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Charcot-Marie-Tooth disease(CMT)

Alternative Names::Morbus Charcot-Marie-Tooth, Charcot-Marie-Tooth neuropathy, hereditary motor and sensory neuropathy (HMSN), hereditary sensorimotor neuropathy (HSMN), or peroneal muscular atrophy.

Definition:
Charcot–Marie–Tooth disease (CMT) is  an inherited disorder of nerves (neuropathy) that takes different forms. It is characterized by loss of muscle tissue and touch sensation, predominantly in the feet and legs but also in the hands and arms in the advanced stages of disease. Currently incurable, this disease is one of the most common inherited neurological disorders, with 36 in 100,000 affected.

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In 1886, Professor Jean Martin Charcot of France (1825-1893) and his student Pierre Marie (1853-1940) published the first description of distal muscle weakness and wasting beginning in the legs, calling it peroneal muscular atrophy.

Howard Henry Tooth (1856-1926) described the same disease in his Cambridge dissertation in 1886, calling the condition peroneal progressive muscular atrophy. Tooth was the first to attribute symptoms correctly to neuropathy rather than to myelopathy, as physicians previously had done.

In 1912, Hoffman identified a case of peroneal muscular atrophy with thickened nerves. This disease was referred to as Hoffman disease and later was known as Charcot-Marie-Tooth-Hoffman disease.

In 1968, CMT disease was subdivided into 2 types, CMT 1 and CMT 2, based on pathologic and physiologic criteria. CMT disease has been subdivided further based on the genetic cause of the disease.

•In CMT type 1, the peripheral nerves’ axons – the part of the nerve cell that transmits electrical signals to the muscles – lose their protective outer coverings, their myelin sheaths. This disrupts the axons’ function.

•In CMT type 2, the axons’ responses are diminished due to a defect within the axons themselves. CMT type 2, the less common of the two classes, can be further separated into at least six subtypes, caused by defects in different genes.

Symptoms:
Symptoms of the CMT usually begin in late childhood or early adulthood. Some people don’t experience symptoms until their early thirties or forties. Usually, the initial symptom is foot drop early in the course of the disease. This can also cause claw toe, where the toes are always curled. Wasting of muscle tissue of the lower parts of the legs may give rise to “stork leg” or “inverted bottle” appearance. Weakness in the hands and forearms occurs in many people later in life as the disease progresses.

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English: The foot of a person with Charcot-Mar...

English: The foot of a person with Charcot-Marie-Tooth. The lack of muscle, high arch, and hammer toes are signs of the genetic disease. This patient was diagnosed with CMT-1A. Deutsch: atrophischer Hohlfuß bei hereditärer motosensibler Neuropathie I (Charcot-Marie-Tooth) (Photo credit: Wikipedia)

Symptoms and progression of the disease can vary. Breathing can be affected in some; so can hearing, vision, and the neck and shoulder muscles. Scoliosis is common. Hip sockets can be malformed. Gastrointestinal problems can be part of CMT, as can chewing, swallowing, and speaking (as vocal cords atrophy). A tremor can develop as muscles waste. Pregnancy has been known to exacerbate CMT, as well as extreme emotional stress.

Neuropathic pain is often a symptom of CMT though, like other symptoms of CMT, it’s presence and severity varies from case to case. For some people, pain can be significant to severe and interfere with daily life activities. However, pain is not experienced by all people with CMT. When pain is present as a symptom of CMT, it is comparable to that seen in other peripheral neuropathies, as well as Postherpetic neuralgia and Complex regional pain syndrome, among other diseases

The most common symptoms of Charcot-Marie-Tooth disease may include:

*Weakness in your legs, ankles and feet
*Loss of muscle bulk in legs and feet
*High foot arches
*Curled toes (hammertoes)
*Decreased ability to run
*Difficulty lifting your foot at the ankle (footdrop)
*Awkward or higher than normal step (gait)
*Frequent tripping or falling
*Decreased sensation in your legs and feet
*Numbness in the legs and feet

As Charcot-Marie-Tooth disease progresses, symptoms may not be limited to the feet and legs but may also involve the thighs, hands and arms. Charcot-Marie-Tooth disease generally doesn’t cause pain.

