A diverticulum (called diverticula if there are more than one of them) is a protrusion of the inner lining of the intestine through the outer muscular coat to form a small pouch with a narrow neck. The commonest site for diverticula to develop is the lower left part of the colon. The presence of diverticula is often referred to as diverticulosis.
Is the cause of diverticula known?
A diverticulum can occur naturally and this is most likely in the small intestine, with a majority of British people over seventy years of age having diverticula in the large intestine. Diverticula increase in incidence with the years and are much commoner in later life. Incidence of diverticula is lower in rural parts of the world such as Africa although the reasons for this are not clear. Diet may well be an important difference between rural countries and western developed countries due to the colon's function of processing the typical plant foods which are relatively indigestible.
Western populations eat much less fibrous material than other world regions which are often more vegetarian. Large amounts of fibre in the colon means that the soft and bulky intestinal contents keep the bowel walls apart. Too little fibre makes the stools smaller and firmer so when the colon walls contract the contents do not keep the tubular colonic walls apart. The colonic contractions squeeze like a ring and mix the contents, moving them along the tube. Pressure can become high in closed segments of the colon and it may be that this is the cause of the pouches.
Is the presence of diverticula harmful?
We all begin life with an appendix, which is a diverticulum in many ways, and we do not worry about it. In the same way many of us have diverticula projecting from the wall of our colon. We do not know we have them and they cause us no trouble. However, just like the appendix, a diverticulum can become inflamed due to infection. If this occurs it causes local pain, can make a person feel ill, and can be dangerous because it may perforate or bleed. Inflammation of one or more diverticula is called diverticulitis.
What is diverticular disease?
In most people with diverticula the intestinal muscle is normal in appearance and thickness, but in some people it becomes thicker than normal and has an unusual structure under the microscope. The thickening of the muscle narrows the colon which becomes irregular in outline. The reason for this is not known but it is important to realise that it is not due to infection and may not be related to diet. The muscle abnormality can develop when very few diverticula are present and occasionally it occurs without any diverticula. The combination of abnormal muscle and diverticula is known as diverticular disease. This is confusing because diverticula and diverticular sound the same, hence the use of the word disease.
Diverticular disease symptoms
The symptoms of diverticular disease include an irregularity of bowel habit with pellet like stool, bowel actions with blood passed with them, wind and bloating and pain in the abdomen down the lower left side. Irritable bowel syndrome has similar symptoms to diverticular disease perhaps secondary to both problems involving functional muscle abnormality.
The necessity of investigation
When conditions such as bleeding rectum or pain in the abdomen are investigated by endoscopy (sigmoidoscopy or colonoscopy) or x-ray barium enemas then diverticula are often discovered as a side effect. Elderly people who are well typically have diverticula so their importance as to the cause of the symptoms or not is important to establish. Evidence of inflammation on blood tests and tenderness of the diverticular area indicate the diagnosis is diverticular disease. The increased folds in the left, lower colon lining which can be present are the abnormal muscle finding in diverticular disease.
Explaining the situation
Reassurance that a more serious disorder is not present helps people not to worry about the symptoms. An explanation of the difference between symptoms due to infection and those due to abnormal contraction of the muscle, without inflammation, helps people understand why one treatment may be advised and not another. - 14130
Is the cause of diverticula known?
A diverticulum can occur naturally and this is most likely in the small intestine, with a majority of British people over seventy years of age having diverticula in the large intestine. Diverticula increase in incidence with the years and are much commoner in later life. Incidence of diverticula is lower in rural parts of the world such as Africa although the reasons for this are not clear. Diet may well be an important difference between rural countries and western developed countries due to the colon's function of processing the typical plant foods which are relatively indigestible.
Western populations eat much less fibrous material than other world regions which are often more vegetarian. Large amounts of fibre in the colon means that the soft and bulky intestinal contents keep the bowel walls apart. Too little fibre makes the stools smaller and firmer so when the colon walls contract the contents do not keep the tubular colonic walls apart. The colonic contractions squeeze like a ring and mix the contents, moving them along the tube. Pressure can become high in closed segments of the colon and it may be that this is the cause of the pouches.
Is the presence of diverticula harmful?
We all begin life with an appendix, which is a diverticulum in many ways, and we do not worry about it. In the same way many of us have diverticula projecting from the wall of our colon. We do not know we have them and they cause us no trouble. However, just like the appendix, a diverticulum can become inflamed due to infection. If this occurs it causes local pain, can make a person feel ill, and can be dangerous because it may perforate or bleed. Inflammation of one or more diverticula is called diverticulitis.
What is diverticular disease?
In most people with diverticula the intestinal muscle is normal in appearance and thickness, but in some people it becomes thicker than normal and has an unusual structure under the microscope. The thickening of the muscle narrows the colon which becomes irregular in outline. The reason for this is not known but it is important to realise that it is not due to infection and may not be related to diet. The muscle abnormality can develop when very few diverticula are present and occasionally it occurs without any diverticula. The combination of abnormal muscle and diverticula is known as diverticular disease. This is confusing because diverticula and diverticular sound the same, hence the use of the word disease.
Diverticular disease symptoms
The symptoms of diverticular disease include an irregularity of bowel habit with pellet like stool, bowel actions with blood passed with them, wind and bloating and pain in the abdomen down the lower left side. Irritable bowel syndrome has similar symptoms to diverticular disease perhaps secondary to both problems involving functional muscle abnormality.
The necessity of investigation
When conditions such as bleeding rectum or pain in the abdomen are investigated by endoscopy (sigmoidoscopy or colonoscopy) or x-ray barium enemas then diverticula are often discovered as a side effect. Elderly people who are well typically have diverticula so their importance as to the cause of the symptoms or not is important to establish. Evidence of inflammation on blood tests and tenderness of the diverticular area indicate the diagnosis is diverticular disease. The increased folds in the left, lower colon lining which can be present are the abnormal muscle finding in diverticular disease.
Explaining the situation
Reassurance that a more serious disorder is not present helps people not to worry about the symptoms. An explanation of the difference between symptoms due to infection and those due to abnormal contraction of the muscle, without inflammation, helps people understand why one treatment may be advised and not another. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Manchester visit his website.
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