Monday, September 14th, 2009




India’s top movie star, Amitabh Bachchan, 63, was confined to hospital, for nearly three weeks after having surgery for an intestinal ailment, diverticulitis. Bachchan’s hospitalization has put the spotlight on diverticulitis, a painful yet little known disease, which involves ruptures in pockets of intestines that is common to many patients in India.

What is diverticulitis?

Diverticulitis is a common disease of the bowel, in particular the large intestine. It is common for people older than age 60 to have saclike pea-or grape-sized protrusions (diverticula) bulging in the intestinal tract— the condition known as diverticulosis. Diverticulitis happens, if tiny cuts in the pouches become infected or inflamed, the result can be severe, causing fever, chills, nausea, and pain

How does it occur?

They typically form if an individual suffers from frequent constipation. Eating a low fiber diet, may contribute to the development of diverticulosis, pouch like protrusions on the intestinal wall. Without sufficient fiber to soften and add bulk, stools are harder to pass. Evacuation then involves increased pressure­— and often as a result of straining over a number of years during bowel movements can cause pouches to form at weak points in the wall of the colon. Once diverticula develop, they do not go away. The good news is that these pouches seldom cause any problems; you may never know you have them.

What causes diverticulosis?

Other than insufficient intake of fiber old age, smoking and stress are aggravating factors for this condition of pouch like protrusions on intestinal wall, diverticulosis. The walls of the large intestine often weaken as a person ages, this is a condition affecting older rather than younger people. The exact reason is not known but smoking and stress make symptoms worse. Infact, this is a classic example of stress-related disorder.

When do diverticulosis develop in diverticulitis?

Sometimes a bit of stool may become lodged in one of the pouches, leading to infection. A small tear or perforation can also develop in an infected pouch, which in turn can cause an infection within your abdomen (peritonitis). If the infection is limited to an area around the wall of your colon where the diverticula’s are inflamed, you may develop a localized collection of pus known as an abscess.

What are the symptoms?

Diverticulitis can be acute or chronic. Symptoms include cramping, bloating, tenderness on the left side of abdomen that is relieved by expelling gas or a bowel movement, constipation or diarrohea, nausea, and an almost continual need to eliminate. There may be blood in the stool. Less common symptoms include frequent urination or difficulty while urinating.

How is it diagnosed?

Diverticulitis can range from minor inflammation to a massive infection. Diverticulitis can be serious, see your doctor right away if you suspect you’re having an attack

Diagnosis depends on the symptoms and physical examination by the doctor. Certain tests like sigmoidoscopy or colonoscopy (looking inside the large intestine with a flexible lighted tube), rectal biopsy and barium enema are helpful.

Your doctor is likely to examine your abdomen for tenderness. You may also have a blood test to check your white blood cell count and an imaging test such as a CT scan to help visualize the pouches that are inflamed or infected. A CT scan uses a series of computer-directed X-rays to provide a comprehensive view of your internal organs.

What are the complications?

In rare cases, an infected or inflamed pouch may rupture, spilling intestinal waste into your abdomen and leading to peritonitis — an inflammation of the lining of your abdominal cavity (peritoneum). Peritonitis is a medical emergency and requires immediate care.

Other complications of diverticulitis may include a blockage in your colon or small intestine, an abscess or a fistula. A fistula is an abnormal passageway that occurs between different parts of your intestine, your intestine and your bladder or vagina, or your intestine and abdominal wall. Sometimes fistulas themselves become infected — a condition that can be life threatening if left untreated.

Although there’s no evidence that diverticular disease increases your risk of colon or rectal cancer, it can make cancer more difficult to diagnose.

What is the treatment available?

If your symptoms are mild, a liquid or low-fiber diet and antibiotics may be all you need. Once your symptoms improve — often in two to four days — you can gradually start increasing the amount of high-fiber foods in your diet.

But if you’re at risk of complications or have recurrent attacks of diverticulitis, you may need more advanced care. About half the people with diverticulitis require hospitalization and many need intravenous antibiotics. You’re more likely to be hospitalized if you have vomiting, a fever above 100 F, a high white blood cell count or are at risk of complications such as a bowel obstruction or peritonitis. You’re also likely to need additional care if you are older, have another disease or have a weakened immune system.

If you have recurring diverticulitis, your doctor may recommend surgery to remove the diseased part of your colon. There are two types of surgery:

Primary bowel resection. This is the standard surgery for people with diverticulitis. Your surgeon removes the diseased part of your intestine and then reconnects the healthy segments of your colon (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open (traditional) surgery or laparoscopic surgery. It may not be an option if you are very overweight or have extensive inflammation.
Bowel resection with colostomy. This surgery may be necessary if you have so much inflammation in your colon that it’s not possible to rejoin your colon and rectum. During a colostomy, your surgeon makes an opening (stoma) in your abdominal wall. The unaffected part of your colon is then connected to the stoma, and waste passes through the opening into a bag. A colostomy may be temporary or permanent. Several months later — once the inflammation has healed — your surgeon may be able to perform a second operation to reconnect your colon and rectum.

Which steps can prevent diverticular disease?

  • The key to controlling this intestinal disorder is to consume an adequate amount of fiber and lots of water. You need at least 30 grams of fiber every day.
  • Eat a low-carbohydrate diet with high levels of protein from vegetable sources and fish. Do not eat grains, seeds or nuts, as these foods are hard to digest, resulting in bloating and gas. Also eliminate dairy, sugar products, red meat, fried foods, spices and processed foods.
  • Try to obtain vitamin K from natural sources. Eat plenty of green leafy vegetables.
  • Eat garlic for its healing and detoxifying properties.
    Try to have a bowel movement at the same time each day. Take fiber first thing in the morning, before breakfast, to help the bowels move at this time.
  • Do not overuse laxatives; they can irritate the colon wall.
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