Sigmoid colon diverticulosis: symptoms, causes and treatment features

This article will discuss the symptoms and treatment of sigmoid colon diverticulosis.

According to statistics, this disease is diagnosed in every fifth person in the world. Its symptoms are manifested, in most cases, in the elderly, and is associated with age-related disorders in the body. After 80 years, a similar disease is detected in more than half of patients.

Description

Diverticulosis of the sigmoid colon is considered to be a pathological process, which is characterized by the formation of a diverticulum (saccular herniform protrusions on the walls of the intestine). As a rule, the disease develops closer to 50 years, since it is at this age that the walls of the sigmoid colon begin to weaken and squeeze out with an increase in intracavitary pressure.

The formation of a diverticulum is usually not a congenital disease, but is manifested under the influence of adverse factors, as well as from malnutrition. When the formation of multiple diverticulums is noted in the sigmoid colon, a similar disease is characterized as diverticulosis of the sigmoid colon (code K57 according to ICD-10), however, it should be distinguished from diverticulitis, the main factor in the occurrence of which is inflammatory processes.

Development reasons

The fundamental reason for the development of this pathological phenomenon in clinical medicine is considered to be age-related changes that lead to degeneration of the muscles of the intestinal walls and provoke general degenerative disorders in the body.

Another factor contributing to the development of diverticulosis is the weakness and underdevelopment of connective tissue, which occurs as a result of acquired or congenital malfunctions in the synthesis of collagen fibers.

In addition, disruptions in intestinal motility are considered a common cause of this disease. This is manifested in such a way that with an increase in the intestinal pressure, the fibers of the intestinal walls seem to stretch and form specific protrusions, which are called diverticula. They can form with spasms of the intestinal muscles, which lead to squeezing of blood vessels inside the intestinal walls and impaired blood circulation in them. As a result, there is a distension and dystrophy of the spaces near such vessels, which eventually leads to similar protrusions.

The cause of the formation of diverticulum can be a hereditary factor, and the likelihood of developing this disease increases many times if there are cases of sigmoid colon diverticulosis in the family.

An important role in the development of pathology is played by diet. Numerous scientific studies confirm that, for example, in India and African countries with the prevailing prevalence of plant products in food, there are much fewer cases of the development of such a disease than in Europe, where preference is usually given to food of animal origin.

Types of disease

Depending on the initial factors that provoked the development of sigmoid colon diverticulosis, the pathology is classified as congenital or acquired.

Given the nature of the pathology, diverticulosis may be:

• asymptomatic;
• with pronounced, characteristic signs;
• complicated.

False and true diverticulosis

In addition, the disease is divided into false and true diverticulosis. True refer, as a rule, to congenital forms of pathology, which is characterized by protrusion of all layers of the intestine, its mucosa, muscle and submucous membranes. The false form of diverticulosis is acquired, and develops throughout life. It can occur by protrusion of the mucous membrane of the sigmoid colon.

Characteristic symptoms

It is best to start the treatment of this disease with the onset of initial symptoms, however, it is sometimes difficult to detect diverticulosis of the sigmoid colon, as in most patients the pathological process can proceed without visible signs and is detected, most often, by chance during any examinations.

The most common symptom of this disease is pain in the lower abdomen. In this case, pain can be of a very different nature and can be perceived by people as a violation in the digestive tract, and in women as a violation in the reproductive sphere. Patients often associate unpleasant manifestations with nutritional errors and do not seek medical help, since the pain usually disappears after bowel movement.

Very often, symptoms of sigmoid colon diverticulosis develop against the background of intestinal irritation syndrome. When an inflammatory process occurs, the symptoms of the disease begin to significantly increase. The pain in the left iliac part becomes persistent and prolonged, and its intensity after the act of defecation, as a rule, does not decrease.

The pain syndrome can last several days and intensify upon palpation of this area and even during movements. Stool instability can be accompanied by nausea, vomiting, abdominal cramps and a constant feeling of discomfort.

