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Ailmemts & Remedies

Diverticular disease

Alternative Name:   Diverticulosis…………..click for picture

Definition:
Over a lifetime, it’s estimated the human gut digests more than 65 tonnes of food and drink. Much of this food will be low in fibre, putting the gut under strain.

One common outcome of this is diverticular disease, a condition affecting the large bowel, or colon, believed to be the result of too little fibre in the diet.

A diet low in fibre creates the ideal conditions for constipation to develop. When this happens, the pressure in the large part of the gut increases, which forces small parts of the gut lining outwards through the muscles surrounding the gut. This causes the lining to form small balloon-like pouches called diverticula..

CLICK & SEE THE PICTURES

Author: U.S. National Institute of Diabetes an...
Author: U.S. National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), National Institutes of Health (NIH) Source URL: http://win.niddk.nih.gov/publications/gastric.htm Copyright tag: Why? Because it’s from an NIH department. Category:Obesity images (Photo credit: Wikipedia)

Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.

click to see the picture

About one in two adults over 50 is affected, and most adults are affected by the time they reach 80 to 90. Men and women are affected equally.

Diverticular disease is very uncommon in countries such as Africa, where diets are high in fibre. In Western countries, where many people still don’t eat enough fibre, it becomes more common as people get older.

Symptoms:
Signs and symptomsMost people with colonic diverticulosis are unaware of this structural change. When symptoms do appear in a person over 40 years of age it is important to obtain medical advice and exclude more dangerous conditions such as cancer of the colon or rectum.

The clinical forms of colonic diverticulosis are

*Symptomatic colonic diverticulosis………..click to see the picture
This is the most common complication of colonic diverticulosis. This is when the motility (that is, the onward propulsive nature of contractions) of the bowel becomes disorganized. Sometimes, spasm can develop. This results in pain in the left lower abdomen and often is accompanied by the passage of small pelletty stools and slime which relieves the pain. Symptoms can consist of (1) bloating, (2) changes in bowel movements (diarrhea or constipation), (3) Non-specific chronic discomfort in the lower left abdomen, with occasional acute episodes of sharper pain, (4) abdominal pain, often aftick to see the pictureer meals often in the left lower abdomen. If these persist clinical investigation is advised.

*Complicated colonic diverticulosis
This is very uncommon but highly dangerous. The diverticulae may bleed, either rapidly (causing bleeding through the rectum) or slowly (causing anaemia). The diverticulae can become infected and develop abscesses, or even perforate. These are serious complications and medical care is needed. Infected diverticulae and development of abscesses merits the term diverticulitis. First time bleeding from the rectum, especially in individuals aged over age 40, could be due to colon cancer, colonic polyps and inflammatory bowel disease rather than diverticulosis and requires clinical investigation.

Infection in the diverticula, possibly caused by an impacted piece of faeces, is responsible for the inflammation that develops. When this happens – called diverticulitis – the pain is very severe and usually felt in the lower left side of the abdomen.

A person will often feel feverish and have nausea and vomiting. They may pass blood rectally.

Risk factors:
1.increasing age
2.constipation
3.a diet that is low in dietary fiber content or high in fat
4.high intake of meat and red meat
5.connective tissue disorders (such as Marfan syndrome) that may cause weakness in the colon wall.

The exact aetiology of colonic diverticulosis has yet to be fully clarified and many of the claims are only anecdotal.  The modern emphasis on the value of fiber in the diet began with Cleave. A strong case was made by Neil Painter  and Adam Smith  that a deficiency of dietary fiber is the cause of diverticular disease. They argued that the colonic muscles needed to contract strongly in order to transmit and expel the small stool associated with a fiber deficient diet. The increased pressure within the segmented section of bowel over years gave rise to herniation at the vulnerable point where blood vessels enter the colonic wall. Denis Burkitt had suggested that the mechanical properties of the colon may be different in the African and the European subjects. Because Africans eat a diet containing much more fiber than Europeans and use the natural squatting position for defecation, they pass bulky stools, and hence rarely if ever develop colonic diverticulosis. The US National Institutes of Health (NIH) considers the fiber theory “unproven.”