Causes:
Charcot–Marie–Tooth disease is caused by mutations that cause defects in neuronal proteins. Nerve signals are conducted by an axon with a myelin sheath wrapped around it. Most mutations in CMT affect the myelin sheath. Some affect the axon.

The most common cause of CMT (70-80% of the cases) is the duplication of a large region in chromosome 17p12 that includes the gene PMP22. Some mutations affect the gene MFN2, which codes for a mitochondrial protein. Cells contain separate sets of genes in their nucleus and in their mitochondria. In nerve cells, the mitochondria travel down the long axons. In some forms of CMT, mutated MFN2 causes the mitochondria to form large clusters, or clots, which are unable to travel down the axon towards the synapses. This prevents the synapses from functioning.

Risk Factors:
Charcot-Marie-Tooth disease is hereditary, so you’re at higher risk of developing the disorder if anyone in your immediate family has had the disease. Other causes of neuropathies, such as diabetes, may cause symptoms of or worsen Charcot-Marie-Tooth disease.

Complecations:
Complications of Charcot-Marie-Tooth disease vary in severity from person to person, with foot abnormalities and difficulty walking generally being the most serious problems. Muscle weakness may also increase, and injury to areas of the body with decreased sensation may occur.

Diagnosis:
CMT can be diagnosed through symptoms, through measurement of the speed of nerve impulses (electromyography), through biopsy of the nerve, and through DNA testing. DNA testing can give a definitive diagnosis, but not all the genetic markers for CMT are known.CMT is first noticed when someone develops lower leg weakness and foot deformities such as foot drop, hammertoes and high arches. But signs alone do not lead to diagnosis. Patients must be referred to a neurologist or a physical medicine and rehabilitation physician (physiatrist). To see signs of muscle weakness the neurologist will ask patients to walk on their heels or to move part of their leg against an opposing force. In order to identify sensory loss the neurologist will test for deep tendon reflexes, such as the knee jerk, which are reduced or absent in CMT. The doctor will also ask about family history because CMT is hereditary. The lack of family history does not rule out CMT, but it will allow the doctor to rule out other causes of neuropathy such as diabetes or exposure to certain chemicals or drugs.

In 2010, CMT was one of the first diseases where the genetic cause of a particular patient’s disease was precisely determined by sequencing the whole genome of an affected individual. Two mutations were identified in a gene, SH3TC2, known to cause CMT. Researchers then compared the affected patient’s genome to the genomes of the patient’s mother, father, and seven siblings with and without the disease. The mother and father each had one normal and one mutant copy of this gene, and had mild or no symptoms. The offspring that inherited two mutant genes presented fully with the disease. Sequencing the initial patient’s whole genome cost $50,000, but researchers estimated that it would soon cost $5,000 and become common.

CMT is divided into the primary demyelinating neuropathies (CMT1, CMT3, and CMT4) and the primary axonal neuropathies (CMT2), with frequent overlap. Another cell involved in CMT is the Schwann cell, which creates the myelin sheath, by wrapping its plasma membrane around the axon in a structure that is sometimes compared to a Swiss roll.

Neurons, Schwann cells, and fibroblasts work together to create a working nerve. Schwann cells and neurons exchange molecular signals that regulate survival and differentiation. These signals are disrupted in CMT.

Demyelinating Schwann cells causes abnormal axon structure and function. They may cause axon degeneration. Or they may simply cause axons to malfunction.

The myelin sheath allows nerve cells to conduct signals faster. When the myelin sheath is damaged, nerve signals are slower, and this can be measured by a common neurological test, electromyography.

When the axon is damaged, on the other hand, this results in a reduced compound muscle action potential (CMAP).

There are many different genetic variants. Most cases are inherited as an autosomal dominant condition, but some are inherited in an autosomal recessive or x-linked pattern.

