Diverticulosis - Diverticulitis

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Diverticulosis - Diverticulitis
Diverticulosis - Diverticulitis
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Diverticulosis and diverticulitis

In diverticulosis there are numerous protuberances on the intestinal wall, so-called diverticula. All layers of tissue in the intestinal wall can turn outwards at certain points. These are also known as “real” diverticula. If only parts of the intestinal wall are affected - the mucous membrane of the intestine and / or the layer of tissue between the mucous membrane and the muscle layer - this is also called a pseudodiverticulum.

In principle, diverticula can occur in hollow organs in the body (e.g. urinary bladder or in the esophagus). They most often occur in the left third of the colon (sigmoid diverticulosis). These are mostly pseudodiverticula that often arise in places where blood vessels pass through to supply the intestinal mucosa. One form of diverticulum in which all layers of the intestinal wall protrude is the Meckel's diverticulum in the small intestine.

Diverticula can be harmless and often do not cause any symptoms. However, acute or recurrent inflammation of the diverticula and the surrounding area can also occur - diverticulitis.

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  • What are the causes of diverticulosis and diverticulitis?
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  • Whom can I ask?

Colon diverticula become inflamed, for example, from stool residues that collect in the protuberances and block them, causing bacteria to multiply or the formation of feces which irritate the intestinal wall. In more complicated but not too frequent cases, abscesses and fistulas or perforation (“bursting”) of the intestinal wall can occur. If the inflammation spreads, this can lead to life-threatening complications, such as peritonitis or intestinal obstruction.

What are the causes of diverticulosis and diverticulitis?

The causes for the development of diverticula and inflammation are not yet fully understood. There is a connection with the accumulation of diverticulosis with increasing age - as well as with changes in metabolism, nerves and / or disturbances in the conduction of stimuli and disturbances in the ability of the bowel to move. Genetic components also play a role in the development.

In addition, lifestyle factors with regard to the occurrence of diverticulitis and diverticulosis are examined. This relates, for example, to the connection between the complaints and a low-fiber diet, overweight, smoking and alcohol consumption. The use of certain medications (e.g. NSAIDs, aspirin, paracetamol, corticosteroids, opioids), various diseases, immunosuppression, etc. is likely to be related to the severity of the disease and / or complications.

What are the symptoms?

Diverticula in the intestine do not have to cause any symptoms and can represent a chance finding, for example during a preventive examination or as part of a colonoscopy to clarify diseases.

With diverticulosis, however, the following symptoms can occur:

  • Pain in the abdomen (usually in the left lower abdomen),
  • irregular bowel movements,
  • Constipation, diarrhea (can alternate) as well
  • Flatulence.

Symptoms of diverticulitis include:

  • Pain (usually in the area of ​​the left lower abdomen),
  • Fever as well
  • Possibly difficult, painful urination (dysuria), increased urination at night (nocturia), usually in connection with pain radiating to the lower abdomen.

Bleeding can be a complication of diverticulitis (blood when you have a bowel movement).

Diverticulitis is divided into stages according to the severity and extent of the inflammation. Diverticulosis is referred to as stage 0. Diverticula exist, but without symptoms. Further stages are:

  • Stage I (uncomplicated diverticulitis): the acute inflammation affects the intestinal wall.
  • Stage II (complicated diverticulitis): the acute inflammation has spread. Depending on how far, it is divided into levels (ac). In the worst case, the intestine ruptures and thus an emergency situation occurs! It may be necessary to operate immediately.
  • Stage III: Diverticulitis is chronically recurrent - that is, it keeps coming back.

How is the diagnosis made?

Symptoms of diverticulosis or diverticulitis sometimes occur with other inflammations or diseases. In any case, these should be clarified and treated by a doctor at an early stage.

The suspicion of diagnosis is clarified by taking anamnesis (including lifestyle, bowel movements) and various examinations (e.g. palpation, percussion and auscultation of the abdomen, palpation of the anus).

To clarify diverticulosis, the following are also carried out

X-ray examination of the large intestine with contrast enema (irrigoscopy), whereby this examination is now largely replaced by so-called CT colonography or, ideally, a colonoscopy is performed so that preventive measures can be carried out at the same time

Inflammation (diverticulitis) can occur as a complication of diverticulosis. To diagnose diverticulitis, the following are also carried out:

  • Determination of laboratory values ​​(ESR, serum CRP, urine test),
  • CT of the abdomen, ultrasound,
  • Colonoscopy (colonoscopy), irrigoscopy (X-ray examination of the large intestine) with water-soluble contrast medium and / or CT colonography. In the case of contrast agent allergy (iodine), an MRI is an alternative.

Note Symptoms such as stomach pain, diarrhea, constipation, etc. are often difficult to classify for those affected. In the event of certain symptoms (e.g. severe pain, rapid deterioration in the general condition, etc.), medical help must be called immediately (emergency number 144 or 112) !

How is the treatment carried out?

The treatment is tailored to the individual situation of the patient.

If diverticula are not a problem, they do not necessarily require treatment. In general, a high-fiber diet with sufficient fluid intake, abstinence from nicotine and sufficient exercise is recommended. The attending physician can also discuss measures depending on any medication intake and lifestyle (e.g. smoking, alcohol consumption).

In the course of treating symptoms of diverticulosis, a diet rich in fiber is recommended. Constipation (constipation) can be treated with mild laxatives (laxatives). In addition, antispasmodics (antispasmodic, muscle-relaxing drugs) can be used.

The diverticulitis is treated depends on the symptoms and the severity of the disease. In milder cases, medication may be sufficient; in severe cases or recurrent diverticulitis, hospitalization and, if necessary, an operation are necessary.

Treatment therefore includes:

  • Broad spectrum antibiotics,
  • Drugs that regulate stool,
  • Endoscopy (colonoscopy) for example for bleeding to stop bleeding
  • Surgery (e.g. for abscess, breakthrough, intestinal obstruction, fistulas and bleeding that cannot be stopped by other forms of treatment), part of the intestine may be removed,
  • intravenous medication, parenteral nutrition, food abstinence or light food

In the case of recurring diverticulitis, longer-term drug treatments and an operation can be considered.

So-called NSAIDs (non-steroidal anti-inflammatory drugs) as they are very often used as "pain medication" should be avoided.

Whom can I ask?

Contact persons for symptoms affecting the gastrointestinal area are:

  • Family doctor,
  • Specialist in internal medicine (and possibly additional qualification in gastroenterology),
  • Specialist in general surgery.

The symptoms in the course of diverticulosis or diverticulitis are often not clearly assignable for those affected. These can also indicate other gastrointestinal problems and diseases. In the event of severe symptoms, e.g. severe pain, rapid deterioration in the general condition, notify the emergency doctor immediately (144 or 112)! Even if, for example, no more bowel movements are possible, etc., medical help should be sought quickly. An inpatient stay (hospital stay) may be necessary.

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