Diverticulitis - How serious is it?
Is Diverticulitis Serious?
Diverticulitis - A Recent Encounter
Recently, whilst working on a ship, a patient was medically disembarked due to discomfort/pain at the lower left side of the abdomen. I thought the patient looked pretty comfortable, and I actually expected a diagnosis of trapped wind or constipation. I was shocked when she was disembarked to hospital with a diagnosis of possible diverticulitis.
The doctor who saw the patient explained to me that the patient demonstrated a classic presentation of diverticulitis. Although the pain was relatively mild and had been present for four days before they had presented to the medical centre, it concerned the doctor enough to immediately request blood tests, which indicated a decent infection somewhere in the body, and added enough evidence for him to disembark the patient for immediate medical review – Unfortunately we don’t have any facilities to scan patients on a Cruise Ship.
Despite working on a Gastro ward for 18 months in the past, my knowledge on diverticulitis is pretty poor. So I’ve done some research and thought I would share what I’ve learnt.
So What Is Diverticulitis?
Our intestines are a ridiculous 28ish feet long, so it is unsurprising that sometimes things can go wrong. As we age, it is possible to develop small protrusions in our intestines. These bulges can and often are present with absolutely no symptoms whatsoever. When this is the case, the protrusions are named diverticula (one) or diverticular (multiple) and it is possible to have them and never know about it. However, if these diverticular become painful it is called diverticular disease. If things get worse, and they become infected or inflamed causing symptoms to feel more severe (see below), this is then called diverticulitis.
What Are The Symptoms Of Diverticulitis?
Lower left quadrant abdominal pain is a classic symptom. Often this pain feels worse when eating or having a poo, but sometimes is eased slightly when passing wind. It is possible to notice constipation, diarrhoea and even blood or mucus in your poo. Nausea and vomiting and a high temperature are also possible symptoms. Diverticulitis can be mistaken for a urine infection due to going for a wee more often and sometimes experiencing pain when doing so. It is also possible to bleed from your bottom.
Any symptoms of diverticular disease or diverticulitis should be investigated immediately. Other conditions such as, bowel cancel, irritable bowel syndrome, Crohn’s disease and coeliac disease may also cause the same symptoms. Diagnosing diverticular disease/diverticulitis will likely involve blood tests, scans and likely a colonoscopy (a very small camera that goes up your bottom). Imagine looking inside a nice empty-of-poo intestine, it will look like a soft light pink tunnel, now imagine Swiss cheese (the cheese with the little holes in). If your intestine appears to look like a tunnel of Swiss cheese or Leerdammer then you have diverticula/r
Preventing Formation of Diverticular
It is thought that diverticular are caused by our poo being too hard. Cases of diverticular disease are increasing, and evidence suggests this is mostly due to our diet. Higher rates of obesity than ever before and increasing reliance on processed foods, has slowed up our guts. The rate our food moves through our intestines has slowed, and our intestines must work harder than ever before to shift this food.
This delayed motility is likely due to a lack of fibre in the diet, as the increased cases of diverticular disease coincides with the invention of white flour, which contains much less fibre than whole grains. Fibre is important in many ways; it helps us to feel fuller for longer and aids with the digestion of food and prevents constipation. Fibre can be had from cereals, fresh fruit, vegetables, beans and pulses, rye crackers, potatoes with the skins on, nuts and seeds and we should aim to eat around 32ish grams of fibre a day. Yes, these foods are very high in carbs, but carbs are amazing, do not hate them. (Read this post about Keto for more information on carbs). If you struggle to eat any of the above foods, it is also possible to get supplements in powder (made into a drink) or tablet form from chemists or health food shops. Other great ways to get constipated include, not drinking enough fluid, not moving enough, or taking opiate medications (like codeine for example).
Other risk factors for developing diverticular are; age (so don’t grow old), being overweight, smoking, not exercising, a diet high in animal fats (cough, keto) and taking medications such as steroids and ibuprofen.
Is Diverticulitis Serious?
As with any infection, it can be. If left untreated it can cause sepsis which can be fatal. It is likely you will need antibiotics, however, depending on the severity of the symptoms, hospital admission may be required for intravenous antibiotics, IV fluids and possibly surgical intervention. In serious cases, surgery may be required to remove the section of affected bowel. You may require a colostomy which involves the end of your bowel being rerouted through an opening in your abdomen. It is possible to develop an abscess in your intestine which will require draining.
One medical paper I found online claims that in the US, diverticulitis accounts for around 150,000 hospital admissions a year, with 50,000 of those people admitted requiring a bowel resection due to a perforation of a diverticula. Diverticula are like little stretched balloons protruding from the sides of our intestine, like a balloon, they are weaker when stretched and it is possible for them to pop – or perforate which is very bad news! A perforated diverticula can cause peritonitis – infection of the lining of the abdomen. This is a medical emergency and may require immediate surgery.
Scarring caused by the infection can cause a partial or complete blockage of the bowel – also bad news and a trip to theatre which may lead to a colostomy being fitted.
It is also possible to develop an ileus. Our intestines move food along them by the contraction of the muscles which line them, this is called Peristalsis. However, if something happens to disrupt this motion you can get a horrible backlog of, well, a log! Our poo can become stuck, and everything behind it also grinds to a halt, including liquid and gas. I was lucky enough to have an ileus after having gallbladder removal surgery and it was honestly the most excruciating experience of my life which took five days to eventually resolve – give me childbirth any day! An ileus can lead to a perforation (the popping of a balloon) and your back to having sections of bowel chopped away.
Thankfully, these are the more serious cases. If someone knows they have diverticular disease and experience symptoms (the point where the pain starts but it hasn’t developed into diverticulitis yet), they should contact their GP as soon as possible to start antibiotics. They may well be put on a fluid only diet for a few days until things settle.
Well, that was cheerful, but I hope it was interesting. I’m off to satisfy my craving for cheese..
Did you know that there are 25 feet of intestines in your body – so if you lay these out on a tennis court….
.. You would die.