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What is Diverticular Disease and What Causes It?

diverticular-diseasesDiverticular disease occurs when pouches (diverticula) in the intestine, usually the large intestine/colon, become inflamed or get remnants of food in them. Everyone has diverticula, it’s just whether or not your will become inflamed AND infected, differing diverticulitis and diverticulosis. Diverticulitis is caused by not eating enough fiber and eating too much of processed foods, artificial sweeteners, etc. Without the fiber, your body can’t get rid of those food that are bad for you fast enough, causing them to sit and inflame and infect your colon. Diverticulosis is the presence of many diverticula along the intestinal wall which causes only inflammation. Both of these diseases occur more in countries like the US where the diet is low fiber, more than 50% of adults over 70 have diverticulitis and most don’t know.

The difference between diverticulitis and diverticulosis is simply whether or not the diverticula become infected as well as inflamed. If they become infected as well it’s diverticulitis, which needs to be treated with antibiotics, often causes hospitalization, and usually needs surgery to remove that part of the colon so it doesn’t happen again. With diverticulosis typically all you need is a liquid diet for a while and take it easy for a few days and let your body heal. So how can you remember which is which? Well, “itis” is an inflammation, diverticulitis is like appendicitis, a serious condition that can be life threatening if untreated and usually requires surgery to fix. Like appendicitis, you don’t want any diverticula to burst causing peritonitis. The lining of the pockets (diverticula) is thin, so if a great pressure is exerted, they can burst and the wall becomes infected with bacteria filled stool causing diverticulitis. Diverticulosis has nothing to do with thin diverticula, it’s actually thickening. The problem in diverticulosis are high pressure zones caused by thickened muscles called mychosis, this thickening is generally in the sigmoid colon. When a colonoscopy is done, you see a small colon and large thickened muscles called muscular hypertrophy.

Diverticular disease, which includes both diverticulitis and diverticulosis, symptoms can range from no symptoms at all to constant pain and spasm, to diverticulitis which includes pain, fever, and tenderness. These also tend to progress over time and there is no way to decrease the progression. Some other symptoms caused can be abdominal pain (typically after a meal), painless rectal bleeding or blood in stool, fever, nausea, vomiting, irregular bowel movements, gas, and bloating. Some patients may also develop peritonitis, an inflammation of the lining of the abdomen. Some symptoms of this are sudden abdominal pain, muscle spasms, guarding (involuntary contraction of muscles in the infected area), or sepsis which is the term for an infection that has spread to the blood. Peritonitis can be life threatening if left untreated.

Some patient stories include this one from Rob C on medinenet.com:

“I suffered from my first bout of diverticulitis when I was 30. I was admitted to the hospital for a few days having been unable to pass stools due to stabbing pains in my lower abdomen and groin area. After scans and then a colonoscopy I was diagnosed with (some) diverticula. A year or two later, I had a minor flare-up, and was treated with metronidazole. Then, on the 08/05/16, I had my most serious flare up. The worrying thing was, my warning was a gassy feeling on the Monday with mildly loose stools, tiredness and fever on the Tuesday and then pain (escalating to ‘I’m dying’ levels) on the Wednesday. Ambulance came and I was rushed into surgery for a laparoscopic lavage. After that, I spent 10 days in hospital with drains, tubes, 3 antibiotics (gentamicin/trimethoprim/metronidazole), and ketamine for pain. It was literally a nightmare. I was discharged after 10 days. I spent a week at home, eating what I thought I should (vegetables, lean meat, no chemicals, etc.), to then suffer another fever, etc., a week later. I ended up by in Accident and Emergency and admitted for 2 more days. Blood work showed infection again and inflammation markers, and heart rate (resting) of 105 bpm. I just left with metronidazole and Cipro tablets for 10 days; also advice to eat ‘low residue’ which feels unhealthy but I’m doing it (white bread, meat, white pasta, 10 g fiber per day). Fingers crossed I get over this bout, otherwise I’m back for some intestine removal and a stoma. Once healed, I’m cutting all processed food, seeds, artificial sweeteners, fizzy drinks and junk from my diet. I’ve clearly abused myself in the past and need to wake up before it is too late. Bacon, sausages, snack bars, processed package foods and maybe a liter of diet Pepsi a day have taken their toll and I wish I could go back in time now and change my behavior. I also believe lifting is a factor. I can match flare ups to go-karting endurance races and before my serious bout recently, I’d move 5 tons of topsoil and stone for my garden by hand (on my own).”

Another patient story from Kenny Dreyling says:

“It sucks! The changing of the diet is what sucks the most. The on and off of being tired is not fun, the stomach cramps are pretty terrible. The no peanuts, sunflower seed, almonds, etc. stinks, being someone who lifts weights, the easiness of grabbing almonds for a snack with a protein shake is so easy and nice, now I can’t do that. I’m on my initial antibiotics (2) right now and they also prescribed me Tramadol for the pain. That’s the only medicine I’ve been prescribed. They found it by doing a CT scan because I intitially thought I possibly had a kidney stone. We are playing the waiting game right now and waiting out the antibiotics. If they do the job and take care of the infection, I’ll be good to go. They said if the antibiotics don’t work, I’ll likely have that portion removed. The thing most people don’t understand is that your body is fighting an infection and that’s why you’re tired a lot, not fun at all. From what I understand it is rare for people under 40 to have diverticulitis, I’m 36!”

What causes diverticular disease? The main cause is still unknown, but there may be many factors that are thought to contribute to it. Aging, the movement of waste through the colon, changes in intestinal pressure, a low fiber diet, and physical abnormalities can all lead to inflammation of the colon. The people most at risk are those who smoke, have a low fiber diet, older than 70, are obese, are physically inactive, have a family history, and/or are male. Other contributors can be having a high fat intake, lack of regular activity, and use of nonsteroidal anti-inflammatories.

How can you prevent diverticular disease? Eat a high fiber diet, typically 25-35 grams per day, and low fat containing lots of vegetables. This diet can also benefit your overall health, reducing the risk of heart disease and cancer. Avoid a lot of red meat which can be fatty. Avoid foods that may block the opening of a diverticulum and lead to inflammation such as high-fat foods. And exercise regularly, studies have shown that those who run have a lower risk of developing diverticular disease than those who don’t. If you have regular flare-ups, respond poorly to medical therapy, or have other complications, surgery may be suggested so that you stop having flare-ups.

Nutrition plays a big role in preventing diverticular disease, mainly diverticulosis, you can minimize attacks and improve treatment by following specific dietary recommendations. The following foods are associated with a lower risk of diverticular disease: cucumber, lettuce, spinach, and whole grain bread to name a few, typically all high-fiber. Food is the best source of fiber but there are also supplements that you can take to help. Humfeld Family Chiropractic can help in assisting you with the right amount to take and which of our supplements will help, we have several high fiber that could be beneficial. Herbs as well are a way to strengthen and tone the body’s systems, but should only be taken if ok’d by a health care provider.

Diverticular disease can be prevented if you are conscious of what you eat and do. High-fiber is the main take away, if you eat high fiber your risk is decreased by a great amount. Always be conscious and careful of what you eat and it will help you in the long run.