Diverticulosis is a disease in which the formation of so-called pockets occurs, that is, single or multiple protrusions of the intestinal mucosa, which are herniform. Their size can be up to 5 mm in diameter, sometimes even a little more. They are called diverticula.
Interestingly, back in the 1930s and 40s, the prevalence of this disease, according to x-ray studies, was no more than 7%. While in recent years, the figure has increased to 30%. It should be borne in mind that very often, at least at the beginning of the disease, diverticulosis is asymptomatic. That is, in fact, its prevalence can be much higher - up to 50%.
At the same time, mainly residents of economically developed countries suffer from pathology, which suggests that lifestyle and eating habits play an important role in its pathogenesis.
Causes of diverticulosis
Currently, the causes of the development of diverticulum in the walls of the intestine are unknown to medicine. The most common theory is that it is believed that such protrusions are the result of increased pressure inside the intestine itself - the weakest places and form the described "pockets".
As for pressure changes, they are associated with nutritional characteristics. If a person receives enough fiber, this ensures the normal motility of the intestine and the gradual movement of feces along it.
If a person does not get enough fiber, then this leads to certain stagnant processes inside the intestine, as a result of which its contents press on the walls, and after a while diverticulums form.
Interestingly, they form where many vessels pass through the muscle layer. These places are considered the weakest.
Considering the diverticulosis of the intestine, the symptoms and treatment of this disease, it should also be noted that a number of risk factors work for it, which include:
- chronic constipation;
- the presence of inflammatory processes in the intestine;
- excess weight;
- decrease in dietary fiber.
Currently, the relationship between the use of coffee or alcohol and the development of diverticulosis has not been established. However, it is proved that the risk of developing pathology is associated with the use of large amounts of fats and red meat. Reducing the risk will help the introduction of fiber contained in vegetables and fruits into the diet.
Colonic diverticulosis: the main symptoms
Three forms of diverticulosis are distinguished - asymptomatic (when diverticuli are found during the examination by chance), uncomplicated when there are certain clinical manifestations, and also complicated (diverticulitis is most often added).
Diverticula usually appear in the large intestine. Much less often - in the small and duodenum.
Considering diverticulosis of the large intestine, the symptoms can be identified as follows:
- Pain syndrome. Moreover, the pain can be of a different nature - from a slight tingling to severe attacks. In between, aching sensations may appear.
- Nausea and vomiting.
- Unstable stools when constipation alternates with diarrhea. Interestingly, after defecation, many symptoms, including pain, disappear for a while.
- Signs of intestinal dyspepsia (flatulence, bloating, distinct rumbling).
Abdominal pain in the disease does not have a clear localization. The patient can only say that it hurts somewhere on the left, in the iliac region. As the intestines fill with content, the discomfort intensifies.
Interestingly, constipation in such cases occurs in approximately 85% of patients, but diarrhea occurs in only 15%. Most often, the pain syndrome is provoked either by malnutrition (for example, by consuming too much fatty foods), or by uncontrolled intake of laxatives, or by some psychoemotional reasons.
Considering diverticulosis, symptoms and treatment in adults, it should be noted that with an uncomplicated form of this disease, signs of other pathologies are often manifested, with which the appearance of diverticulum is associated. They can be divided into several groups:
- obesity;
- inferiority of connective tissue (congenital or acquired);
- impaired motor function of the intestine.
Often at the same time diseases of the biliary tract develop with their characteristic symptoms.
Diagnosis of the disease
Complaints of pain or even simply discomfort in the abdomen, periodic stool delays, the other symptoms listed above are sufficient grounds for additional diagnosis.
The doctor must conduct an examination, while palpation of the abdomen helps to identify painful areas - usually they are on the left. But the appearance of symptoms of peritoneal irritation may indicate the development of complications, including intestinal obstruction.
For the diagnosis of diverticulosis, a rather informative method is irrigoscopy (intestinal examination using a barium enema, which helps to determine the presence of protrusions). A colonoscopy is also prescribed, which allows you to determine the presence of inflammatory changes or perforations - complications of diverticular disease.
Conservative therapy
Considering intestinal diverticulosis, symptoms and treatment in adults, it should be noted that conservative methods are almost always used. Unfortunately, they usually do not affect the reasons for the development of the disease described above, therefore, to increase efficiency, it is necessary to take comprehensive measures, for example, to fight obesity, to make adjustments to the usual way of life.
If we are talking about a form of diverticulosis without clinical manifestations, then even special treatment is not required, it is enough to take more fiber daily - at least 200 g of vegetables. Some experts consider the use of bran to be effective.
If we are talking about the classic symptoms of diverticulosis, the treatment will be slightly different. Usually this is an uncomplicated form, but to avoid the progression of the disease and the development of concomitant pathologies, you need to undergo courses of conservative therapy 2-3 times a year. Their duration is determined by the doctor, based on the overall picture, on average, they can last 2-6 weeks.
Treatment of the disease as a whole includes three areas:
- A special diet with an increased amount of fiber and dietary fiber to normalize digestion and eliminate constipation.
- Drug treatment, including the use of antispasmodics and prokinetics, depending on the nature of motor disorders.
- Elimination of constipation by taking osmotic laxatives - mainly drugs containing lactulose.
An important nuance - the use of stimulant laxatives with diverticulosis is contraindicated, since they affect the pressure in the intestinal lumen.
Surgical intervention is indicated only in severe cases of the disease and the development of complications.
Drug therapy for diverticulosis
Treatment of a dorsicular disease in the presence of pain involves taking drugs such as antispasmodics, such as No-Shpa, Papaverin, Drotaverin. You can take them only after consulting a doctor.
