Part One - Diverticulitis And Diverticular Disease

Author: Jonathan Blood-smyth

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 diverticulosis.

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 many diverticula.

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.

Giving information

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 about Physiotherapists, physiotherapy, physiotherapists 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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