Diverticulitis is a condition of the bowels (intestines). It mainly affects the large intestine (cecum and colon) but may also involve the small intestine or other parts of the gut. Diverticula are abnormal pouches that form in the bowels, especially in the large intestine. When these pouches become inflamed then it is known as diverticulitis. The condition is more common after the age of 40 years and affects more than 65% of people by the age of 85.
Most people with diverticula do not experience any symptoms and are not aware of the diverticula. However, about 1 in 5 people will experience diverticulitis. Usually diverticula on its own do not cause any significant problem but diverticulitis can sometimes lead to serious complications. Without prompt medical attention, a severe case of diverticulitis can lead to death.
What happens in diverticulitis?
The exact reason why the diverticula become inflamed is unclear. It appears that one or more diverticula becomes blocked with feces or undigested food. Mucus normally secreted by the colon lining accumulates in the now obstructed pouch (diverticulum). Colonic bacteria are also trapped within the blocked diverticulum and a bacterial overgrowth occurs.
Eventually this causes erosion of the colon wall which can culminate in a rupture of the diverticulum. Small perforations are often walled off by surroundng fat tissue but larger tears can lead to abscess formation and peritonitis. The exact cause of diverticulitis has also not been conclusively identified. However, it is associated with constipation. Obesity and a low-fiber diet, which are other contributing factors to constipation, may also be involved.
Read more on diverticulitis.
How to Spot Diverticulitis
Diverticulitis may present with signs and symptoms similar to many other abdominal conditions. It should be suspected in people with a history of diverticula or in the elderly with the following signs and symptoms. Further diagnostic investigation may be necessary to confirm diverticulitis. It is therefore important to seek medical attention as soon as possible to confirm the diagnosis and commence with appropriate treatment. As mentioned, delay in treatment can lead to serious and even life-threatening complications.
Abdominal pain is one of the most common symptoms that occurs in diverticulitis. This pain is usually described as a crampy pain but can be severe in nature when complications like peritonitis arises. The location of the pain depends on where the inflamed diverticulum or diverticula are located. Most of the time the pain is experienced in the left lower abdomen due to diverticultis affecting the descending and/or sigmoid colon.
However, the abdominal pain is non-specific and can be mistaken for other conditions. When the transverse colon is affected, the pain is located in the upper abdomen and may be mistaken for peptic ulcer disease, pancreatitis or gallstones. When the ascending colon or cecum is affected, then the pain is located on the right side of the abdomen. It may be mistaken for appendicitis. Sometimes diverticulitis pain in women is mistaken for gynecological pain.
Nausea and Vomiting
Nausea is another common symptom but may not always be present with the abdominal pain. Vomiting may or may not occur along with the nausea. In addition there may be a loss of appetite. These symptoms are more likely to occur with severe diverticulitis. However, nausea, vomiting and loss of appetite are non-specific symptoms and along with the pain it may be mistaken for other abdominal and/or digestive conditions.
A fever is usually present and may be low grade in uncomplicated diverticulitis. However, in severe cases and when there is a large rupture then a high fever may be present. Systemic infections that arise as a result of a complicated diverticulitis tmay also present with a persistently high fever. The fever along with abdominal pain, nausea, vomiting and loss of appetite are also present in peritonitis which could occur due to other causes other than diverticulitis.
Abdominal tenderness over the affected area (localized) is another common symptom. A tender mass may also palpable during a physical examination. Tenderness is usually present in both uncomplicated and complicated diverticulitis. It may precede the onset of pain. As the condition progresses, the tenderness may become more severe. Generalized abdominal tenderness is more likely to occur with peritonitis.
- Abdominal distension is usually present, although it may not be obvious in the early stags.
- Bowel sounds may be diminished or absent.
- Alterations in bowel habit, usually constipation but sometimes diarrhea.
- Urinary symptoms like frequent urination, painful urination and urgency may also be present.
- Blood in the stool may be present but can also occur with diverticula that are not inflamed or infected.
Dangers of Diverticulitis
Diverticula are not usually considered to be a serious condition until the pouches become infected and inflamed. If left untreated or not properly treated on time then complications can arise. It is these complications that can be dangerous and even deadly. Some of the complications of diverticuiltis are discussed further.
Collection of pus in the blocked and inflamed pouch. This abscess may enlarge and further weakens the diverticulum. Eventually the abscess may burst and the intestinal wall may tear.
Abnormal passage that forms between the bowel and bladder or different parts of the bowel. The contents of each tract can then pass into the other tract.
Blockage in the bowels usually due to the formation of scar tissue. This obstructs the movement of intestinal contents which may in turn lead to other complications.
Tear in the bowel wall, usually at the site of the inflamed divertcula, which allows the bowel contents to spill into the abdominal cavity.
Read more on burst bowels.
Spillage of the intestinal contents into the abdominal cavity may lead to inflammation of the abdominal cavity lining (peritoneum) and other abdominal organs. This is known as peritonitis.
Sepsis is where there is a severe systemic response to the infection. The immune chemicals to fight the infection can cause widespread inflammaton in the body and affect multiple organs. This can lead to septic shock which is very serious and potentially life-threatening.