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Understanding and Preventing Diverticulitis

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A Shared Experience with Pope Francis

Around 200,000 Americans undergo surgery for diverticulitis every year, a medical condition that Pope Francis himself recently recovered from. This sheds light on the seriousness of this ailment impacting the colon. In this article, we will explore the reasons behind the occurrence of diverticulitis, its common symptoms, and available treatment options.

What is Diverticulitis?

Diverticulitis stems from diverticulosis, a condition that develops when weak areas of the colon's inner wall protrude outward, forming small pouches. The prevalence of diverticulosis increases with age and affects approximately 58% of adults aged 60 and above in the United States. Adequate dietary fiber intake can help protect against the development of diverticulosis.

The Silent Presence: Recognizing Diverticulosis

Many individuals are unaware of having diverticulosis as it rarely presents symptoms. Often, the diagnosis only emerges incidentally during a colonoscopy or abdominal CT scan conducted for other reasons. Although diverticulosis itself doesn't cause any noticeable signs, it is more commonly found in individuals who have irritable bowel syndrome or experience constipation, bloating, and abdominal discomfort after eating.

Dr. Matthew Hamilton, a gastroenterologist at Harvard-affiliated Brigham and Women's Hospital, emphasizes that while diverticulosis is prevalent, only a fraction of those affected will develop diverticulitis due to inflammation or infection of one of the pouches.

Spotting the Signs of Diverticulitis

The primary symptoms of diverticulitis include abdominal pain, typically on the lower left side, and fever. The pain is sharp and distinctive, often intensifying over a few hours. Other possible symptoms may include decreased appetite, nausea, vomiting, abdominal bloating, cramping, and a lack of passing gas or stool.

Mild cases of diverticulitis with minimal lower abdominal pain may resolve within a day or two without medical intervention. However, if the symptoms persist or worsen, such as experiencing escalating pain, fever, bloody stools, or abdominal bloating accompanied by vomiting, immediate medical attention should be sought.

Treatment for Uncomplicated Diverticulitis

Uncomplicated diverticulitis indicates that the inflammation or infection is limited to a specific section of the colon without any complicating factors. Such cases can typically be managed at home with oral antibiotics. "Bowel rest" is often advised, involving a few days on a clear liquid diet, which allows the bowel to rest, heal, and potentially reduce pain. A low-fiber diet, ranging from 10 to 15 grams of fiber daily, is recommended until symptoms improve.

In some instances, hospitalization may be necessary to receive intravenous (IV) antibiotics. This is more likely for individuals aged 65 and above or those with underlying medical conditions such as heart disease, diabetes, or chronic obstructive pulmonary disease. Patients generally experience improvement within three days, and if the symptoms subside and their condition stabilizes, they can gradually return to their regular diet.

If symptoms persist despite a week of antibiotic treatment, further diagnostic tests like CT scans may be conducted to evaluate the presence of complicated diverticulitis.

Treatment for Complicated Diverticulitis

Complicated diverticulitis refers to cases where specific complications arise, necessitating prolonged IV antibiotic therapy and potentially surgery. For instance, if scarring from previous diverticulitis episodes causes narrowing (stenosis) in a segment of the colon, surgical intervention may involve removing the affected portion and reconnecting the remaining colon, similar to Pope Francis' case.

During an active diverticulitis infection, other complications like abscesses, perforations (causing bowel contents to spill into the abdominal cavity), or the formation of fistulas (abnormal connections between the inflamed colon segment and adjacent organs) may arise. Appropriate medical interventions, such as drainage procedures guided by CT scans, surgery to repair holes, or colon resection to remove fistulas, may be necessary.

Preventing Diverticulitis: Fiber and Stress Management

Although no guaranteed method exists to prevent infected or inflamed diverticula once diverticulosis develops, adopting a high-fiber diet and managing stress could potentially lower the risk of diverticula formation in the colon. While these lifestyle interventions may not offer foolproof protection, they can contribute to reducing the likelihood of diverticulitis occurrence.

In conclusion, understanding diverticulitis and its treatment options is crucial for individuals who may be affected by this condition. By recognizing the signs, seeking timely medical attention, and making appropriate dietary and lifestyle choices, one can manage diverticulitis effectively and minimize its impact on overall health.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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