Did you know that a low intake of fiber in your diet could lead to development of a disease within your bowel? This condition, known as diverticular disease, is the development of small pouches in your large bowel. It may not cause symptoms in the initial stages, but nevertheless places you at an increased risk of sudden complications such as bowel obstruction, bowel rupture, pus collection in the abdomen, and acute bleeding episodes from the rectum.

Diverticular disease affects the colon, which is part of your large intestine. The colon stores and removes waste material from your body. In this condition, there are small pouches or sacs that form in the bowel particularly in the lining of the large intestine. The bulging sac or pouch is called a diverticulum. More than one diverticulum is called diverticula. These sacs seem to occur more commonly in the lower end of the left colon (sigmoid colon).

While it is not certain why diverticulosis develops, there are a few theories that have been suggested. Both are related to diet and age. With advancing age, the muscular wall of the colon becomes thicker making it difficult to pass feces. Also, diet plays an important role. A diet low in fiber makes stools small and dry and ultimately difficult to pass. Intestinal muscles need to contract with greater pressure to force the stools along. This causes segments of the colon to close off from the rest of the colon. The pressure then increases causing the colon to push the inner intestinal lining outward (herniation) through weak areas in the muscular walls. This results in the formation of diverticula.

Common types of diverticular disease are diverticulosis, diverticulitis, and diverticular bleeding.

Diverticulosis is the term for the presence of more than one diverticulum in the large bowel. Infection may develop when bacteria or stool gets caught in the diverticula. This can result in the rupture of the colon, and infection or collection of pus in the tissues that surround the colon. This condition is termed as diverticulitis. When bleeding originates from a diverticulum, it is called diverticular bleeding. A person who suffers the consequences of diverticulosis in the colon is referred to as having diverticular disease.

Factors that increase the risk of developing diverticular disease include:

• Advancing age
• Obesity
• Family history
• Chronic constipation
• Lack of exercise
• Frequent use of laxatives

It is very uncommon for someone to get the disease before the age of 40. It is most common after the age of 60 and both men and women are equally affected.

The majority of patients with diverticulosis may have few or no symptoms. It may be found by chance during an endoscopic or X-ray examination. Symptoms may include pain and discomfort in the left lower abdomen, bloating, or change in bowel habits (constipation/ diarrhea, severe and constant pain over the left lower abdomen, high temperature, vomiting, abdominal tenderness, and constipation/diarrhea). There may be acute bleeding from the rectum in cases with diverticular bleeding. This may be associated with shock-like symptoms and dizziness depending on the amount of blood loss.

A diverticulum can also rupture and bacteria within the colon can spread to the tissues surrounding the colon. The collection of pus around the inflamed diverticulum can lead to formation of an abscess.

Your doctor may diagnose diverticular disease by performing one or more of the following tests. A barium enema (X-ray test performed with injection of liquid material into the colon through the rectum) will help in visualizing the anatomy of the colon, and identify if diverticula, polyps, or growths are present.

A doctor may perform a colonoscopy, by aid of a thin, flexible tube with a light and camera, and look for diverticula as well as polyps and other growths. A CT scan (X-ray test that takes multiple section pictures of the body) can help to identify diverticula.

Treatment for the condition depends on how serious the problem is and whether you are suffering from diverticulosis or diverticulitis. Once a diverticulum has formed in the colon, it will not go away. If symptoms are not present, a doctor may recommend increasing the fiber in your diet to soften and bulk stool, drink more fluids, and exercise regularly to prevent the development of more diverticula or associated complications. High-fiber foods include beans and legumes, bran, whole wheat bread, whole grain cereals, fruits (apples, bananas, and pears), vegetables such as broccoli, carrots, corn and squash, brown rice and whole-wheat pasta. Laxatives in consultation with your doctor may help in avoiding constipation.

Mild cases of diverticulitis may be managed with oral antibiotics, dietary restrictions, and stool softeners. More severe cases require hospitalization with intravenous antibiotics and dietary restraints. If there is pus collection around the colon, then a doctor may need to drain it by a catheter passed into the abdomen through the skin.

Acute bleeding due to diverticulosis requires in-hospital management with intravenous fluids, blood transfusions, and diagnostic procedures to locate the bleeding. For a patient who does not respond to medical management, has recurrent episodes of diverticulitis, an obstruction of the colon, or severe bleeding from the diverticulum surgery, it may be necessary to remove the affected area of the colon.

It is not known if diverticular disease can be prevented. Having a diet rich in fiber (minimum of 15 to 30 grams daily), restriction of foods with indigestible particles such as popcorns, nuts, and fruits with small seeds, avoiding excessive use of laxatives, drinking plenty of fluids, and exercising regularly are a few measures in the prevention of diverticular disease.