Treatment:
Although there is no current standard treatment, the use of ascorbic acid has been proposed, and has shown some benefit in animal models. A clinical trial to determine the effectiveness of high doses of ascorbic acid (vitamin C) in treating humans with CMT type 1A has been conducted. The results of the trial upon children have shown that a high dosage intake of ascorbic acid is safe but the efficacy endpoints expected were not met. In 2010, a study published in the Journal Science indicated that scientists had identified those proteins that control the thickness of myelin sheath. This discovery is expected to open the avenue to new treatments in the coming years.

The most important activity for patients with CMT is to maintain what movement, muscle strength and flexibility they have. Therefore, physical therapy and moderate activity are recommended but overexertion should be avoided. A physical therapist should be involved in designing a exercise program that fits a patient’s personal strengths and flexibility. Bracing can also be used to correct problems caused by CMT. Gait abnormalities can be corrected by the use of either articulated (hinged) or unarticulated, braces called AFOs (ankle-foot orthoses). These braces help control foot drop and ankle instability and often provide a better sense of balance for patients. Appropriate footwear is also very important for people with CMT, but they often have difficulty finding well-fitting shoes because of their high arched feet and hammer toes. Due to the lack of good sensory reception in the feet, CMT patients may also need to see a podiatrist for help in trimming nails or removing calluses that develop on the pads of the feet. A final decision a patient can make is to have surgery. Using a podiatrist or an orthopedic surgeon, patients can choose to stabilize their feet or correct progressive problems. These procedures include straightening and pinning the toes, lowering the arch, and sometimes, fusing the ankle joint to provide stability.

The Charcot-Marie-Tooth Association classifies the chemotherapy drug vincristine as a “definite high risk” and states that “vincristine has been proven hazardous and should be avoided by all CMT patients, including those with no symptoms.”

There are also several corrective surgical procedures that can be done to improve physical condition.

Genetic testing is available for many of the different types of Charcot-Marie-Tooth and may help guide treatment.

Lifestyle & Homeremedies:
Certain tactics may prevent complications caused by Charcot-Marie-Tooth disease and improve your ability to manage the effects of the disorder.

Started early and followed regularly, at-home activities can provide protection and relief:

*Stretch regularly. The goal of stretching is to improve or maintain the range of motion of your joints. Stretching improves your flexibility, balance and coordination. Stretching may also reduce your risk of injury. If you have Charcot-Marie-Tooth disease, regular stretching can prevent or reduce joint deformities that may result from uneven pulling of muscle on your bones.

*Exercise daily. Exercising every day keeps your bones and muscles strong. Low-impact exercises, such as biking and swimming, are less stressful on fragile muscles and joints. By strengthening your muscles and bones, you can improve your balance and coordination, reducing your risk of falls.

*Improve your stability. Muscle weakness associated with Charcot-Marie-Tooth disease may cause you to be unsteady on your feet, which can lead to falling and serious injury. Walking with a cane or a walker can increase your stability. Good lighting at night can help you avoid stumbling and falling.
Foot care is important
Because of foot deformities and loss of sensation, regular foot care is important to help relieve symptoms and to prevent complications:

*Inspect your feet. Daily inspection of your feet is important to prevent calluses, ulcers, wounds and infections.

*Take care of your nails. Cut your nails regularly. To avoid ingrown toenails and infections, cut straight across and avoid cutting into the nailbed edges. Consider regular professional pedicures.

*Wear the right shoes. Use shoes that fit properly and are roomy and protective. Consider wearing boots or high-top shoes for ankle support.

*Soak and moisturize the skin of your feet. Brief, daily cold and warm foot soaks followed by the application of moisturizing lotions keep the skin of the feet moist and pliable. This can be very effective in reducing neuropathic pain and foot discomfort.

Coping & Support:
Support groups, in conjunction with your doctor’s advice, can be valuable in dealing with Charcot-Marie-Tooth disease. Support groups bring together people who are coping with the same kinds of challenges, along with their families and friends, and offer a setting in which people can share their common problems.

Ask your doctor about support groups in your community. Your local health department, public library and telephone book and the Internet also may be good sources to find a support group in your area.

