Diverticular Disease

All current literature recommends that the most effective way to prevent or manage diverticulosis is through the adoption of a diet high in fibre.

 

Fibre is the indigestible portion of plant foods which aids in bulking up the stool (by forming the bulk or the roughage) to assist it in passing through the body to assure regular bowel movements.

 

There are two type of fibre in the diet, soluble and insoluble fibre, both of which aid in the creation of a stool and prevent constipation.

1) Soluble fibre: dissolves easily in water and takes on a soft texture in the intestines. This fibre is the bodies main means of bulking the stool.

2) Insoluble fibre: passes through the gastro-intestinal tract virtually unchanged.

 

As plant materials are passed through the body, the removal of water, protein, fats, carbohydrates and essential nutrients occurs.

Upon entering the colon, all that remains to be digested is water. The colon should remove this remaining water, thus forming the stool.

 

If an individual is not eating sufficient amounts of fibre containing foods, a very dry, hard stool is produced. Stools of this consistency have difficulty moving through the bowel and require higher amounts of pressure to be passed through. Gradually the body becomes incapable of creating these high amounts of pressure, and begins to rely on the force of the movement of the abdominal walls to transport stools through the bowel. This is known as straining, and puts an excessive amount of pressure on the abdominal wall, resulting in the formation or aggravation of diverticula.

 

On the other hand, diets containing sufficient amount of fibre end in the production of a softer, bulkier stool, which is easily moved through the bowel without requiring high pressures to do so.

 

 

By ensuring an adequate amount of fibre in the diet it is possible to prevent the occurrence diverticular disease or to manage existing diverticular disease by reducing the required pressure for stools to pass through the bowel.

Current recommendations for fibre intake per day are:

1      At least 25 grams of fibre per day for adult women.

2      At least 30 grams of fibre per day for adult men.

3      28 grams of fibre per day for pregnant women over the age of eighteen.

4      27-30 grams of fibre per day for women who are breastfeeding.

Another requirement for the formation of a soft, bulky stool is an adequate fluid intake. This will ensure that the stool retains sufficient water to be soft and that the bowel is able to produce mucous. The secretion of mucous allows the stool to pass easily through the bowel rather than sticking to the wall of the colon.

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In many cases, diverticular disease presents with no symptoms and thus no treatment is required, however it is ideal that the individual adopt an optimal diet to ensure no symptoms do occur.

 

In the event that symptoms appear, the main form of treatment of diverticulosis is through the adoption of an optimal diet (addressed in chapters 5 and six).

 

In some cases medications are required.

For an individual who develops diverticulitis (the active phase of the disease) treatment is more intense. Should symptoms or complications of diverticulitis become severe enough, an individual may often require hospitalisation. In hospital they are treated with changes to diet and appropriate antibiotics. Surgery is the final option, and is only implemented for individuals who suffer from recurring diverticulitis. Surgery generally involves the removal of certain sections of the bowel and consequent resection and is generally suggested if a patient has two or more occurrences of diverticulitis or if a large perforation or peritonitis is present.

 

 Surgery is generally performed via two operations. The first operation aims to remove the diseased section of the colon and clean the abdominal cavity. During this operation, it is not appropriate to rejoin the colon due to the high risk of the patient developing infection or a bowel obstruction. Instead surgeons divert the path of the faecal matter via a colostomy. A colostomy involves the attachment of the colon to the skin in which faeces are passed through a hole into a bag stored externally.

 

After a period of time has elapsed and the infection in the colon has been successfully treated and subsided, the bowel is reattached, thus enabling normal bowel functions and the patient to cease the use of the colostomy bag. The hole that was previously made in the skin is surgically closed..

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