However, change in the strength of the colonic wall with age may be an aetiological factor. Connective tissue is a significant contributor to the strength of the colonic wall. The mechanical properties of connective tissue depend on a wide variety of factors, the type of tissue and its age, the nature of the intramolecular and intermolecular covalent cross links and the quantity of the glycosaminoglycans associated with the collagen fibrils. The submucosa of the colon is composed almost entirely of collagen, both type I and type III. Several layers of collagen fibres make up the submucosa of the human colon. The collagen fibril diameters and fibril counts are different between the left and right colon and change with age and in colonic diverticulosis,. The implication being that changes which are normally associated with ageing are more pronounced in colonic diverticulosis. Iwasaki found that the tensil strength of the Japanese colon obtained at postmortem declined with age. Similarly the mechanical properties of the colon are stronger in African than European subjects. However, this race-based claim is contradicted by the virtually identical incidence of diverticular disease in black and white Americans.

The strength of the colon decreases with age in all parts of the colon, except the ascending colon. The fall in tensile strength with age is due to a decrease in the integrity of connective tissue. Cross linkage of collagen is increased in colonic diverticulosis. The mucosal layer is possibly more elastic and it is likely that the stiffer external layers break and allow the elastic mucosa to herniate through forming a diverticulum. Collagen has intermolecular and intramolecular cross links which stabilise and give strength to the tissue in which it is located. Accumulation of covalently linked sugar molecules and related increasing cross linking products are found in a variety of tissues with ageing, skin, vascular tissue, the cordae tendinae of heart valves and the colon.  This reduces the strength and pliability of the collagen. Colonic diverticulosis increases in frequency with age.  There is a reduction in the strength of the colonic mucosa with age, and that increased contractions in the descending and sigmoid colon secondary to an insufficient fibre content of the diet cause protrusion through this weakened wall. Colonic diverticulosis is in general a benign condition of the bowel which uncommonly becomes symptomatic and even less commonly becomes a truly clinical complicated problem.

Diagnosis:
In cases of asymptomatic Diverticulosis, the diagnosis is usually made as an incidental finding on other investigations.

While a good history is often sufficient to form a diagnosis of Diverticulosis or Diverticulitis, it is important to confirm the diagnosis and rule out other pathology (notably colorectal cancer) and complications.

Investigations:-

*Plain Abdominal X-ray may show signs of a thickened wall, ileus, constipation, small bowel obstruction or free air in the case of perforation. Plain X-rays are insufficient to diagnose Diverticular Disease.

*Contrast CT is the investigation of choice in acute episodes of Diverticulitis and where complications exist.

*Colonoscopy will show the diverticulum and rule out malignancy. A Colonoscopy should be performed 4–6 weeks after an acute episode.

*Barium enema is inferior to colonoscopy in terms of image quality and is usually only performed if the patient has strictures or an excessively tortuous sigmoid colon where colonoscopy is difficult or dangerous.

*MRI provides a clear picture of the soft tissue of the abdomen, however its expense often outweighs the benefits when compared to contrast CT or colonoscopy.

*There is no blood test for Diverticulosis.

It is important to note that both Barium enema and Colonoscopy are contraindicated during acute episodes of diverticulitis.

Management  & Treatment:
Many patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A high-fiber diet and fiber supplements are advisable to prevent constipation  . The American Dietetic Association recommends 20-35 grams each day. Wheat bran has much to commend it as this has been shown to reduce intra colonic pressure  Ispaghula is also effective at 1-2 grams a day. Colonic stimulants should be avoided. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says foods such as nuts, popcorn hulls, sunflower seeds, pumpkin seeds, caraway seeds, and sesame seeds have traditionally been labelled as problem foods for people with this condition; however, no scientific data exists to prove this hypothesis. The seeds in tomatoes, zucchini, cucumbers, strawberries, raspberries, and poppy seeds, are not considered harmful by the NIDDK. Treatments, like some colon cleansers, that cause hard stools, constipation, and straining, are not recommended. Some doctors also recommend avoidance of fried foods, nuts, corn, and seeds to prevent complications of diverticulosis. Whether these diet restrictions are beneficial is uncertain; recent studies have stated that nuts and popcorn do not contribute positively or negatively to patients with diverticulosis or diverticular complications. When the spasm pain is troublesome the use of peppermint oil (1 drop in 50 ml water), or peppermint tablets (e.g., colpermin), can be helpful. Complicated diverticulosis requires treatment of the complication. These complications are often grouped under a single diagnosis of diverticulitis and require skilled medical care of the infection, bleeding and perforation which may include intensive antibiotic treatment, intravenous fluids and surgery. Complications are more common in patients who are taking NSAIDS or aspirin. As diverticulosis occurs in an older population such complications are serious events.

