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Diverticulosis is characterized by small sac-like protrusions (hernias) of inner intestinal tissue through the muscular wall of the large intestine (colon). These protrusions are called diverticula and may occur in any part of the colon, but most frequently are found in the lowest part (sigmoid).
Diverticulosis is characterized by small sac-like bodies (diverticula) that protrude through the wall of the colon. The diverticular wall consists of a thin layer of mucous membrane tissue. Diverticula can vary in size from 0.1 inch to larger than 1 inch in diameter.
In most cases, individuals with diverticulosis exhibit no symptoms of the disorder (asymptomatic) other than the development of diverticula. However, in rare cases, diverticulosis may cause abdominal pain, constipation, diarrhea, an uncomfortable feeling after eating (dyspepsia), and/or bleeding from a portion of the large intestine (rectum).
In some cases, the diverticula may become inflamed or infected (diverticulitis). (For more information on this disorder, see the Related Disorders section of the report.)
Diverticulosis may be caused by a highly refined diet lacking sufficient fiber and bulk. The lack of bulk may cause muscle spasms of the colon, especially in the lower section called the sigmoid. Pressure inside the colon builds up and the mucous tissue eventually pushes through the muscular coat of the colon, usually where the blood vessels pierce the muscle. Ulceration of the diverticulum may occur causing rectal bleeding. Chronic constipation may also cause diverticulosis. If the sacs become infected, diverticulosis becomes diverticulitis. (For more information, see the Related Disorders section of this report.)
Diverticulosis is a common disorder affecting 30 to 40% of persons over age 50. The incidence increases with each subsequent decade of life. It affects males and females in equal numbers. Diverticulitis is less common than diverticulosis.
Diverticulitis is characterized by inflammation of one or more diverticula. Perforation of a diverticulum may lead to inflammation or contamination of the surrounding tissues in the abdominal cavity. The inflamed bowel segment often adheres to other parts of the bowel or the vagina. An abnormal connection to those organs (fistula) may develop. With repeated inflammation, the colon wall thickens, its cavity narrows, and acute obstruction or perforation may occur.
Carcinoma (adenocarcinoma) of the colon is characterized by pain in the lower abdomen, constipation or diarrhea, excessive gas (flatulence), liquid narrow feces streaked with blood, and nausea. Patients with this disorder lose weight. The cause of this type of cancer is unknown. It may be associated with polyps or ulcerative colitis. This cancer tends to run in families and has a peak incidence between the ages of 50 and 60.
Familial polyposis of the colon is a genetic digestive disorder that is usually without noticeable symptoms for years. A polyp is a mass of tissue that arises from the mucous membrane of the intestine and protrudes into its cavity. Familial polyposis is characterized by rectal bleeding, possibly diarrhea or constipation, intermittent abdominal pain and weight loss. The polyps usually develop during puberty or early adulthood. Untreated patients with familial polyposis have a very high risk of developing colonic cancer. (For more information, choose "polyposis" as your search term in the Rare Disease Database.)
The diagnosis of diverticulosis is usually confirmed by the presence of diverticula on CAT-scan or x-ray images. Examination of the diverticula can also be done directly by inserting a very thin, flexible tube through the rectum into the colon. This tube is equipped with a tiny, powerful camera that helps the doctor determine if inflammation is present in the diverticula.
In some cases, especially in people over 50, a diagnosis of diverticulosis may be suspected if the individual is overweight, exhibits signs of thickening of the inner layers of the walls of certain arteries (atherosclerosis), and experiences abdominal pain or rectal bleeding.
Some cases of diverticulosis are treated by antibiotics and a few days of liquid diet followed by a diet high in fiber (e.g., whole wheat bread, bran cereal, etc.) Application of heat, adequate rest, a diet with substantial bulk and medication usually relieve symptoms. Small doses of barbiturates, or muscle relaxant, as well as antispasmodic agents may also relieve abdominal distress. Rectal bleeding may be treated by a clear liquid diet, blood transfusions, repair of coagulation defects, and/or the administration of fluids through the veins (intravenously).
Treatment options depend upon the severity of the bleeding. If severe bleeding persists or recurs, surgical intervention may be necessary.
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.
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For information about clinical trials sponsored by private sources, contact:
Berkow R., ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:747-48.
Kasper, DL, Fauci AS, Longo DL, et al. Eds. Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill Companies. New York, NY; 2005:159-60.
Yamada T, Alpers DH, Kaplowitz N, Laine L, et al. Eds. Textbook for Gastroenterology. 4th ed. Lippincott Williams & Wilkins. Philadelphia, PA; 2003:1844-45.
Eglash A, Lane CH, Schneider DM. Clinical inquiries. What is the most beneficial diet for patients with diverticulosis? J Fam Pract. 2006;55:813-5.
Brian West A. The pathology of diverticulosis: classical concepts and mucosal changes in diverticula. J Clin Gastroenterol. 2006;40(7 Suppl 3):S126-31.
Spiller R. How inflammation changes neuromuscular function and its relevance to symptoms in diverticular disease. J Clin Gastroenterol. 2006;40(7 Suppl 3):S117-20.
Bogardus ST Jr. What do we know about diverticular disease? A brief overview. J Clin Gastroenterol. 2006 Aug;40(7 Suppl 3):S108-11.
FROM THE INTERNET
Diverticulosis and Diverticulitis. National Digestive Diseases Information Clearinghouse (NDDIC). October, 2006.
Bebarta V, Heard K. Diverticulosis and Diverticulitis. EMedicineHealth. Last Editorial Review: 8/10/2005
Diet for Diverticulosis. Department of Nutrition and Dietetics. The Ohio State University Medical Center.©(5/2003).
Report last updated: 2009/12/10 00:00:00 GMT+0