Tuesday, May 31, 2005

Patient information about- Diverticulosis and Diverticulitis

Compiled by the staff of Community Health Care/Canal Fulton

Diverticulosis is a condition affecting 10% of Americans over age 40 and 50% of those over age 60. Most people with diverticulosis, in fact, don't even know they have it. Diverticulosis, however, can lead to a serious condition called diverticulitis. This information describes both disorders and tells why a diet high in fiber may be helpful in preventing both conditions.

What is DIVERTICULOSIS?
Diverticulosis is a condition rather than a disease. It affects the colon---the flexible tube-like organ responsible for removing water from the contents of the intestines. A normal colon is strong and relatively smooth. A colon affected by diverticulosis has weak spots in its walls. These defects allow the formation of balloon-like "sacs: or "pouches". These pouches, called "diverticulae" (die-ver-tick'-you-lie) occur when the inner intestinal lining has pushed through the weakened areas of the colon wall. A single pouch is called a "diverticula" (die-ver-tick'-you-lah).

What causes DIVERTICULOSIS?
Experts aren't even certain what causes diverticulosis, but it may be related to an increase in the pressure within the colon. The wall thickens with age, and when it contracts, it causes increased pressure that promotes formation of the "pouches" (diverticulae). A second theory relates to nutrition---in western countries (the U.S.), our diets are deficient in dietary fiber. It is felt that this diet results in less bulk in your stool (solid waste), and the colon must narrow and increase pressure in order to move the stool. In countries where there is more fiber in the normal diet, very few people have this problem at all.

What are the symptoms of DIVERTICULOSIS?
Most people with diverticulosis have no symptoms at all. Occasionally, one may experience lower abdominal pain or discomfort and rarely may have some painless rectal bleeding.

How is DIVERTICULOSIS diagnosed?
Because diverticulosis usually causes no symptoms, the disorder is usually discovered during an x-ray or intestional examination performed for other reasons.

Does DIVERTICULOSIS require treatment?
Treatment is usually not necessary. Recommendations include:
Fiber-rich diet
Avoid food with seeds, nuts, corn, popcorn, cucumbers, figs, and strawberries. These tend to get stuck in the "pouches" and cause inflammation
Avoid laxatives and enemas, which can irritate the colon if used regularly

What is FIBER?
Fiber is present in all plant foods that have not undergone more than a minimum of commercial processing. There are many kinds of fiber, including celluluse, pectins, and gums. Each is placed in one of two categories--- water-soluable or water-insoluable---depending on its degree of soluability in water. Most plant foods are a combination of both categories.

Why is FIBER beneficial?
Fiber, when taken with adequate amounts of water, causes the stool to become larger, softer, and easier to pass. This helps to prevent constipation and may reduce the risk of diverticulosis and diverticulitis. Fiber has been proven to reduce the risk of colorectal cancer, reduce the size of hemorrhoids, and lessen hemorrhoidal bleeding.
Additional health benefits are associated with soluable fiber---to reduce high blood cholesterol (a risk factor for heart disease), to improve glucose tolerance in some diabetics, and to help prevent gallstones.

How much FIBER do I need daily?
The U.S. Food and Drug Administration (USDA) has not established a recommended dietary allowance in grams for fiber, but recommends a diet rich in grain products, fruit, and vegetables. Experts in general don't agree on how much dietary fiber is best, but most say that more fiber, from a variety of food sources, should be gradually introduced. Water intake should be increased to at least eight cups a day. One leading authority, the National Cancer Institute, recommends 20-30 grams of fiber a day---about double what the average American take in on a daily basis. Such fiber intake might be all right for healthy adults, but might not be appropriate for children, the elderly, or persons consuming special diets for other reasons.
Fiber intake should be increased GRADUALLY to give the intestines time to adjust to the change. This helps to prevent diarrhea, discomfort, and gas. Don't take the bulk of your fiber all in one meal---unpleasant cramping and unplesant GAS could result. It may take several months to reach the peak amount of fiber.

How does DIVERTICULOSIS lead to DIVERTICULITIS?
Diverticulitis develops when particles of undigested food become trapped in a diverticula (pouch) and cause the pouch to become inflamed or infected. Usually the infection remains in that one spot, but it is possible for the bacteria to break through the colon wall and can cause inflammation of the membrane that covers the abdominal organs. This condition, called PERITONITIS, can be life-threatening and requires immediate medical attention.

What are the symptoms of DIVERTICULITIS?
The person with diverticulits may have sharp, sudden pain in the lower abdomen (usually lower left side), with nausea and fever. The pain may be crampy or persistent. If peritonitis develops, additional symptoms, such as pain, fever, distended (swollen, puffed up) abdomen, inability to pass stool or gas, low blood pressure, and increased thirst may be present.

What's the treatment for DIVERTICULITIS?
Treatment may very by severity. For mild cases, the doctor may prescribe bedrest, a liquid diet, painkillers, and antibiotics to combat infection. In other cases, the patient may need to be hospitalized and have IV antibiotics. In the most severe cases, the affected part of the colon may need to be removed, and the healthy ends rejoined. While most people recover from diverticulitis without surgery, if the inflammation extends throughout the abdomen and causes peritonitis, surgery is almost always required. Always report, pain, fever, or bleeding without delay.

(c) Community Health Care

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