Someone with diverticulitis may be treated at home with painkillers, antibiotics, laxatives and dietary advice. But diverticulitis is often severe, and can need hospital treatment with antibiotics and fluids given through a drip.

In some cases, the bowel may perforate, become obstructed or bleed heavily. When this happens, the situation becomes an emergency and an operation may be needed.

Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there’s little or no response to medication. Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.

Surgical treatment for diverticulitis removes the diseased part of the colon, most commonly, the left or sigmoid colon. Often the colon is hooked up or “anastomosed” again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks. In emergency surgeries, patients may require a temporary colostomy bag. Patients are encouraged to seek medical attention for abdominal symptoms early to help avoid complications.

Complications:
Infection of a diverticulum can result in diverticulitis. This occurs in 10-25% of persons with diverticulosis (NIDDK website). Tears in the colon leading to bleeding or perforations may occur; intestinal obstruction may occur (constipation or diarrhea does not rule this possibility out); and peritonitis, abscess formation, retroperitoneal fibrosis, sepsis, and fistula formation are also possible occurrences. Rarely, an enterolith may form.

Low fiber, high fat diet, constipation and use of stimulant laxatives increase the risk of bleeding, also history of diverticulitis increases the chance to bleed.

Infection of a diverticulum often occurs as a result of stool collecting in a diverticulum.

More than 10% of the US population over the age of 40 and half over the age of 60 has diverticulosis. This disease is common in the US, Britain, Australia, Canada, and is uncommon in Asia and Africa . Large-mouth diverticula are associated with scleroderma.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/diverticulardisease1.shtml
http://en.wikipedia.org/wiki/Diverticulosis
http://www.fascrs.org/patients/conditions/diverticular_disease/

http://www.procto-med.com/images/2009/05/diverticular-disease.gif

Understanding Diverticular Disease

http://www.advgastro.com/diverticulitis.htm

Categories
Ailmemts & Remedies

Diverticular Disorders

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Description:
Diverticular disease is a condition that occurs when a person has problems from small pouches, or sacs, that have formed and pushed outward through weak spots in the colon wall. Each pouch is called a diverticulum. Multiple pouches are called diverticula.

The colon is part of the large intestine. The large intestine absorbs water from stool and changes it from a liquid to a solid form. Diverticula are most common in the lower part of the colon, called the sigmoid colon.

The problems that occur with diverticular disease include diverticulitis and diverticular bleeding. Diverticulitis occurs when the diverticula become inflamed, or irritated and swollen, and infected. Diverticular bleeding occurs when a small blood vessel within the wall of a diverticulum bursts.

CLICK & SEE THE PICTURES
When a person has diverticula that do not cause diverticulitis or diverticular bleeding, the condition is called diverticulosis. Most people with diverticulosis do not have symptoms. Some people with diverticulosis have constipation or diarrhea. People may also have chronic

cramping or pain in the lower abdomen—the area between the chest and hips
bloating.

One in ten Americans over age 40 and half of those over age 60 have a diverticular disorder. But this isn’t a disease of aging per se; it’s a disease of lifestyle, particularly lack of fiber and exercise. A few simple measures can help.

Diverticular disease is a condition that occurs when a person has problems from small pouches, or sacs, that have formed and pushed outward through weak spots in the colon wall.

Other conditions, such as irritable bowel syndrome and stomach ulcers, cause similar problems, so these symptoms do not always mean a person has diverticulosis. People with these symptoms should see their health care provider.

Diverticulosis becomes more common as people age, particularly in people older than age 50.3 Some people with diverticulosis develop diverticulitis, and the number of cases is increasing. Although diverticular disease is generally thought to be a condition found in older adults, it is becoming more common in people younger than age 50, most of whom are male.

 

Symptoms

Often there are no symptoms.
In some cases, bloating, gas, nausea, and constipation alternate with diarrhea.

People with diverticulitis may have many symptoms, the most common of which is pain in the lower left side of the abdomen. The pain is usually severe and comes on suddenly, though it can also be mild and then worsen over several days. The intensity of the pain can fluctuate. Diverticulitis may also cause

*fevers and chills
*nausea or vomiting
*a change in bowel habits—constipation or diarrhea
*diverticular bleeding

In most cases, people with diverticular bleeding suddenly have a large amount of red or maroon-colored blood in their stool. Diverticular bleeding may also cause

*weakness
*dizziness or light-headedness
*abdominal cramping

 

When to Call Your Doctor

If you have fever, chills, and abdominal swelling or are vomiting — these may be signs of a ruptured diverticulum.
If you have blood or mucus in the stool or any other symptoms of diverticulitis.
If diverticular pain does not subside despite self-care.
Reminder: If you have a medical condition, talk to your doctor before taking supplements.

