Digestive Problems
Diseases: Colon and Rectum: Diverticulosis / Diverticulitis
Endoscopic image of diverticulosis
along colon wall.
Diverticuli are small sacs or pouches on the wall of the colon. They are similar to the small bulge that appears on a rubber inner tube tire. This condition is known as diverticulosis. The sacs are caused by high pressures within the colon which occur when there is not enough fiber in the bowel movement (feces).
When the colon is relatively empty, normal contractions of the colon muscles cause very high pressures in isolated segments that are empty. These high pressures cause bulging to occur in certain weak spots of the colon, where blood vessels enter the wall from the outside. These sacs, or diverticuli, can get as large as 1/2 inch in size.
Diverticuli do not empty well. Feces can be trapped in these sacs and then become infected, causing inflammation. This causes pain, irritation and scarring. Scarring may cause adhesions later which may twist (kink) the colon.
Diverticulitis is an inflammation of the little sacs (pouches) due to infection. It causes pain or tenderness to the touch. Doctors give antibiotics by vein in the hospital if the pain, tenderness and swelling are severe. Swelling can cause blockage of the colon. Infected diverticuli can rupture. Such a condition requires surgery.
In about 95% of cases, the diverticuli do not cause any symptoms. Diverticuli are very common; perhaps 50% of people over age 60 have diverticuli.
Doctors recommend surgery after two attacks of diverticulitis requiring hospitalization with intravenous antibiotics. The operation is done through an abdominal incision and twelve to eighteen inches of the colon are removed.
Less common complications of the diverticulosis are perforation (rupture) of the colon, blockage, and bleeding. If medicines do not cure these complications, then sometimes part of the colon must be removed.
Since diverticuli do not occur in the rectum, it is unusual to need a permanent colostomy for diverticulosis or its complications. With new techniques, surgeons can often avoid even a temporary colostomy. Special techniques clean out the colon during surgery so that even emergency surgery does not require a colostomy as it did a few years ago.
Adapted from Dr. Christopher Lahr's book "Shining Light on Constipation."