Diverticulosis is a disease in which the formation of so-called pockets, that is, single or multiple protrusions of the intestinal mucosa, of a hernial nature. Their size can be up to 5 mm in diameter, sometimes even a little more. They are called diverticula.
Interestingly, back in the 1930s and 40s, the prevalence of this disease, according to X-ray studies, was no more than 7%. While in recent years the figure has increased to 30%. It should be taken into account that very often, at least at the beginning of the disease, diverticulosis is asymptomatic. That is, in fact, its prevalence can be much higher - up to 50%.
At the same time, mainly residents of economically developed countries suffer from pathology, which suggests that lifestyle and eating habits play an important role in its pathogenesis.
Causes of diverticulosis
Currently, the causes of the development of diverticulum in the walls of the intestine are unknown to medicine. The most widely accepted theory is thatit is believed that such protrusions are the result of increased pressure inside the intestine itself - the weakest points form the described "pockets".
As for changes in pressure, they are associated with the peculiarities of nutrition. If a person receives enough fiber, this ensures normal intestinal motility and the gradual movement of feces through it.
If a person receives insufficient fiber, this leads to certain stagnant processes inside the intestines, as a result of which its contents press on the walls, and after a while diverticula form.
It is interesting that they form where many vessels pass through the muscle layer. These places are considered the weakest.
When considering intestinal diverticulosis, symptoms and treatment of this disease, it should also be noted that a number of risk factors operate for it, which include:
- chronic constipation;
- presence of inflammatory processes in the intestines;
- overweight;
- decrease in dietary fiber.
Currently, the relationship between coffee or alcohol consumption and the development of diverticulosis has not been established. However, it has been proven that the risk of developing pathology is associated with the use of large amounts of fat and red meat. Adding fiber from fruits and vegetables to your diet can help reduce your risk.
Diverticulosis of the large intestine: main signs
There are three forms of diverticulosis - asymptomatic (when diverticula are found during examinationaccidentally), uncomplicated, when there are certain clinical manifestations, as well as complicated (most often diverticulitis is added).
Diverticula usually appear in the large intestine. Much less often - in the small intestine and duodenum.
When considering colonic diverticulosis, symptoms can be identified as follows:
- Pain syndrome. Moreover, the pain can be of a different nature - from a slight tingling to severe attacks. There may be aching sensations in between.
- Nausea and vomiting.
- Unsteady stools when constipation alternates with diarrhoea. Interestingly, after a bowel movement, many symptoms, including pain, disappear for a while.
- Signs of intestinal dyspepsia (flatulence, bloating, distinct rumbling).
Pain in the abdomen during the disease do not have a clear localization. The patient can only say that it hurts somewhere on the left, in the iliac region. As the intestines fill with contents, the discomfort intensifies.
Interestingly, constipation in such cases occurs in about 85% of patients, but diarrhea occurs in only 15%. Most often, the pain syndrome is provoked either by malnutrition (for example, eating too much fatty food), or by uncontrolled intake of laxatives, or by some psycho-emotional reasons.
When looking at diverticulosis, symptoms, and treatment in adults, it should be noted that uncomplicated diverticulosis often presents with other symptoms.pathologies associated with the appearance of diverticulum. They can be divided into several groups:
- obesity;
- connective tissue deficiency (congenital or acquired);
- impaired intestinal motility.
Biliary tract diseases with characteristic symptoms often develop simultaneously.
Diagnosis of disease
Complaints of pain or even just discomfort in the abdomen, periodic delays in stool, other symptoms listed above are sufficient grounds for additional diagnostics.
The doctor must conduct an examination, while palpation of the abdomen helps to identify painful areas - usually they are on the left. But the appearance of symptoms of peritoneal irritation may indicate the development of complications, including intestinal obstruction.
For the diagnosis of diverticulosis, a rather informative method is barium enema (an examination of the intestine with a barium enema, which helps to determine the presence of protrusions). A colonoscopy is also prescribed, which allows you to determine the presence of inflammatory changes or perforations - complications of diverticular disease.
Conservative Therapy
When considering intestinal diverticulosis, symptoms and treatment in adults, it should be noted that almost always conservative methods are used. Unfortunately, they usually do not affect the causes of the development of the disease described above, therefore, in order to increase efficiency, it is necessary to take comprehensive measures, for example, fight obesity, makeadjustments to the usual way of life.
If we are talking about a form of diverticulosis without clinical manifestations, then even special treatment is not required, it is enough to take more fiber daily - at least 200 g of vegetables. Some experts find bran to be effective.
If we are talking about the classic symptoms of diverticulosis, the treatment will be a little different. Usually this is an uncomplicated form, but in order to avoid the progression of the disease and the development of comorbidities, it is necessary to take courses of conservative therapy 2-3 times a year. Their duration is determined by the doctor, based on the overall picture, on average, they can last 2-6 weeks.
Treatment of the disease in general includes three areas:
- Special diet with increased fiber and dietary fiber to improve digestion and eliminate constipation.
- Drug treatment, including antispasmodics and prokinetics, depending on the nature of motor disorders.
- Relieve constipation by taking osmotic laxatives - mainly drugs containing lactulose.
An important caveat - taking stimulant laxatives in diverticulosis is contraindicated, as they affect the pressure in the intestinal lumen.
Surgical intervention is indicated only for severe disease and complications.
Drug therapy for diverticulosis
Treatment of verticular disease in the presence of pain involves taking drugs such as antispasmodics,these are "No-Shpa", "Papaverin", "Drotaverin". You can take them only after consulting a doctor.
