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Diverticulitis

Predominantly this is a western disease which is virtually non-existent in Asia and Africa.  This condition occurs in the colon, which is the part of the large intestine responsible for evacuating waste. As we get older, the walls of the colon and the large intestine deteriorate. When too much pressure is applied (such as from passing hard stools or straining during bowel movement, both usually brought on by a diet low on fibre) on the colon, small pouches called diverticula start to swell from the intestine walls.

This is known as diverticulosis.  They are usually as big as a marble and tend to bulge like weak spots in a tire. 

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Statistically, but the time you reach the age of 50, you have a 50% chance of having diverticulosis and when you get to the age of 80, your chances are 70%.  This condition is usually benign and you may have it without exhibiting any symptoms or merely very mild symptoms.  However, if the diverticula becomes infected with bacteria from faecal matter, diverticulosis turns into diverticulitis, which is a whole different story. Usually it starts with pain that increases gradually on the left side of the abdomen.  See symptoms below.  Both diverticulosis and diverticulitis are considered a diverticular diseases.  At third type (or phase) of diverticular disease is known as diverticular bleeding, which occurs when blood vessels near the diverticulum (singular for diverticula) bursts.  The main symptom of this is dark or bright red clots in the stool.

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In recent years more cases of people as young as 20 years old are reported.  Because very often these individuals are obese, a link has been established between diverticulitis and obesity. An additional link is low fibre intake caused by a low fibre and processed food diet which is prevalent in the western part of the world. Fibre is crucial in keeping stools soft, and thereby allowing them to pass smoothly through the digestive system.  Yet, it is not fully understood why the diverticula becomes infected. One reason can be the rapid spread and multiplication of bacteria in the colon.  Another reason could be because a diverticulum becomes blocked, probably by faeces, which leads to infection.

Risk Factors

Both genders are equally affected by diverticular disease. Apart from aging, other risk factors are obesity, smoking, unhealthy fat and low fibre diet and lack of physical activity.  Some medications might also be associated with diverticulitis, such as steroids, non-steroidal anti-inflammatory drugs (NSAIDs) and opiates. Some claim that consuming nuts, corn and seeds may also cause diverticular disease but there’s no scientific evidence to support this.

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Diagnosis

Diverticular disease can be diagnosed through blood tests, x-rays, manual rectal examination, colonoscopy or a flexible sigmoidoscopy. Where the symptoms are severe, a CT scan may also be recommended, as it can help ascertain if the inflammation has spread to other part or abscesses have formed.

Is it hereditary?

Probably not.  It is an age-related, lifestyle- acquired condition which cannot be passed down through generations.  Furthermore, diverticulitis is not infectious.  However, some particular genetic disorder can cause a disposition to the formation of diverticulum. These include Ehlers-Danlos Syndrome, polycystic kidney disease, Williams syndrome and Coffin-Lowry syndrome.

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Symptoms

Chances are that even if diverticula (diverticulosis) are found in your colon during colonoscopy or CT scan, if you’ve never experienced abdominal pain or diarrhoea it’s unlikely that painful symptoms will develop in the future. Symptoms of diverticulosis are usually non-existent or mild, and include belly pain, bloating, constipation or diarrhoea (less common) and abdominal cramps.  Usually, increasing fibre intake will help reduce the risk of any symptoms developing into diverticulitis. 

The symptoms of diverticulitis are more intense and painful and include constant and sever pain of the lower abdomen, bloating, nausea and vomiting, fever, chills, fatigue, blood in the stool and change in bowel habits (such as interchangeable constipation and diarrhoea).   The pain can either come suddenly or intensify over a period of several days.  It usually starts below the belly button and then moves to the lower left hand side of the abdomen. The pain may be more intensive during or after eating and diminish after passing stool and flatulence.

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Possible complications

Although rare, serious problems may arise if the illness is neglected. This is why you should consult a healthcare professional as soon as you experience symptoms.

