Long Island Medical Care Services

Diverticulosis is a condition affecting 10 percent of Americans over age 40, and 50 percent of those overage 60. Most people with diverticulosis, in fact, never even know it. Diverticulosis, however, may lead to a serious condition known as diverticulitis. This brochure describes both disorders and explains why a diet high in fiber may be helpful in preventing their occurrence.

What Is Diverticulosis?
Diverticulosis is a condition, rather than a disease. It affects the colon-the flexible tube-like organ responsible for removing water from the contents of the intestine. A normal colon is strong and relatively smooth. A colon affected by diverticulosis has weak spots in the walls. These defects allow the development of balloon-like sacs or pouches. These pouches, called diverticulae, occur when the inner intestinal lining has pushed through weakened areas of the colon wall. A single pouch is called a diverticula.

What Causes Diverticulosis?
Experts aren't certain what causes diverticulosis, but it may be related to an increase in pressure within the colon. The wall thickens with age and when it contracts, it causes increased pressure which promotes the formation of the diverticulae. A second theory relates to nutrition. In western countries, diets are deficient in dietary fiber. It is felt that the diets results in less fecal bulk, narrowing of the colon, and increase in the pressure necessary to move the feces.

What Are The Symptoms Of Diverticulosis?
Most people with diverticulosis experience no symptoms at all. Occasionally one may experience lower abdominal discomfort and rarely may have painless rectal bleeding.

How Is Diverticulosis Diagnosed?
Because diverticulosis usually causes no symptoms, the disorder is usually discovered during an X ray or intestinal examination performed for reasons that may be unrelated to the diverticulosis.

Does Diverticulosis Require Treatment?
Treatment is usually not necessary. When diverticulosis is diagnosed, a physician may recommend a fiber-rich diet and to avoid laxatives and enemas, which can irritate the colon when used regularly.

How Does Diverticulosis Lead To Diverticulitis?
Diverticulitis, also known as diverticular disease, develops when particles of undigested food or stool become trapped in a diverticula, causing the pouch to become inflamed and/or infected. Usually the infection remains localized, but it is possible for bacteria to break through the colon wall and cause inflammation of the membrane that covers the abdominal organs. This condition, known as peritonitis, can be life-threatening and requires immediate medical attention.

What Are The Symptoms Of Diverticulitis?
The person with diverticulitis may experience  acute pain in the lower abdomen (usually on the lower left side), nausea and fever. The pain may be cramping or persistent. If peritonitis develops, additional signs and symptoms may be present, including pain, fever, distended abdomen, inability to pass feces or gas, low blood pressure and increased thirst.

What Is The Treatment For Diverticulitis?
Treatment for diverticulitis varies. For mild diverticulitis, the doctor may prescribe only bed rest, a liquid diet, painkillers and antibiotics to combat any infection. In some cases, patients may need hospitalization and intravenous antibiotics. In more severe cases, it may be necessary to remove the affected portion of the colon-the healthy ends are then rejoined. While most people recover from diverticulitis without surgery, if the inflammation extends throughout the abdomen causing peritonitis surgery is almost always required.

What Is Fiber?
Fiber is present in all plant foods that have commercial processing. There are many types of fiber, including cellulose, pectin's and gums. Each is placed in one of two categories-water-soluble or insoluble-depending on its overall degree of solubility in water. Most plant foods are a combination of both water-soluble and insoluble fibers.

Why Is Fiber Beneficial?
Fiber has known and suspected health benefits, due to its varying properties and perhaps because of its interaction with components in other foods. Insoluble fiber, when taken with adequate amounts of water, causes stool to become larger, softer and easier to pass. This helps to prevent constipation and may reduce the risk of diverticulosis and diverticulitis. Insoluble fiber may also reduce the risk of colorectal cancer, reduce the size of hemorrhoids and lessen hemorrhoidal bleeding. Different health benefits are associated with soluble fiber. This type of fiber has been shown to reduce high blood cholesterol-a risk factor for coronary heart disease. Soluble fiber may also improve glucose tolerance in some diabetics (thus decreasing the need for insulin) and help to prevent gallstones. Foods rich in insoluble fiber include wheat bran, corn bran and asparagus. Foods rich in soluble fiber include oat bran, apples, oranges and beans.

How Much Fiber Do I Need Daily?
The U.S. Food and Drug Administration has not established a Recommended Dietary Allowance in grams for fiber, but recommends a diet rich in grain products, fruits and vegetables. Experts in general don't agree on how much dietary fiber is best, but most say that more fiber, from a variety of food sources, should be gradually introduced into the American diet. Water intake should be simultaneously increased to at least eight cups a day. One leading authority, the National Cancer Institute, recommends 20-30 grams of fiber a day-about double the current estimated intake of the average American. While such a fiber intake may be appropriate for healthy adults, it may not be appropriate for children, the elderly or persons consuming special diets.

Is It Possible To Eat Too Much Fiber?
There is some evidence that extremely high fiber intake could interfere with the body's ability to absorb magnesium, calcium, zinc, iron and other minerals. This could be detrimental, especially to children, the elderly and those whose diets are nutritionally deficient. Healthy adults who eat a balanced diet and increase fiber intake should not have a problem with mineral absorption. Fiber-rich foods, themselves, are generally high in minerals.

Why Should Fiber Be Increased Gradually?
Fiber intake should be increased gradually to give the gastrointestinal tract time to adjust to the change. This helps to prevent diarrhea, discomfort, and flatulence. It should be noted that it is not wise to consume the bulk of one day's fiber goal at a single meal - unpleasant side effects such as flatulence could result. It may take several months to reach peak amount of fiber.

Why Should Fluid Intake Be Increased?
Fiber absorbs water from the bowel. Without an adequate amount of fluid, constipation could occur.

What About Fiber Pills?
Some people, including those unable to alter their diet, might benefit from a fiber supplement in the form of a pill. Though fiber supplements are available without a prescription, it is not wise to take them without the advice and approval of a physician.

For More Information About Diverticulosis and Diverticulitis, Contact
Your Primary Physician.

Information is from US Health Care Brochure 5932-3-95