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/charcotmarietooth1.shtml
http://www.mayoclinic.com/health/charcot-marie-tooth-disease/DS00557
http://www.genome.gov/11009201
http://emedicine.medscape.com/article/1232386-overview

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Claustrophobia

Definition:
A phobia is a form of anxiety disorder in which someone has an intense and irrational fear of certain objects or situations. Anyone suffering from high levels of anxiety is at risk of developing a phobia. One of the most common phobias is claustrophobia, or the fear of enclosed spaces. A person who has claustrophobia may panic when inside a lift, aeroplane, crowded room or other confined area.

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Some other phobias, borne from anxiety, include social phobia – fear of embarrassing yourself in front of others – and agoraphobia, which is the fear of open spaces. The cause of anxiety disorders such as phobias is thought to be a combination of genetic vulnerability and life experience. With appropriate treatment, it is possible to overcome claustrophobia or any other phobia.

It is an anxiety disorder that involves the fear of enclosed or confined spaces. Claustrophobes may suffer from panic attacks, or fear of having a panic attack, in situations such as being in elevators, trains, or aircraft.

Conversely, people who are prone to having panic attacks will often develop claustrophobia.[citation needed] If a panic attack occurs while they are in a confined space, then the claustrophobe fears not being able to escape the situation. Those suffering from claustrophobia might find it difficult to breathe in enclosed spaces. Like many other disorders, claustrophobia can sometimes develop due to a traumatic incident in childhood.

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Claustrophobia can be treated in similar ways to other anxiety disorders, with a range of treatments including cognitive behavior therapy and the use of anti-anxiety medication. Hypnosis is an alternative treatment for claustrophobia.

The name claustrophobia comes from the Latin word claustrum which means “a bolt, a place shut in” and the Greek word phobos meaning “fear”.


Causes :-

Claustrophobia can develop from either a traumatic childhood experience (such as being trapped in a small space during a childhood game), or from another unpleasant experience later on in life involving confined spaces (such as being stuck in an elevator).

When an individual experiences such an event, it can often trigger a panic attack; this response then becomes programmed in the brain, establishing an association between being in a tight space and feeling anxious or out-of-control. As a result, the person often develops claustrophobia.

Symptoms:
If a person suffering from claustrophobia suddenly finds themselves in an enclosed space, they may have an anxiety attack. Symptoms can include:

*Sweating
*Accelerated heart rate
*Hyperventilation, or ‘overbreathing’
*Shaking
*Light-headedness
*Nausea
*Fainting
*Fear of actual harm or illness.

Specific symptoms of claustrophobia:-
When in an enclosed space, the signs of claustrophobia may include:

  • Inside a room – automatically checking for the exits, standing near the exits or feeling alarmed when all doors are closed.
  • Inside a vehicle, such as a car – avoiding times when traffic is known to be heavy.
  • Inside a building – preferring to take the stairs rather than the lift, and not because of health reasons.
  • At a party – standing near the door in a crowded room, even if the room is large and spacious.
  • In extreme cases – for a person with severe claustrophobia, a closed door will trigger feelings of panic.

The catch-22 of avoidance
Once a person has experienced a number of anxiety attacks, they become increasingly afraid of experiencing another. They start to avoid the objects or situations that bring on the attack. However, any coping technique that relies on avoidance can only make the phobia worse. It seems that anticipating the possibility of confinement within a small space intensifies the feelings of anxiety and fear.

Frequency:-
It was found that 5-10.6% of people screened before an MRI scan had claustrophobia. Furthermore, it was found that 7% of patients had unidentified claustrophobia, and had to terminate the scanning procedure prematurely. 30% reported milder distress due to the necessity to lie in a confined space for a long time. For specific phobias in general, there is a lifetime prevalence rate of 7.2%-11.3%. Other forms of Claustrophobia include conditions such as Agrophobia and panic attacks.

The thought of treatment can be frightening
For someone with a disabling phobia, the realisation that this fear is irrational and that treatment is needed can cause further anxiety. Since most treatment options depend on confronting the feared situation or object, the person may feel reluctant.

Support and encouragement from family and friends is crucial. A person trying to overcome a phobia may find some treatment methods particularly challenging and will need the love and understanding of their support people. The therapist may even ask the family members or friends to attend certain sessions, in order to bolster the courage of the person seeking treatment.

