Are small blisters that form in the intestines and are difficult to treat? Let's talk about (Diverticulitis)!

Do you sometimes have stomach pain, especially in the lower left side of your abdomen? Or do you sometimes feel like you have a fever and bloating? These can be symptoms of certain medical conditions, even though we sometimes don't pay much attention to them. That's why this condition, which requires a little attention, is called `(Diverticulitis). Let's talk about this in detail today, okay?

What is this `(Diverticulitis)`?

Simply put, diverticulitis is when little pockets form on the inside of your colon - we call them diverticula - that become infected, scarred, and inflamed. Think of it like little bubbles forming in the wall of your colon, and food particles and stool getting stuck in them, causing bacteria to grow and infect you.

Many people develop these pouches called `(Diverticula)` in their intestines as they get older. We call this condition `(Diverticulosis)`. That is, those little pouches are there in the intestines, but they are not causing any problems. But not everyone has a problem with this. However, it is only when one of those little pouches becomes infected that the severe pain and other symptoms start to appear. If that happens, it means that there is an `infection` inside it, and you need to get medical treatment immediately.

How common is Diverticulitis?

The diverticulosis I mentioned earlier, which is the formation of small pouches in the intestines, can occur in many people after the age of 50-60. However, the infection of those pouches, called diverticulitis, is a little less common. About 4% of people with diverticulosis develop diverticulitis. That means that if a hundred people have diverticulosis, only four will develop diverticulitis. But if it occurs once, there is a 20% chance of it occurring again. Therefore, it is better for those who have had it once to be a little more careful.

Are there different types of diverticulitis?

Yes, doctors divide this into two main ways:

1. Acute and Chronic Diverticulitis.

2. Uncomplicated and complicated (Diverticulitis).

Now let's take a look at each of these.

What is Acute / Chronic Diverticulitis?

Diverticulitis often begins as an acute problem. This means that the illness comes on suddenly, with severe pain and fever-like symptoms, and then gets better within a few days with treatment.

But for some people, it can be recurring. Just like some people have recurring illnesses like asthma. For others, the infection can be chronic. That is, it doesn't get better completely, but keeps getting worse. There are different theories as to why this happens. It could be because the sudden illness doesn't get better completely, or it could be related to another long-term condition in your gut.

What is Uncomplicated / Complicated Diverticulitis?

Most of the time, about 80% of cases, diverticulitis is uncomplicated. That means the problem is an infection in the pouches of the intestine, sometimes just a minor infection. If treated properly, it can easily be cured.

Diverticulitis becomes complicated when the infection causes other complications. This can be quite serious. For example, a severe infection can cause a diverticulum (a pouch) to rupture. This can cause the contents of the intestine to leak into the stomach. A long-term infection can cause scarring of the intestine, which can lead to blockage of the intestine.

What are the symptoms of `(Diverticulitis)`?

These symptoms may vary from person to person, but the main things you can see are:

• Stomach pain: This is the main symptom. It is often severe.
• Bloating or a feeling of the intestines catching: The stomach may feel swollen, and sometimes it may feel like a part of the intestines is catching when touched.
• Fever: You can get a fever if your body gets too hot.
• Nausea and vomiting: Loss of appetite can be accompanied by nausea and vomiting.
• Rectal bleeding: Blood may pass through the stool .
• Constipation or possibly diarrhea: Constipation is the most common, but diarrhea-like conditions can also occur rarely.

What does the pain feel like when you have diverticulitis?

Whether you have a sudden onset of diverticulitis or a flare-up of an existing condition, the pain is very similar. In an acute episode, the pain may come on suddenly. In a chronic episode, the pain may gradually increase over several days. The pain is felt exactly where the infected diverticulum is. It can feel like a sharp stabbing pain or a burning sensation. The pain usually ranges from moderate to severe.

Where in the stomach is the pain felt?

This is an interesting fact. For people of European descent, these pouches called `(Diverticula)` often develop in the last part of the large intestine, which is called the `(Sigmoid Colon)`. This is located on the left side of your lower abdomen, and then turns slightly to the right to connect to the rectum. That is why most people experience `(Diverticulitis)` pain on the left side of their lower abdomen. Sometimes this lower abdominal pain can spread to the pelvis and even the back.

However, for people of Asian descent (like us), this `(Diverticulosis)` condition is more likely to occur in the upper right quadrant of the colon. In that case, the pain of `(Diverticulitis)` can come from the upper right quadrant of the abdomen.

What are the causes of diverticulitis?

