Diverticulitis and Diverticulosis

What are they?

Diverticulosis occurs when small, bulging pouches, know as diverticula, develop in the digestive tract.

They are found most often in the lower part of the large intestine (colon).

Congenital or true colonic diverticulosis is a rare condition that involves all layers of the structure, including muscularis propria and adventitia, False diverticula (also known as “pseudodiverticula”) do not involve muscular layers or adventitia.

Incidence and causes

The incidence of diverticular disease increases with age. In the age group between 40 and 50 years, it is 40%, while it exceeds 71% after 70 years.
Data show that females have a significantly higher incidence of developing diverticula than males.
Diverticulosis is rare in patients younger than age 30. However, more recent literature has reported an increase in the incidence of diverticular disease among younger patients..
Diverticula can be present from birth and in this case the disease is defined as congenital.
In the Western world, diverticular disease has largely been thought to be due to environmental risk factors such as sedentary lifestyle, dehydration, a diet rich in saturated fats and low in fiber, rich in yeast-based and processed products.

Classification

Symptomatic diverticular disease is classified into several distinct types:

• Prediverticular state represents the onset of diverticula, with symptoms similar to irritable bowel syndrome;
• Diverticulosis refers to the presence of diverticula in the intestinal mucosa. Diverticulosis is common, doesn’t cause symptoms or need treatment.;
• Diverticulitis is inflammation (swelling) and infection in one or more diverticula.

Symptoms

The presence of diverticula in the intestine, without inflammation or symptoms, is called diverticulosis. Instead, If the diverticula become inflamed or infected, causing more severe symptoms, it’s called diverticulitis.

Symptoms of diverticulitis are:

• Very frequent abdominal pain, especially on the left side;
• Pain in the abdomen after eating;
• Alternation of constipation and diarrhea;
• Meteorism and aerophagia;
• Poor digestion
• Fever;
• Bleeding in 2% of patients.,
• The most serious symptomatology associated with the presence of diverticula is peritonitis, that is, inflammation of the peritoneum, a sac that lines the abdominal cavity. In this case, the diverticula break, releasing intestinal waste in the abdomen.

Diagnosis

The most frequent tests to diagnose the presence of diverticula in the intestinal mucosa are:

• Magnetic resonance;
• Colonoscopy, which can only be performed in the case of diverticulosis. If there is already inflammation and therefore diverticulitis, the examination is not recommended, due to the risk of intestinal perforation;
• CT of the abdomen, with contrast media;
• There are no laboratory tests capable of confirming the  presence of diverticula.

Treatment and nutrition

To prevent diverticulosis from turning into diverticulitis, special guidelines must be followed:

• Increase fiber-rich foods such as fruit, vegetables or whole grains. Fibers can favor the formation of softer stools and decrease endo-luminal pressure, responsible for the formation of diverticula;
• Get at least 30-40 minutes of physical activity per day, to increase intestinal peristalsis;
• Avoid foods of animal origin, rich in saturated fats;
• Avoid processed foods, rich in additives and preservatives;
• Avoid foods or drinks rich in simple sugars;
• Eating too much in one sitting. Prefer small and frequent meals;
• Eat at least 30 grams of fiber per day.
• Avoid fruit or vegetables rich in seeds, such as kiwis, tangerines, strawberries, berries, tomatoes, artichokes, green beans, peppers, aubergines.
• Legumes must be always well cooked to prevent them from getting stuck in diverticula;
• Drink only decaffeinated tea and coffee, as theine and caffeine are highly inflammatory;
• Drink only lactose-free milk, as lactose has an inflammatory action;
• Avoid any form of alcohol or spirits.

Natural remedies

There are a number of herbal teas and infusions with soothing for intestines:

• Lemon balm herbal tea is rich in tannins and mucilages, which relax the muscles of the intestine. It is excellent for relieving cramps and abdominal pain;
• Mallow herbal tea, is rich in mucilages that increase the fecal mass, avoiding constipation.
• Herbal tea with psyllium seeds, which have a soothing, anti-inflammatory and moisturizing action on the intestinal mucosa.