonly caused by infection with H. pylori bacteria or drugs such as aspirin or NSAIDs.

In the lower digestive tract, the large intestine and rectum are frequent sites of bleeding. Hemorrhoids are the most common cause of visible blood in the digestive tract, especially blood that appears bright red. Hemorrhoids are enlarged veins in the anal area that can rupture and produce bright red blood, which can show up in the toilet or on toilet paper. If red blood is seen, however, it is essential to exclude other causes of bleeding since the anal area may also be the site of cuts (fissures), inflammation, or cancer.

Benign growths or colon polyps are very common and are thought to be forerunners of cancer. These growths can cause either bright red blood or occult bleeding. Colorectal cancer is the third most frequent of all cancers in the United States and often causes occult bleeding at some time, but not necessarily visible bleeding.

Inflammation from various causes can produce extensive bleeding from the colon. Different intestinal infections can cause inflammation and bloody diarrhea. Ulcerative colitis can produce inflammation and extensive surface bleeding from tiny ulcerations. Crohn's disease of the large intestine can also produce bleeding.

Diverticular disease caused by diverticula—pouches in the colon wall—can result in massive bleeding. Finally, as one gets older, abnormalities may develop in the blood vessels of the large intestine, which may result in recurrent bleeding.

Patients taking blood thinning medications (warfarin) may have bleeding from the GI tract, especially if they take drugs like aspirin.

<sub>Resources:
Digestive Diseases A-Z. National Digestive Diseases Information Clearinghouse (NDDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH Publication No. 00-2750: February 2000

Bleeding in the Digestive Tract. National Digestive Diseases Information Clearinghouse (NDDIC. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 05–1133: November 2004

Image Credit: NIDDK Image Library. National Digestive Diseases Information Clearinghouse (NDDIC. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Page Last Revised: August 4, 2012</sub>