The main reason for the infection of those pouches called ``diverticula'' is that a small tear or hole (``tear``) forms in their walls, allowing bacteria to enter and cause an ``infection.`` However, in this case, it is not exactly clear whether the hole forms first, or whether the bacteria become infected first.

Imagine, if something like a piece of stool gets stuck inside that little pouch, it's a perfect place for bacteria to grow. Then, due to the bacterial infection, it can swell, become injured, and the wall of that ``(Diverticulum)`` can rupture.

On the other hand, if the wall of the pouch tears for another reason (for example, a hard piece of stool while passing stool), even bacteria that normally live in the intestines can easily enter through the tear and cause an infection. Some studies have found that viral infections such as ``Cytomegalovirus - CMV`` can also contribute to the development of ``(Diverticulitis)``.

Is Diverticulitis hereditary?

Diverticulitis often occurs by chance. That is, it is not a disease that is directly inherited. However, the condition called diverticulosis, which is the formation of pouches in the intestines, may have some genetic influence. For example, as we discussed earlier, Europeans are said to have more pouches in one part of the intestines, while Asians have more pouches in another part. This may be influenced by genes. Also, genes may affect how susceptible someone is to chronic infections. This is being further researched.

What are the possible complications of diverticulitis?

Most of the time, about 80% of cases, diverticulitis resolves without complications. However, if it becomes severe or persists, complications such as:

• Gastrointestinal bleeding: Bleeding from diverticula can be severe and can also cause anemia. Just think, if you keep bleeding, your body will lose blood, right?
• Intestinal obstruction: If the swelling is severe, your intestines may become temporarily blocked. Prolonged swelling can cause scarring (stricture) and permanent blockage of the intestines.
• Fistula: An infected, decayed part of the intestine can connect to another body passage (for example, your small intestine, bladder, or vagina), forming an abnormal opening between the two.
• Bladder inflammation: If you have diverticulitis near your bladder, it can cause a blockage and infection in your bladder. If a fistula forms in your bladder, the infection can spread there as well.
• Abscess: An abscess is a collection of pus that may need to be drained. If it bursts, the infection can spread to your abdominal cavity (peritoneal cavity) and cause a dangerous condition called peritonitis. This is an emergency!
• Gastrointestinal perforation: If a diverticulum becomes too large and ruptures, bacteria from the intestine can leak into the abdominal cavity. This can cause peritonitis, which can lead to a dangerous condition called sepsis, which is a bacterial infection that spreads throughout the body. This is also a very dangerous emergency!

Important: These complications don't happen to everyone, but it's good to be aware that these things can happen.

What are the symptoms of complicated diverticulitis?

If you have these symptoms, you may have complications from diverticulitis:

• If there is fresh blood in the stool.
• If the face is pale and the body feels lifeless (this could be a sign of `Anemia`).
• If you feel like you need to urinate frequently , or if you have burning or pain when urinating.
• If your abdomen is hard and painful to the touch (this could be a sign of peritonitis).

If you notice something like this , see a doctor immediately.

How to diagnose `(Diverticulitis)`?

If you and your doctor already know that you have `(Diverticulosis)`, you may suspect that it is `(Diverticulitis)` based on the symptoms you are experiencing. However, many people do not know that they have `(Diverticulosis).` Furthermore, the symptoms of `(Diverticulitis)` can be similar to those of many other stomach diseases.

Therefore, the doctor will ask you about your symptoms and perhaps do some basic tests, such as a blood test (`comprehensive metabolic panel`), a stool test, and a urine test.

Then, if diverticulitis is suspected, imaging tests will be ordered to confirm the diagnosis. A CT scan is a good option. It can quickly determine the extent of the infection and any other complications. In some cases, your doctor may need to look inside your colon with a lighted scope (a tube with a camera attached to it). Some complications can be treated at the same time as the colonoscopy.

Does diverticulitis get better on its own?

If the illness is mild and uncomplicated , it may get better on its own. But don't just wait until you see a doctor. You should definitely see a doctor to find out exactly what's wrong. You may need to take antibiotics for an infection. Some people may also need prescription pain medications. Your doctor will also give you instructions on how to stay home until you recover. It will take about a week to recover. It's important to stay in touch with your doctor during that time.

How to treat diverticulitis at home?

If your doctor allows it, you can treat it at home in the following ways:

• A liquid diet: Avoiding solid foods gives your intestines a rest and helps you recover from illness. Your doctor will tell you exactly what to eat and how long you should stay on this diet.
• Doctor-prescribed `Antibiotics`: Not everyone needs them, but if you do, your doctor will give you some medicine to take home. The type of `antibiotic` depends on the type of `infection` you have.
• Acetaminophen: Of the over-the-counter (OTC) pain relievers available at the pharmacy, it is best to use something like Acetaminophen (e.g. Tylenol®).