What It Is

There are two main types of diverticular disorders: diverticulosis and the more serious diverticulitis. In diverticulosis, the inner lining of the large bowel pushes through the muscular layer that usually confines it, forming pouches (diverticula) ranging from pea-size to more than an inch in diameter. Though diverticulosis often produces no symptoms, food can get trapped in these pouches, which then become inflamed and infected. The result is diverticulitis, whose symptoms are impossible to ignore.

What Causes It

Most cases of diverticulosis probably stem from a low-fiber diet. A lack of fiber means the colon must work harder to pass the stool, and straining during bowel movements can aggravate the condition. A diet low in fiber also increases the likelihood of diverticulitis because waste moves slowly, allowing more time for food particles to become trapped and cause inflammation or infection. And lack of exercise makes the colon contents sluggish. The tendency toward such disorders may run in families.

What is fiber?
Fiber is a substance in foods that comes from plants. Fiber helps soften stool so it moves smoothly through the colon and is easier to pass. Soluble fiber dissolves in water and is found in beans, fruit, and oat products. Insoluble fiber does not dissolve in water and is found in whole-grain products and vegetables. Both kinds of fiber help prevent constipation.

Constipation is a condition in which an adult has fewer than three bowel movements a week or has bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass.

High-fiber foods also have many benefits in preventing and controlling chronic diseases, such as cardiovascular disease, obesity, diabetes, and cancer.

Diagnosis:
Based on symptoms and severity of illness, a person may be evaluated and diagnosed by a primary care physician, an emergency department physician, a surgeon, or a gastroenterologist—a doctor who specializes in digestive diseases.

The health care provider will ask about the person’s health, symptoms, bowel habits, diet, and medications, and will perform a physical exam, which may include a rectal exam. A rectal exam is performed in the health care provider’s office; anesthesia is not needed. To perform the exam, the health care provider asks the person to bend over a table or lie on one side while holding the knees close to the chest. The health care provider slides a gloved, lubricated finger into the rectum. The exam is used to check for pain, bleeding, or a blockage in the intestine.

The health care provider may schedule one or more of the following tests:

Blood test. A blood test involves drawing a person’s blood at a health care provider’s office, a commercial facility, or a hospital and sending the sample to a lab for analysis. The blood test can show the presence of inflammation or anemia—a condition in which red blood cells are fewer or smaller than normal, which prevents the body’s cells from getting enough oxygen.

*Computerized tomography (CT) scan. A CT scan of the colon is the most common test used to diagnose diverticular disease. CT scans use a combination of x rays and computer technology to create three-dimensional (3–D) images. For a CT scan, the person may be given a solution to drink and an injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or a hospital by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. CT scans can detect diverticulosis and confirm the diagnosis of diverticulitis.

*Lower gastrointestinal (GI) series. A lower GI series is an x-ray exam that is used to look at the large intestine. The test is performed at a hospital or an outpatient center by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. The health care provider may provide written bowel prep instructions to follow at home before the test. The person may be asked to follow a clear liquid diet for 1 to 3 days before the procedure. A laxative or enema may be used before the test. A laxative is medication that loosens stool and increases bowel movements. An enema involves flushing water or laxative into the rectum using a special squirt bottle. These medications cause diarrhea, so the person should stay close to a bathroom during the bowel prep.

For the test, the person will lie on a table while the radiologist inserts a flexible tube into the person’s anus. The colon is filled with barium, making signs of diverticular disease show up more clearly on x rays.
For several days, traces of barium in the large intestine can cause stools to be white or light colored. Enemas and repeated bowel movements may cause anal soreness. A health care provider will provide specific instructions about eating and drinking after the test.

*Colonoscopy. The test is performed at a hospital or an outpatient center by a gastroenterologist. Before the test, the person’s health care provider will provide written bowel prep instructions to follow at home. The person may need to follow a clear liquid diet for 1 to 3 days before the test. The person may also need to take laxatives and enemas the evening before the test.
In most cases, light anesthesia, and possibly pain medication, helps people relax for the test. The person will lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The test can show diverticulosis and diverticular disease.

