Part One - Diverticulitis And Diverticular Disease
A diverticulum (called diverticula if there are more
than one of them) is a protrusion of the inner lining of the intestine
through the outer muscular coat to form a small pouch with a narrow
neck. The commonest site for diverticula to develop is the lower left
part of the colon. The presence of diverticula is often referred to as
Is the cause of diverticula known?
A diverticulum can occur naturally and this is most likely in the small
intestine, with a majority of British people over seventy years of age
having diverticula in the large intestine. Diverticula increase in
incidence with the years and are much commoner in later life. Incidence
of diverticula is lower in rural parts of the world such as Africa
although the reasons for this are not clear. Diet may well be an
important difference between rural countries and western developed
countries due to the colon's function of processing the typical plant
foods which are relatively indigestible.
In the west we eat less fibre than in other, primarily vegetarian,
regions of the world. If the colon has plenty of fibre to deal with,
the bulky soft contents keep the walls of the bowel apart. If little
fibre is present, the stools tend to be smaller and harder, and they do
not keep the walls of the tube-like colon apart when the muscles in the
wall of the colon contract. These contractions form a ring-like
narrowing to mix and push the contents along. Closed segments occur
within which pressure is high and it is thought that this pressure
pushes out the pouches.
Are diverticula risky or harmful?
An appendix is a form of diverticulum in some ways and is not the cause
of anxiety. Many people have a colon with many diverticula protruding
from its walls, are unaware of them and they are not problematic in any
way. The appendix can however become inflamed and so can diverticula,
often from infection. This can cause pain locally when it occurs, make
someone feel unwell and can be medically risky if it should bleed or
perforate. Diverticulitis is the name given to inflammation of one or
What is diverticular disease?
In most people with diverticula the intestinal muscle is normal in
appearance and thickness, but in some people it becomes thicker than
normal and has an unusual structure under the microscope. The
thickening of the muscle narrows the colon which becomes irregular in
outline. The reason for this is not known but it is important to
realise that it is not due to infection and may not be related to diet.
The muscle abnormality can develop when very few diverticula are
present and occasionally it occurs without any diverticula. The
combination of abnormal muscle and diverticula is known as diverticular
disease. This is confusing because diverticula and diverticular sound
the same, hence the use of the word disease.
What are the symptoms of diverticular disease?
Symptoms are due to the muscle abnormality and consist of pain, usually
in the left lower part of the abdomen, often bloating, an irregular
bowel habit with pellet-like stools, and sometimes small quantities of
blood passed with bowel actions. These symptoms are similar to those of
irritable bowel syndrome which is not surprising because both
disorders, at least in part, are due to abnormal muscle function.
The role of investigations
When conditions such as bleeding rectum or pain in the abdomen are
investigated by endoscopy (sigmoidoscopy or colonoscopy) or x-ray
barium enemas then diverticula are often discovered as a side effect.
Elderly people who are well typically have diverticula so their
importance as to the cause of the symptoms or not is important to
establish. Evidence of inflammation on blood tests and tenderness of
the diverticular area indicate the diagnosis is diverticular disease.
The increased folds in the left, lower colon lining which can be
present are the abnormal muscle finding in diverticular disease.
Since more worrying conditions can also produce symptoms it is
important to reassure patients. Muscle contraction changes and
infections can both cause symptoms without any signs of inflammation.
Explanation helps patients realise the reasons why various treatments
are tried and not others.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles
in London, back pain, orthopaedic conditions, neck pain and
injury management. Jonathan is a superintendant physiotherapist at an
NHS hospital in the South-West of the UK.
Article Source: http://www.articlesbase.com/health-articles/
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