Medicines not to use when you have diverticulitis

Doctors advise against using nonsteroidal anti-inflammatory drugs (NSAIDs) when you have diverticulitis, as they can increase the risk of GI bleeding. These NSAIDs include:

• Aspirin (e.g. Bayer® or St. Joseph®)
• `Ibuprofen` (e.g. `Motrin®` or `Advil®`)
• `Naproxen sodium` (e.g. `Aleve®`)

What happens if diverticulitis is left untreated?

If you have a very mild, uncomplicated condition, you may not need treatment. But you should definitely tell your doctor about your diverticulitis. If you don't, you could end up with a more serious condition and complications. There are some infections that don't get better without antibiotics or antivirals. Infections that don't get better can lead to other complications. The pain can also be severe.

What can you do to cure diverticulitis?

If simple home treatments don't help, or if you have severe, long-term, or complicated diverticulitis, you may need to stay in the hospital for treatment. Treatments that may be given at the hospital include:

• IV medication: Your doctor may give you antibiotics or antivirals through an IV (like a saline solution). This way, the medication goes directly into your bloodstream, so it works faster. Painkillers can also be given this way. Some people may need to take strong painkillers like opioids for severe pain.
• Blood transfusion: If you have lost a lot of blood due to a bleeding diverticulum, you may need an emergency blood transfusion to replace the loss.
• Endoscopic procedures: Your doctor may use a colonoscope or sigmoidoscope (these are types of endoscopes that look into the colon) to treat minor complications. For example, they can stop bleeding, drain an abscess, or widen a blocked section of the colon.
• Surgery: Some people may need surgery for an abscess, persistent bleeding, perforation, or fistula. Rarely, people with persistent diverticulitis may need surgery to remove the affected part of the colon (colectomy). This may involve a temporary colostomy, which is a tube placed through the side of the abdomen to drain stool.

Can diverticulitis be prevented from occurring or recurring?

To be honest, doctors still don't fully understand why diverticulitis develops or recurs. So it's hard to say for sure how to prevent it. But they do think that maintaining good intestinal health in general can help .

• Eat more plant-based foods and reduce animal fats.
• Drinking enough water throughout the day.
• Exercising regularly.

These things can help your bowel movements go smoothly. For some people, doctors may also recommend fiber supplements or probiotics.

There was an old belief that people with diverticulosis should not eat nuts, as they could get stuck in the diverticulum and cause diverticulitis. This is now largely considered a myth. Nuts are a good source of fiber and plant-based protein. Therefore, rather than worrying about accidentally getting a nut stuck in your colon, it is best to eat a balanced, healthy diet.

What can we expect in this situation?

A very small percentage of people develop complicated diverticulitis. Of those, only a small number need surgery. In most cases, complicated diverticulitis can be treated quickly and completely. Diverticulitis will not affect your normal life expectancy. However, as I mentioned earlier, the only risk is if there is a very rare, life-threatening complication, such as a bowel perforation or an abscess bursting. So don't panic, see a doctor right away.

What to do if diverticulitis continues to develop?

If you can't prevent diverticulitis from recurring despite diet and lifestyle changes, you may have other factors that increase your risk. For example, people with weakened immune systems may get infections more often and take longer to recover. People with autoimmune diseases are more likely to develop persistent infections. The balance of different bacteria living in your gut can also affect your gut's immune system.

Doctors can't always say for sure why some people keep getting diverticulitis. However, if you have had it more than once and have had at least one complication, they may recommend an elective bowel resection, which is a surgical procedure to remove the small part of your bowel that is causing the problem . If it's not an emergency, it can often be done in one operation without a colostomy.

Take-Home Message

So, `(Diverticulitis)` is a complication that can occur in people with `(Diverticulosis)`, but it is not very common. `(Diverticulitis)` is even less likely to cause further complications. But if it happens to you, you may need urgent treatment.

Therefore, if you have symptoms of `(Diverticulitis),` definitely see a doctor without delay.

They will then decide what kind of treatment you need, whether you can treat it at home or whether you need to be hospitalized. Don't worry, most of the time this condition can be managed well and you will recover quickly. Take care of your gut health, okay?

` Diverticulitis, colon infection, stomach pain, diverticulosis, bowel disease, colonoscopy, digestive system