If at the first stages of occurrence the symptoms of sigmoid colon diverticulosis are practically absent, then over time they make themselves felt. Due to stagnation of feces, the development of complications of this disease begins - inflammation of the protrusion of the intestinal walls (diverticulitis). In this case, the pain syndrome becomes constant and is accompanied by severe intoxication phenomena in the body and fever.

With a prolonged course of sigmoid colon diverticulosis and the formation of a large diverticulum, the following symptoms may occur:

• pain of a pulling nature in the lower left abdomen caused by spasm of the sigmoid colon;
• constipation or unstable stools for a long time;
• bloating in the left side and flatulence;
• a feeling of heaviness and overflow in the abdomen, especially in its left part, which passes after the stool.

It is important to know how to treat sigmoid diverticulosis.

Possible consequences

When complications occur, a deterioration in the patient's condition is noted, which is accompanied by severe weakness and fever. In the absence of treatment, the following pathologies develop:

1. Intestinal bleeding, which occurs in most cases suddenly and is caused by vascular damage due to the formation of erosion or ulcers inside the inflamed diverticulum. The patient notes the appearance of blood in the feces, the amount of which depends on the size of the affected vessel. Sometimes bleeding can be very profuse, and if this symptom acquires a chronic form, the patient begins to develop anemia, dizziness, shortness of breath, weakness, and a fast heartbeat.
2. The development of diverticulitis. This complication is provoked by bacteria that accumulate and multiply in the feces. This pathological process is manifested by severe pain, hyperthermia and the appearance of mucous elements in the feces.
3. Perforation of the diverticulum, when its contents exit the sigmoid colon into the abdominal cavity and peritonitis begins, is a life-threatening condition. If it enters the retroperitoneal cavity, a phlegmon (suppuration of tissues) is formed.
4. Abscess in the cavity of pathological protrusion of the intestine. If this formation breaks into the intestines, an improvement in the patient's condition is observed. In case of a breakthrough into one of the neighboring organs, the formation of an internal fistula begins. With an intestinal-vaginal fistula, patients have abundant discharge with an unpleasant odor and an admixture of feces from the genital tract. Fistulas in the gastrointestinal tract are manifested by repeated vomiting, and intestinal vesicles provoke frequent cystitis, characterized by excretion of urine particles of feces and pus.
5. Bowel obstruction, which develops as a result of a long ongoing diverticulitis and the formation of an adhesive process in the intestine.

How to detect diverticulosis of the sigmoid colon (ICD-10 code - K57)?

Diagnostic measures

The development of this disease threatens with very unpleasant and serious complications, therefore, correct and timely diagnosis will help to take measures in order to avoid life-threatening conditions.

When examining a patient, a specialist should pay attention to a number of certain factors: age, characteristic complaints, lifestyle, tendency to develop constipation, the nature of nutrition. The doctor also examines the patient, revealing painful areas characteristic of such a pathological process by palpation.

A detailed history will also help determine the clinical picture of the pathology and reveal diverticulosis.

To make a diagnosis, a person is also prescribed a series of hardware and laboratory studies. Their list includes:

1. Colonoscopy, which is a research method that allows you to evaluate the condition of the intestinal cavity from the inside. This procedure is carried out using a special flexible probe equipped with a video camera at the end. A probe into the intestine is inserted through the anus. The picture is displayed on the monitor, and the specialist has the opportunity to visually assess the condition of the intestine, determine the presence of a diverticulum and take a piece of tissue for a specific study.
2. Irrigoscopy is an examination in which an x-ray of the intestine is pre-filled with a contrast medium. If diverticula are present in the sigmoid colon, such a substance fills them, and in the picture such bag-shaped protrusions are visualized very well.
3. Laparoscopy, which is a method of diagnosis and therapy at the same time. During this procedure, surgeons make three punctures in the patient’s abdominal wall, through which a miniature chamber is inserted, which makes it possible to examine the surface of organs and to detect even the smallest changes on the walls of the intestine. If necessary, a specialist can remove the diverticulum. The procedure is performed under general anesthesia.
4. In some complicated cases, radiography of the internal organs of the abdominal cavity or visual examination techniques such as MRI and computed tomography are prescribed.
   