Also, enzyme preparations like Creon or Festal can be prescribed to normalize digestive processes. Gastrointestinal motility stimulants (for example, Metoclopramide) cannot be taken on their own, in any case, since they can affect pressure indicators.
But in some cases, the doctor prescribes such drugs according to the results of the examination.
If diverticulosis is accompanied by complications in which antibiotic therapy is prescribed, then probiotics - Linex, Bifidumbacterin - are additionally taken.
Diverticulosis nutrition
As already noted, nutrition for diverticulosis involves the use of so-called ballast substances, or dietary fiber. This is plant fiber, due to the presence of which feces absorb water more intensively, become more loose, which facilitates their promotion. In addition, fiber is a prebiotic, that is, an environment favorable for the active reproduction of beneficial microflora.
The energy value of the daily diet for diverticulosis should be no more than 2500 kcal, provided that the patient has moderate physical activity. At the same time, food should contain at least 30 g of fiber. And you need to include in the menu products that contribute to the normalization of digestive processes. It:
- Whole grain cereals, with unpeeled rice varieties especially useful (this is brown rice).
- Vegetables and fruits. However, especially in the presence of concomitant diseases of the digestive tract, caution should be exercised with them. For example, with gastritis, apples are best eaten not in raw, but in baked form. Up to 500 g of vegetables and fruits should be eaten per day.
- Wholemeal bread.
- Sour-milk products of low fat content.
By the way, all other products of animal origin, except for eggs, kefir and cottage cheese, must be limited. Meat can only be eaten white (rabbit, turkey, chicken) and not more than 150 g per day. You can eat pasta, but only from durum wheat. Semolina from the menu will have to be excluded, wheat bread, too.
Sigmoid colon diverticulosis: symptoms and its treatment
In almost 70% of cases of diverticular disease, protrusions appear in the sigmoid region. This is due to its functional and anatomical features. If this form of diverticulosis is diagnosed, the symptoms and treatment will, in principle, be close to the picture characteristic of the large intestine as a whole.
The sigmoid colon has a smaller diameter, it has many bends, and its contents are more dense. In addition, it performs a reservoir function, which leads to an increase in pressure on its walls.
Thus, if diverticulosis of the sigmoid colon, symptoms and treatment are diagnosed, the diet will be as described above. This form differs from diverticulum in the small intestine in that it is easier to detect, and also with it there is less risk of developing some complications, including bleeding.
Diverticulosis in the elderly: symptoms and treatment
Diverticulosis may be associated with various pathologies, but most often the problem is the weakness of the intestinal wall. With age, the tone of the muscles of the large intestine gradually decreases, the connective tissue wears out, which leads to the appearance of a diverticulum.
Both vascular pathologies and dystrophic changes play their role here. The latter in elderly people arise as a manifestation of general degenerative processes in the body, often they are associated with the development of atherosclerosis.
Intestinal diverticulosis, symptoms and treatment of the elderly are of particular interest, since the risk of disease increases significantly with age. In general, the signs correspond to the clinical picture described above.
In older people, symptoms such as increased gas formation, flatulence, false urge to defecate are more common (and even after the bowel movement is empty, a feeling of fullness remains). In addition, traces of mucus are visible in the feces.
For the elderly, proper nutrition plays a particularly important role. In general, it is recommended to adhere to the above recommendations, that is, include at least 30 g of fiber in the diet. At the same time, nutrition should correspond to treatment table No. 4 according to M. Pevzner. This means that you must adhere to certain rules of culinary processing (dishes can be cooked, steamed, in extreme cases, baked without a crust, but do not fry).
It is necessary to spare the stomach and intestines. This means that you can’t eat too hot food, and spicy, fatty and fried foods, and even more red meat, are excluded from the diet.
Diverticulosis and diverticulitis
It is necessary to distinguish between these two diseases. If diverticulosis is the appearance of protrusions, then diverticulitis is inflammation.
By themselves, the symptoms of diverticulosis may not occur for a very long time, without even giving a reason to go to the doctor. If severe pain appears, this means that the person has developed diverticulitis. True, this happens quite rarely, since approximately 80% of people do not have pain. By the way, the presence of diverticulosis is most often detected during tests that are prescribed for other diseases.
Diverticulitis is a complication of diverticulosis. When the inflammatory process begins, it is already different from the picture that diverticulosis of the large intestine gives, the symptoms and treatment here will be different.
Diverticulitis is characterized by:
- fever, sometimes chills;
- dyspeptic symptoms - nausea, vomiting;
- stool disorders;
- anorexia;
- the appearance of a painful dense sedentary infiltrate in the abdominal cavity.
Sometimes the bladder is also involved in the inflammatory process. Since inflammation is often associated with a bacterial infection, and diverticulosis itself only creates favorable conditions for its spread, therapy most often involves oral antibiotics, and in severe cases, their intravenous administration.
Treatment should generally be conservative. But in some cases, surgical intervention is necessary, although not emergency (urgently operated only with an abscess or peritonitis). This mainly happens with a chronic form with severe symptoms.
Prevention of diverticulosis
Complications of this disease occur only in 20% of cases. However, in medicine this indicator is considered quite high, therefore intestinal diverticulosis, the symptoms and treatment of which are described in the article, must be treated. Not only effective therapy is required, but also prevention.
Since the main risk factors for the development of this disease are overweight and lack of fiber in the diet, you need to adhere to a certain diet and lifestyle. A decrease in the energy value of the diet should be combined with an increase in fiber in it - an average of 32 g per day. Moderate physical activity is also shown, since a sedentary lifestyle affects the functioning of the intestine.