If you chop the large intestine and observe under a microscope , you can see that it has 4 layers. From inside out its named as mucosa (innermost layer), submucosa (below the mucosa), muscular layer (below the submucosa) and the outermost layer serosa. “When the muscle layer becomes weak, the mucosa and submucosa come out through the muscle layer to form a pocket like thing. That is called diverticulum. The condition where this happens is called diverticulosis.”
The most common site for this to occur is part of the large intestine which stores the stools, also known as Sigmoid colon. This is because the pressure inside this part of intestine is high as it stores stools.
Causes of diverticulosis
If one passes stools few number of times a week (less than 4 times), there is a constant high pressure maintained inside the colon (Large intestine). Whenever the pressure inside the intestine which stores the stool increases, there are high chances one can develop diverticulosis.
Low fiber diet
Whenever a person doesn’t take enough amount of fiber in diet, passage of stools decrease. This again increase the chance of developing diverticulosis.
Connective tissue disorder
Group of disorders which include problems in the tissue which supports other body parts like bone, fat, etc are known as Connective tissue disorders. In this case, the muscle layer of the large intestine is weak. This makes it easy for the inner layers to come out when there is even a small increase in pressure, causing diverticulosis.
Symptoms of diverticulosis
Not every time will one come to know if one has the condition or not. Because sometimes this may not show any signs or problems.
Symptoms occur only when the outpocketing intestine gets infected.
- Abdomen pain which lessens after passing gas or stools is a typical of this condition .
- One may have fresh bleeding in a good amount while passing stools.
- One may also have fever in presence of infection.
MRI (Magnetic resonance imaging) or Contrast CT (Computed tomography) scans give a radiographic picture as if the body is cut into a thousand pieces. A doctor can give an outlook by looking at the cut sliced images obtained. This is not much preferred in daily practice as there are much effective investigations available.
There are two main method of investigation by which one can come to know about the present condition of the illness.
- The doctor will insert a small tube in the lower part of the intestines through the anus (opening from where one passes stools). Then he will fill it with a solution called barium sulphate (this does not let the x-ray to pass through, hence giving an impression in an x-ray wherever it fills) and an x-ray is taken. As the solution will go and fill the outpockets, if present, the doctor can make it out easily with this. This is known as barium enema x-ray.
- The doctor may insert a cable, which has a camera fitted in its one end, through the anus (opening through which we pass stools). The other end will be connected to a video monitor. The doctor can see whatever is inside the intestine as a video. If needed he may even capture images. This would give a clear picture of whatever is happening inside. Hence, making it easier to give a confirmed diagnosis. This procedure is known as colonoscopy.
Treatments for Diverticulosis
In cases that does not show any sign, do not need any specific treatment. only when you have signs of infection like fever and abdominal pain or have heavy fresh bleeding while passing stools you may have to get treated.
Aggressive antibiotic treatment may be needed to treat the infection, if it sets in.
Patient may be even kept without food and water for few days to give rest to the colon.
If nothing works out, they might have to undergo surgery.
In severe condition, immediate surgery might be required, if not treated at the proper time it can also lead to the death, because of rupture of the diverticulum causing spread of infection in abdomen leading to septic shock (a condition where vital organs are not properly oxygenated)
Part of the affected large intestine is cut and removed. Then the remaining two ends are rejoined.
Prevention of diverticulosis
- A high fiber food (like whole wheat , barley , oats , etc) will help in easy passage of stools. Hence reducing the pressure inside the intestine. As a result reducing the chances of occurrence.
- Drinking a lot of water also will help regular passing of motion. Hence preventing constant pressures insides the intestine and helping to prevent diverticulosis.
- Defecation when one has the urge to, will also prevent high pressure inside intestine. Hence it is also better not to delay the urge.
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. R. Prabhakaran
Consultant Surgical Gastroenterology
M.B.B.S., M.S. (GENERAL SURGERY), M.Ch. (SGE), DLAP, FACRASI
Dr. S. Akbar
Consultant General and Laparoscopic Surgery
M.B.B.S., M.S (GENERAL SURGERY), D.MAS, F.MAS.