Diverticulosis

What is it?
Diverticulosis, coming from the Latin word diverticulum, means a small pouch or a weak spot in the colon or large intestine that yields to pressure from food or gas within the colon. Tiny pockets of the membrane lining of the colon are pushed out from the inside of the intestinal wall to form small sacs or pouches about the size of a rubber tip of a lead pencil called diverticula.

Diverticula can develop anywhere in the digestive tract but they usually occur in the colon, predominantly in the narrowest part, the sigmoid region.

Is it a rare disease?
In persons under 35 it is unusual, but it is one of the most common diseases of the colon in persons over 40. At least one-third of all Americans over age 45 and more than two-thirds of those over age 60 have diverticulosis.

How serious a disorder is it?
While it can be uncomfortable and burdensome, diverticulosis, in itself, is not a serious condition. It can, however, lead to diverticulitis, a condition caused when the pouches perforate or rupture and become inflamed and infected. Occasionally, the pouches may erode into blood vessels and cause bleeding. Generally, perforation and bleeding of diverticula can be controlled medicinally. Sometimes, hospitalization and surgical treatment are required to control these complications.

Fortunately, with medical supervision, these complications of diverticulosis can usually be avoided. The condition has no direct relation to cancer.

What causes it?
The precise cause of diverticulosis is obscure. The process of aging and muscle shrinkage may weaken the wall of the colon, allowing the pouches to develop. In most case studies, an abnormal thickening of the muscle wall of the colon producing very high pressure inside the colon has been found, and it is thought that this might predispose to the development of pouches.

While constipation, in itself, has not been shown to be a causative factor, the regular use and abuse by millions of Americans of potent laxatives, cathartics and purgatives to cleanse their bowels may well be a contributing factor. Repeated blasting of the colon by these agents, instead of correcting the constipation only makes it worse.

The most likely factor in the high incidence of diverticulosis among Americans is the low residue, low fiber diet consumed in western countries. Africans and Orientals living in rural areas who eat plenty of natural fiber or roughage rarely get diverticulosis. With the technological revolution, our food is more and more highly refined and over-processed and lacking in natural fiber. Fiber is a non-nutrient, but it is essential for normal bowel function.

Fiber deficiency, a leading cause of constipation, results in small hard stools that do not fill out the colon. The colon then develops areas of spasm, which force the pouches through the muscle wall.

Can a diet high in fiber prevent this?
Yes. A high roughage diet will not only prevent the development of diverticulosis but will help treat it once it is established. It will also help correct constipation caused by improper diet.

How does one know if he or she has diverticulosis?
Often, the patient doesn’t know. Most people with widespread diverticulosis have no symptoms. When there are symptoms, they usually include gas, stomach cramps, pain and diarrhea, alternating with constipation.

Aren’t these symptoms common in other disorders?
Yes, including some serious diseases. Before making a diagnosis of diverticulosis, we must first exclude all other possible causes of the symptoms. X-Ray and instrument examination of the colon will confirm the diagnosis by distinguishing diverticulosis from other diseases of the colon with similar symptoms.

How is it treated?
Treatment of diverticulosis is mainly dietary. The condition can usually be cleared up simply by maintaining a high fiber diet. The easiest way to do this is by eating bran cereal every day. Bran, the outer coating of the whole wheat grain which is removed in the processing of grain, has a high percentage of non-nutritive or dietary fiber. Pure bran, which has an even higher percentage of fiber than the bran cereals, can be purchased in health food stores.

While pure bran is very dry, it has almost no taste of its own. It can be mixed into cottage cheese, yogurt, spaghetti, hamburger and many other foods. It is not only high in fiber but it is also an excellent protein “stretcher.”

Psyllium seed commercial preparations (Metamucil, Syllact, etc.) may be prescribed to supplement the fiber in your diet. Medications to reduce the muscular spasm in your colon may also be prescribed for a limited time. Fresh fruits and vegetables are also high in roughage and provide a good amount of fiber.

Should I feed bran to my children in this manner?
Yes. The bran will not even be noticed. You should also see that your children eat raw fruits and vegetables and other high roughage foods. The best way to prevent intestinal abnormalities in later life is to introduce proper dietary habits at an early age.

How long should I remain on a high fiber diet?
Permanently – for as long as you feel well. The fiber that you put back into your normal diet will help you to keep your digestive machinery in high gear. Most people who go on a high fiber diet have such a dramatic improvement that they never revert to their old eating habits. The only time to change the diet is in the event of diverticulitis, with the perforation of one of the pouches. Treatment with antibiotics and a low residue diet are then needed.

What are my chances of developing diverticulitis?
Only about 15% of patients with diverticulosis develop diverticulitis, and the percentage is even smaller for those under the medical supervision on a high fiber diet. Less than 5% of patients with diverticulitis will need surgery. With proper treatment, the complications of diverticulitis can usually be controlled. So it is important to see your doctor at the first sign of symptoms – severe abdominal pain and fever.