It has become a truism to say that we are what we eat. What has not been so easily accepted is that what we do not eat may also have an influence on our health.
Diverticulosis is a condition that affects the bowel. This was a rarity until the early part of this century. Cancer of the bowel, an inflammatory disease of the bowel called ulcerative colitis and hemorrhoids or piles are all thought to be, like diverticular disease, due to our diet which is highly refined and lacks vegetable fiber for bulk.
The word diverticulum comes from the Latin and means a wayside house of ill fame. This is an apt name for these little pockets or blow-outs on the wall of the bowel.
Diverticula are believed to be small hernias of the inner layer of the large bowel (or colon) through the muscle layers at points where the blood vessels enter. All of the colon may be affected but the lower portion just above the rectum is the part most commonly involved.
Where there is a lot of bulk in the diet the food residue takes about 30 hours to pass through the bowel; where this normal bulk is missing the transit time is nearly double and is accompanied by an increase in the pressure inside the bowel.
These factors are believed to cause all the disorders mentioned above.
Diverticular disease affects about 5 percent of those over 40 and becomes more common with age. In its early stages there is a spasm of the muscles in the bowel wall and this may cause symptoms such as lower abdominal pain, and yet no changes will be seen on X-ray.
Later, the rise in pressure inside the bowel causes the bulging out of the pockets through the wall and these are the diverticula. This condition is known as diverticulosis.
The contents of the bowel, the feces, may get caught in these pockets and cause inflammation and infection. This is diverticulitis.
Sometimes the symptoms are mild and vague. There may be lower abdominal pains or just a heaviness felt in the abdomen. There may be either constipation or diarrhea, and flatulence or an excess of wind is common. When infection is present there may be fever and malaise.
Attacks of diverticulitis may last only a few days but are more likely to go on over one or two weeks or longer. An attack of diverticulitis can be recognized on clinical grounds and treated accordingly.
The special investigations to confirm the diagnosis are best left until the acute stage has passed. These include a barium enema, where a solution of a barium salt which is opaque to X-rays is instilled into the rectum and lower bowel. The barium coats the lining of the bowel and so shows its pattern on the X-ray film.
A newer technique in this type of X-ray is to then instil air into the bowel and obtain what are called air contrast studies. This leads to greater accuracy in the investigation.
Sigmoidoscopy is the other necessary test. A hollow tube with a light inside is inserted into the rectum and pushed along into the lower or sigmoid colon. The lining of the bowel can then be seen directly by the doctor.
Cancer of the colon is a common disease, and like diverticulitis, occurs in the same 40-and-over age group. These diseases have similar symptoms and can both be present at the same time. However there is no connection between them – diverticulitis does not lead to cancer. But it is always important when diverticulitis is diagnosed or suspected that cancer be excluded.
In treating an acute attack of diverticulitis, it may be necessary to put the patient to bed. The local application of heat from a hot water bottle may bring relief. Antibiotics are used to control the infection and antispasmodics to relieve the spasm in the muscle of the bowel. Pain relieving drugs may be necessary but these are often constipating.
Diet during an acute attack depends on how the patient feels. Few people with a fever and abdominal pain feel like eating much. Once the acute attack is over it is important to have a diet high in bulk. Plenty of raw vegetables and fruit and unprocessed cereals can provide this necessary residue. Adding bran to the diet has become a popular way of getting this bulk or fiber.
Once the diverticula are present these will not disappear, but further inflammation can be avoided by the proper diet. Unfortunately, a number of complications may develop, which are likely to lead to an operation.
- Colostomy, where the bowel is opened onto the skin, may be a necessary procedure in some of the complications, but this is usually only a temporary measure and the bowel is rejoined within a few months when the area to be rested has healed.
- The inflamed diverticulum may perforate and spill the bowel contents into the abdominal cavity. This can cause a local abscess or generalized peritonitis.
- An abscess may lie over another organ and burst through to form a fistula which connects the bowel to the bladder or the vagina, or to another portion of the bowel.
- The inflammation may lead to scarring or fibrosis and this may narrow the bowel and eventually cause obstruction. Bleeding from the diverticula may happen and this may be so severe as to require blood transfusion.
Diverticulitis is a disease of modern society, due to the changes in diet that seem to go with increasing affluence. We can avoid this condition and several others if we eat a more natural diet, one that contains a lot of vegetable fiber. This indigestible material, thought to be unnecessary, is removed and discarded in the manufacture of highly processed modern food.