Also, to normalize digestive processes, enzyme preparations like "Creon" or "Festal" can be prescribed. Gastrointestinal motility stimulants (this, for example, Metoclopramide) should not be taken on their own in any case, since they can affect pressure indicators.
But in some cases, the doctor prescribes just such drugs based on the results of the examination.
If diverticulosis is accompanied by complications in which antibiotic therapy is prescribed, then probiotics are additionally taken - Linex, Bifidumbacterin.
Diverticulosis diet
As already noted, nutrition in diverticulosis involves the use of so-called ballast substances, or dietary fiber. This is vegetable fiber, due to the presence of which the feces absorb water more intensively, become more loose, which facilitates their movement. In addition, fiber is a prebiotic, that is, an environment favorable for the active reproduction of beneficial microflora.
The energy value of the daily diet for diverticulosis should be no more than 2500 kcal, provided that the patient has moderate physical activity. At the same time, food should contain at least 30 g of fiber. And it is necessary to include in the menu products thatcontribute to the normalization of digestive processes. This is:
- Whole grains, with brown rice being especially beneficial.
- Vegetables and fruits. However, especially in the presence of concomitant diseases of the gastrointestinal tract, they must be treated with caution. For example, with gastritis, it is better to eat apples not raw, but baked. You need to eat up to 500 g of vegetables and fruits per day.
- Wholemeal bread.
- Low-fat dairy products.
By the way, all other products of animal origin, except for eggs, kefir and cottage cheese, should be limited. Meat can only be consumed white (rabbit, turkey, chicken) and no more than 150 g per day. You can eat pasta, but only from durum wheat. Semolina porridge will have to be excluded from the menu, wheat bread too.
Sigmoid diverticulosis: symptoms and treatment
In almost 70% of cases of diverticular disease, protrusions appear in the sigmoid region. This is due to its functional and anatomical features. If this form of diverticulosis is diagnosed, the symptoms and treatment will, in principle, be close to the picture characteristic of the large intestine as a whole.
The sigmoid colon has a smaller diameter, many curves, and its contents are denser. In addition, it performs a reservoir function, which leads to an increase in pressure on its walls.
Thus, if diverticulosis of the sigmoid colon is diagnosed, the symptoms and treatment, the diet will be as described above. Fromdiverticulum in the small intestine, this form differs in that it is easier to detect, and also has a lower risk of developing some complications, including bleeding.
Diverticulosis in the elderly: symptoms and treatment
Diverticulosis can be associated with various pathologies, but most often the problem lies in the weakness of the intestinal wall. With age, the tone of the muscles of the large intestine gradually decreases, the connective tissue wears out, which leads to the appearance of a diverticulum.
Vascular pathologies and dystrophic changes also play their role here. The latter in elderly people occur as a manifestation of general degenerative processes in the body, they are often associated with the development of atherosclerosis.
Intestinal diverticulosis, symptoms and treatment of the elderly are of particular interest, since the risk of the disease increases significantly with age. In general, the signs correspond to the clinical picture described above.
In the elderly, symptoms such as increased gas formation, flatulence, false urge to defecate are more common (and even after emptying the intestines, the feeling of fullness remains). In addition, traces of mucus are visible in the feces.
For the elderly, proper nutrition is especially important. In general, it is recommended to adhere to the above recommendations, that is, to include at least 30 g of fiber in the diet. In this case, nutrition should correspond to the treatment table No. 4 according to M. Pevzner. This means that certain rules must be followed.cooking (dishes can be boiled, steamed, in extreme cases baked without a crust, but not fried).
It is necessary to spare the stomach and intestines. This means that you can not eat too hot food, and spicy, fatty and fried foods, and especially red meat, are excluded from the diet.
Diverticulosis and diverticulitis
One should distinguish between these two diseases. If diverticulosis is the appearance of a bulge, then diverticulitis is inflammation.
The symptoms of diverticulosis themselves may not appear for a very long time, without even giving a reason to go to the doctor. If there is severe pain, this means that the person has developed diverticulitis. True, this happens quite rarely, since in about 80% of people pain never appears. By the way, the presence of diverticulosis is most often detected during tests that are prescribed for other diseases.
Diverticulitis is a complication of diverticulosis. When the inflammatory process begins, it is already different from the picture that gives diverticulosis of the large intestine, the symptoms and treatment here will be different.
Diverticulitis is characterized by:
- increased body temperature, sometimes chills;
- dyspeptic symptoms - nausea, vomiting;
- stool disorders;
- anorexia;
- appearance of a painful dense sedentary infiltrate in the abdominal cavity.
Sometimes the bladder is also involved in the inflammatory process. Since inflammation is often associated with a bacterial infection, and diverticulosis itself only creates for its spreadfavorable conditions, then therapy most often involves oral antibiotics, and in severe cases - their intravenous administration.
Treatment should generally be conservative. But in some cases, surgical intervention is necessary, although not urgent (urgent surgery is performed only with an abscess or peritonitis). It mostly occurs in the chronic form with severe symptoms.
Prevention of diverticulosis
Complications in this disease occur only in 20% of cases. However, in medicine, this indicator is considered quite high, so intestinal diverticulosis, the symptoms and treatment of which are described in the article, must be treated. Not only effective therapy is required, but also prevention.
Because the main risk factors for the development of this disease are overweight and lack of fiber in the diet, you need to follow a certain diet and lifestyle. A decrease in the energy value of the diet should be combined with an increase in fiber in it - an average of up to 32 g per day. Moderate exercise is also indicated, as a sedentary lifestyle affects bowel function.
