HAVE YOU DIVERTICULAR DISEASE ?

Very likely, if you're my age - it's common in maturity.

Diverticular disease can range from just a few pockets on the bowel and no symptoms, to great masses of inflamed tissue blocking the bowel and needing surgical removal.

You can even have "pre-diverticular disease" with the muscle thickened and bowel shortened, but no blown-out pockets.

pre diverticular bowel shortening



Years of extra effort moving harder bowel content, have resulted in thicker muscle running along the bowel.

The bowel concertinas and now looks like corrugated hose.

Diverticulae are the little pockets, blown outᶜ through holes in the muscle where blood vessels pierce the bowel wall.

When do you suspect you have this condition? You've guessed it - if you have abdominal pain (particularly lower left pain, and if related to using your bowel.)

Diverticular disease is also a very common cause of bleeding from the bowel.

Bleeding from the bowel

Bleeding from piles or a crack in your anus, will be probably seen on the toilet paper and be bright red.

Bleeding from diverticulosis will more commonly be darker, plumb colored and mixed with the faeces.

Bleeding from a peptic ulcer in your stomach or duodenum, will produce pitch black stools if it is bad enough. This is a medical emergency, often requiring blood transfusion and urgent endoscopy.

Any bleeding here is a good reason for a check up, as it could be from something more sinister.

Screening for bowel cancer using occult blood tests

Occult bleeding, too little to see in your faeces, can come from pre-malignant polyps of your colon.

These take several years at least, to turn into bowel cancer, allowing for effective prevention of this common disease.

Programs of checking your faeces for blood once a year from the age of fifty, have been shown to save lives.

Recommended.

Diverticulitis

These little pockets are prone to infection, when "diverticulosis" becomes "diverticulitis" (inflamed diverticulae.) Worse pain now.

This is an acute feverish illness, commonly sigmoid diverticulitis, nicknamed left sided appendicitis.

colon anatomy



This figure is facing us, so it shows the end of the small bowel and appendix on our left and the sigmoid at the end of the large bowel on our right - conventional way to show it, silly isn't it.


Diverticulitis is quickly and conveniently treated with a short course of antibiotic.

I'm now mounting my soapbox.

Antibiotic resistance

We all need to become much more careful in our use of these precious gifts of nature.

If you have recurrent attacks of diverticulitis, you may need courses of antibiotics pretty frequently.

Ask your doctor to use a number of different antibiotics, including erythromycinⁿᵒᵗᵉˢ<span style='font-size: 50%'>-a, in strict rotation.

This will hopefully prevent your germs from building up resistance to any one drug (and potentially passing it on to different germs, as transferable resistance genes.)

Germs share genetic material in structures called plasmids, quite separately from their chromosomal DNA. Since the widespread use of antibiotics, these have included resistance plasmids - with DNA fragments coding for antibiotic resistance.

A meta-analysis of medical literature reported on May 19 2010¹ studied the development of subsequent antibiotic resistance in patients prescribed antibiotics in primary care. They found a third of this resistance was still present 12 months after antibiotics.

Probiotics and nutritional immune support

We have about thirty species of germs in our bowel, with which we get along just fine.

These guys can coat the surface of our bowel and muscle out other less friendly types.

Over the age of fifty, we tend to have problems in the balance of germs in our bowel, called dysbiosis. Specifically here, antibiotic use causes this faster than aging!

In one USA study, many people ate meat contaminated with Salmonella but only 18 got obviously ill and 12 of the 18 had been or were taking antibiotics. See Holmberg², in references.

Those twelve people had less protection by friendly germs in their bowel.

It takes 3 or 4 months before the normal balance of flora is restored, after a course of antibiotics.

Probiotic germ supplements are worth considering - for everyone, not just in diverticular disease.

Herbal remedies for diverticular disease.

There are absolutely amazing numbers of natural substances potentially of help for your immune system . These range from old familiars like garlic, to olive leaf extracts and Japanese mushrooms.