Treatment of sigmoid colon diverticulosis

Methods of treating pathology depend on the stage of the disease, the development of complications, well-being and age of the patient, nutritional features and lifestyle. Uncomplicated forms of diverticulosis are treated conservatively, and treatment of a disease of severe stages involves surgical intervention.

Conservative methods for the treatment of diverticulosis of the sigmoid colon involve an integrated approach, which includes a special diet and the use of medications. The patient is prescribed:

1. Broad-spectrum antibacterial agents (penicillins, cephalosporins).
2. Antispasmodic and analgesic medicines that eliminate intestinal muscle spasms (Drotaverin, Mebeverin, No-shpa, etc.).
3. Prokinetics that stimulate motility.
4. Enzymes for the normalization of digestion ("Festal", "Pancreatin").
5. Laxatives containing lactulose (Dufalac).
6. Medicines that restore the intestinal flora ("Bifidumbacterin").
7. Medicines that relieve flatulence and diarrhea ("Sulgin").

With complex forms of the disease, the following activities are carried out:

1. Gastric lavage.
2. Siphon enemas.
3. Infusion therapy with crystalloid solutions.

Surgical treatment is carried out in cases when dangerous complications such as heavy bleeding, intestinal obstruction, peritonitis develop.

Treating sigmoid colon diverticulosis at home can be very effective.

Diet for diverticulosis

To improve the condition, the patient is prescribed a special diet in which the presence of plant fiber predominates. The diet is based on fruits and vegetables, cereals, brown rice and legumes. In order to prevent intestinal irritation, it is recommended to bake, steam or boil foods. What else does the diet for sigmoid colon diverticulosis imply?

You should eat fractionally, taking food 5-6 times a day in small portions. Nutritionists are also advised to adhere to separate nutrition, which contributes to better absorption of food by the body.

Diet for diverticulosis includes bran, whole grain cereals. It is necessary to limit the use of confectionery, convenience foods, chips, flour products.

Whole milk, carbonated drinks, chocolate, coffee and strong tea, alcohol are completely excluded from the diet. Diet in the treatment of sigmoid colon diverticulosis is very important.

In addition, you must include in the menu natural laxatives: dried apricots, prunes, herbal infusions, dairy products. It is also advised to consume garlic, which helps the intestines cleanse and neutralizes many pathogenic bacteria.

Fresh vegetable salads in vegetable oil and a large amount of liquid are recommended for use daily. Freshly squeezed vegetable or fruit juices and liquid dishes are also useful for diverticulosis. A large amount of fiber contains nuts, bran, crops, zucchini, asparagus, cabbage, carrots, spinach.

Consider also the treatment of sigmoid colon diverticulosis with folk remedies.

Folk remedies

Treatment with traditional medicine recipes significantly alleviates the patient’s condition, but they should be used after consultation with the attending physician. The following folk remedies are used:

1. Flaxseed or olive oil. They help get rid of constipation and reduce inflammation. At the same time, it is recommended to take one tablespoon of oil every day during the day and at bedtime, and also use it for dressing salads. What other folk remedies for sigmoid colon diverticulosis are used?
2. Herb tea. For its preparation, dried nettle leaves, chamomile flowers, motherwort, dill seeds and rose hips, in equal proportions, are mixed. In a thermos, you should pour a tablespoon of this mixture and pour 200 ml of hot water, then let it brew for an hour. Then the infusion should be filtered and drunk 100 ml in the morning and in the evening.
3. Decoction of elm bark. One spoon of crushed bark is poured into 200 ml of water and boiled for 20 minutes, then the broth needs to be filtered and taken 100 ml every day.

We examined the symptoms and treatment of sigmoid colon diverticulosis.