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Treatment

Conventional treatment usually involves antibiotics and over the counter pain killers.  When the condition is severe, intravenous antibiotics may be administered or there will be surgical intervention (such as bowel resection).  However, these conventional methods may lead to complications and further side effects.

Alternative treatment to reduce the symptoms include modification of your diet (see below), increase of fluid intake, exercise, increase your intake of probiotics, remove all sugar from your diet, practice healthy bowel habits (eat at regular times and avoid straining during a bowel movement), apply a warm cm press to the area of pain and practice relaxation technics (such as yoga or Heartmath).  Supplements can also help by relieving pain and promoting a healthy digestive process.  These include Digestive enzymes, Aloe, Liquorice root and slippery elm.

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Diet

Whilst a diet cannot reverse this condition it may certainly form a part of a good treatment plan and will help give the digestive system a ‘break’ so it can recover from the infection.  Most healthcare professional will recommend a diet high in fibre, which helps soften the stools, allowing them to better pass through the intestines and colon.  Best sources for fibre include vegetables, fruits, potatoes, legumes and whole grains.   

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However, in severe cases, high fibre diet may be ineffective or even worsen the symptoms.  In such cases, a pure juice diet may be recommended as a starting point. The liquid diet must not include fruit or vegetables containing seed or kernels because they may get trapped in the diverticula sacs. Another recommended addition is ginger tea which can help reduce inflammation and aid digestion.  Once the symptoms have lessened you can resume a high fibre diet, but start with consuming easily digestible foods, preferably grated, steamed or pureed fruits and beg. Smoothies would be a good idea because you don’t lose the fibre content as you do with juices. The next stage should be adding high fibre foods, including raw fruit and veg and unrefined grains (such as fermented grains, quinoa, black rice and sprouted lentils).

Prevention

A good starting point is a high fibre diet because fibre in the stool help prevent constipation and facilitating easy bowel movement. In addition, dietary fibre (although indigestible) also fuels beneficial bacteria that produces compounds that help regulate the immune system. There are two types of fibre in our food. Soluble and insoluble. 

  • Insoluble fibre: This type of fibre includes cellulose, some hemicelluloses, and lignin found in whole grains and other plants. This kind of dietary fibre acts as a natural laxative. It absorbs water, helps you feel full after eating, and stimulates the intestinal walls to contract and relax. These natural contractions, called peristalsis, move solid materials through the digestive tract and therefore play a major role in the elimination process.

By moving food quickly through the intestines, insoluble fibre may help relieve or prevent digestive disorders such as constipation or diverticulitis (infection that occurs when food gets stuck inside small pouches in the wall of the colon). Insoluble fibre also bulks up stool and softens it, reducing the risk of developing haemorrhoids and lessening the discomfort if you already unlucky to have them.  Insoluble fibre is found in foods such as wheat bran, vegetables, and whole grains.

  • Soluble fibre: This fibre, such as pectin in apples and beta-glucans in oats and barley, seems to lower cholesterol level. This tendency may be the reason behind why a diet rich in fibre appears to offer some protection against cardiovascular disease.  Soluble fibre is found in oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. It is also found in psyllium, a common fibre supplement.

The following table shows you which foods are particularly good sources of specific kinds of fibre. A diet rich in plant foods (fruits, vegetables, grains) gives you adequate amounts of dietary fibre.

 

Previously healthcare practitioners recommended to patients with diverticulitis to avoid eating nuts, seed and popcorn because those might get trapped in the diverticula sacs and cause or worsen inflammation.  However, there’s no scientific evidence that this is the case and therefore they are safe to consume.  Other ways to prevent diverticular disease include reducing consumption of red meat, foods rich in unhealthy fats, get plenty of exercise (helps ensure normal bowel function as well as reduces pressure on the colon), drink plenty of liquids (but reduce alcohol and caffeine intake), quit smoking, maintain healthy body weight, don’t take NSAIDs and don’t delay going to the toilet (as this can harden your stools and increase the strain on the colon muscles leading to diverticular disease).

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