There are none universally useful, so use your intuition (appropriately nicknamed your gut feeling.)

The Hagen-Poiseuille equation, fiber and your bowel

Now I'm getting really smart (had to look that one up on

Wikipedia.) Basically, to move your bowel contents, the narrower the bowel the more pressure developed doing the job.

This disease happens because of our western diet lacking vegetable fiber. Attending to this may help prevent it progressing. More fiber, more bulky bowel content, lower pressure.

Processing of foods often removes fiber. Wheat becomes 25% bran, 72% white flour and 3% wheat germ. White flour has only 3% fiber.

Plenty of organically grown fruit and vegetables is the ideal answer. Supplemental wheat bran may not be a good option, as it can be irritant in large doses.

Psyllium (Ispaghula) husks or seeds are cheap and OK. The seeds should be soaked in water before use. Two tablespoons of the seeds is a common dose.

Assuming first that you have had a medical checkup, a therapeutic trial of increasing amounts of fiber supplement, is reasonable for any bowel disturbance.
It can help both loose and constipated bowel, quite apart from helping prevent progression of diverticular disease.

Bowel transit times of 1 day or 4 days, mostly return to 2 days with increased fiber. Eating some beetroot is a simple way to measure yours - watch for the color at the other end.

A cautionary tale here. Years ago I missed two cases of bowel cancer because of the people initially responding well to increased fiber, which delayed the diagnosis.



Notes on diverticular disease.

a. My first practice was in a small country town, in partnership with Dr. Alister Hinchley.
He was a very good diagnostician and surgeon who worked from the 1930's to 1976.

He wrote...

"All people with diverticulitis get indigestion, intermittently, I think associated with the degree of inflammation.
It can't be distinguished from (dyspepsia in) cholecystitis or diaphragmatic hernia.
If it lasts a long time there is often a bit of fever with it.
Erythromycin was a matter of trial and error, working well after failure of others." (antibiotics.)...

..."I suppose there is no reason why it (diverticulitis) should not be due to a gram +ve infection. The worst appendices are Streptococcal. Anyway it was a proven observation in several cases, so I stuck to it."


b. Diverticulitis is common, so will coexist commonly with other conditions.

Writing in bmj, April 6, 1963, a surgeon named D. C. Corry reported that 12 of 120 people referred with diverticulosis, had reactions to milk.

These people were suspected of having cancer of the colon, because of persistent loose motions with mucus and even blood. These symptoms cleared rapidly when milk was stopped.

c. There is some discussion about the cause of these weaknesses, and doubt about the role of increased pressures. See http://www.cghjournal.org/article/S1542-3565%2813%2901308-6/fulltext

Complications of diverticular disease.

Inflammation can lead to scarring. Circumferential inflammation, all round a section of the bowel, can lead to stricture (narrowing of the bowel lumen (cavity.)

This is another reason for unformed bowel actions (slight diarrhoea) in this condition, along with the colicy lower abdominal pain.

Inflammation can lead to an abcess, where the tissues are dissolved and a collection of pus collects in their place. An abcess may burst into the peritoneal cavity or the urinary bladder, leading to peritonitis or vesico-colic fistula. Surgery can then be very useful in diverticular disease.

References for diverticular disease page

1. BMJ. Published online May 19, 2010

2. Holmberg et al, Science 1984 225:833-5



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The peritoneal cavity contains most of our stomach and intestines. If you imagine a very large soft balloon with your hand pushed into the back of it, so it is completely covered by the folded balloon, that is how the gut is enclosed. The cavity of the balloon normally contains a small amount of fluid and a large apron of fat called the omentum. The front wall of the peritoneum lines the wall of the abdomen and the back wall covers the intestines.

A fistula is an opening from an internal hollow organ, either to the outside of the body or as here into another hollow organ (bowel to bladder.)

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