Cramping or bloating may occur during the first hour after the test. Driving is not permitted for 24 hours after the test to allow the anesthesia time to wear off. Before the appointment, people should make plans for a ride home. Full recovery is expected by the next day, and people should be able to go back to their normal diet.

Treatment:
A health care provider may treat the symptoms of diverticulosis with a high-fiber diet or fiber supplements, medications, and possibly probiotics. Treatment for diverticular disease varies, depending on whether a person has diverticulitis or diverticular bleeding.

Diverticulosis
High-fiber diet. Studies have shown that a high-fiber diet can help prevent diverticular disease in people who already have diverticulosis.2 A health care provider may recommend a slow increase in dietary fiber to minimize gas and abdominal discomfort. For more information about fiber-rich foods, see “Eating, Diet, and Nutrition.”

Fiber supplements. A health care provider may recommend taking a fiber product such as methylcellulose (Citrucel) or psyllium (Metamucil) one to three times a day. These products are available as powders, pills, or wafers and provide 0.5 to 3.5 grams of fiber per dose. Fiber products should be taken with at least 8 ounces of water.

Medications. A number of studies suggest the medication mesalazine (Asacol), given either continuously or in cycles, may be effective at reducing abdominal pain and GI symptoms of diverticulosis. Research has also shown that combining mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more effective than using rifaximin alone to improve a person’s symptoms and maintain periods of remission, which means being free of symptoms.4

Probiotics. Although more research is needed, probiotics may help treat the symptoms of diverticulosis, prevent the onset of diverticulitis, and reduce the chance of recurrent symptoms. Probiotics are live bacteria, like those normally found in the GI tract. Probiotics can be found in dietary supplements—in capsules, tablets, and powders—and in some foods, such as yogurt.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/probioticsExternal NIH Link.

How Supplements Can Help

Although supplements cannot reverse diverticulosis once a pouch has developed, they (and changes in your diet) can help prevent or ease flare-ups. Providing fiber that forms bulk, psyllium acts to relieve or prevent constipation. Ground flaxseeds are also rich in fiber and ward off infection by keeping intestinal pouches clear. These two can be taken together long term first thing in the morning to assist with the initial bowel movement, along with probiotics such as acidophilus. The fiber helps protect the acidophilus from stomach acids and carries it into the intestine, where it alters the bacterial balance in the digestive tract, enabling the body to fight off intestinal infections. Acidophilus is especially important if you’re taking antibiotics during a flare-up.

What Else You Can Do

Eat plenty of fruits, vegetables, and whole grains to boost your fiber intake to 20 to 30 grams a day.
Drink at least eight 8-ounce glasses of water or other fluids every day.
Exercise regularly to help prevent constipation. And if you become constipated, take advantage of natural laxatives, such as prunes.

Supplement Recommendations

Psyllium
Flaxseeds
Acidophilus
Aloe Vera Juice
Glutamine
Slippery Elm
Chamomile
Wild Yam/Peppermint/ Valerian

Psyllium
Dosage: 1 tbsp. powder dissolved in water or juice twice a day.
Comments: Be sure to drink extra water throughout the day.

Flaxseeds
Dosage: 2 tbsp. ground flaxseeds in glass of water twice a day.
Comments: Be sure to drink extra water throughout the day.

Acidophilus
Dosage: 2 pills twice a day between meals.
Comments: Get 1-2 billion live (viable) organisms per pill.

Aloe Vera Juice
Dosage: 1/2 cup juice twice a day.
Comments: Containing 98% aloe vera and no aloin or aloe-emodin.

Glutamine
Dosage: 500 mg L-glutamine twice a day on an empty stomach.
Comments: When using for longer than 1 month, add a mixed amino acid complex (follow package directions).

Slippery Elm
Dosage: 1 cup bark powder, prepared like hot cereal each morning.
Comments: Or use tea (1 tsp. per cup) 3 times a day.

Chamomile
Dosage: As a tea, 1 cup 3 times a day.
Comments: Use 2 tsp. dried herb per cup of hot water; steep for 10 minutes, then strain. Alternatively, try melissa tea.

Wild Yam/Peppermint/ Valerian
Dosage: 1 cup tea 3 or 4 times a day.
Comments: Use 2 parts wild yam, 1 part peppermint, 1 part valerian per cup of hot water; steep 10 minutes, strain. Sweeten to taste.

Resources:

 http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/diverticular-disease/Pages/facts.aspx#cause

 Your Guide to Vitamins, Minerals, and Herbs(Reader’s Digest)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.