Treatment:-

There is no cure for claustrophobia, however, there are several forms of treatment that can help an individual control her condition. Treatment for claustrophobia can include behavior therapy, exposure therapy, drugs or a combination of several treatments.
Treating phobias, including claustrophobia, relies on psychological methods. Depending on the person, some of these methods may include:

  • Flooding – this is a form of exposure treatment, where the person is exposed to their phobic trigger until the anxiety attack passes. The realisation that they have encountered their most dreaded object or situation, and come to no actual harm, can be a powerful form of therapy.
  • Counter-conditioning – if the person is far too fearful to attempt flooding, then counter-conditioning can be an option. The person is taught to use specific relaxation and visualisation techniques when experiencing phobia-related anxiety. The phobic trigger is slowly introduced, step-by-step, while the person concentrates on attaining physical and mental relaxation. Eventually, they can confront the source of their fear without feeling anxious. This is known as systematic desensitisation.
  • Modelling – the person watches other people confront the phobic trigger without fear and is encouraged to imitate that confidence.
  • Cognitive behaviour therapy (CBT) – the person is encouraged to confront and change the specific thoughts and attitudes that lead to feelings of fear.
  • Medications – such as tranquillisers and antidepressants. Drugs known as beta blockers may be used to treat the physical symptoms of anxiety, such as a pounding heart.

Alternative claustrophobia treatments include regression hypnotherapy, in which hypnotherapy is used to remember the traumatic event that led to the individual’s claustrophobia. The patient is taught to see the event with ‘adult’ eyes, which helps to decrease the sense of panic that it has instilled into their minds.

Length of treatment
The person may be treated as an outpatient or, sometimes, as an inpatient if their phobia is particularly severe. Generally, treatment consists of around eight to 10 weeks of bi-weekly sessions.

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Click to learn about :->Open MRI reduces patient claustrophobia, study confirms

Anxiety Disorder Treatment

Where to get help

  • Sane Australia Helpline Tel. 1800 187 263
  • Your doctor
  • Psychologist
  • Psychiatrist
  • Trained therapist

Things to remember

  • A phobia is an intense and irrational fear of certain objects or situations.
  • A person who has claustrophobia may panic when inside an enclosed space, such as a lift, aeroplane or crowded room.
  • With appropriate treatment, it is possible to overcome claustrophobia or any other phobia.

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.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Claustrophobia?open
http://en.wikipedia.org/wiki/Claustrophobia
http://www.epigee.org/mental_health/claustrophobia.html

Healing Our Bodies

Touch
Sometimes we might concentrate so much on our spiritual lives that we overlook the wonders of being present in our physical form. When we are more aware of the fact that our bodies are also important in terms of our personal growth, we may find it easier to nurture them. One of the most powerful ways to do this is through human touch, for a loving, comforting touch allows us to access the part of ourselves that yearns for a sense of oneness with the world around us. Even simple forms of touch connect us not just to our bodies but also to the energetic presence of other people.

There are so many ways to incorporate touch in our daily lives, one of the easiest being a heartfelt embrace. Just making a point to hug someone on a daily basis and really feel our energy pass between each other can strengthen the bonds that keep us together. Hugs help us heal any hurt or upset we may have recently experienced by letting us release into the moment of the embrace and realize that no matter what happens to us, we have someone in our lives who supports and cares for us.

Another nourishing form of touch is massage. While we may think of massage as a luxury, it is actually an ancient form of healing that enables us to open up our energetic pathways in order to receive unlimited energy from the universe. It doesn’t matter whether a simple massage comes from a loved one or a massage therapist, but by giving ourselves the gift of massage every once in a while, we are doing something healthy and beneficial for our bodies. Massage helps our bodies activate their own restorative powers, creating a wonderful way to engage fully in our own healing.

Letting ourselves take advantage of the healing nature of touch creates space where we can truly live in and experience the world through our bodies, allowing us to completely immerse ourselves in the loving sense of joy and wonder that is our life.

Sources: Daily Om

Diverticular Disorders

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.

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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.