Diverticula are outward protrusions that usually occur in the intestinal wall of the left-sided colon. However, protrusions do not only occur in the gastrointestinal tract, but can also occur in the urinary tract or, in rare cases, in the heart. This article deals with diverticula of the large intestine.
Here you will find further information as well as selected diverticulum specialists and centers.
Diverticula are outward protrusions of the wall of a hollow organ. They can occur in the entire digestive tract. However, diverticula usually occur in the left-sided colon. The urinary tract(ureter, urethra, urinary bladder) and, in very rare cases, the heart can also be affected.
Depending on whether all or only some of the wall layers are involved in the protrusion, a distinction is made between
Most cases of diverticula are pseudodiverticula. This article therefore refers primarily to pseudodiverticula.
The term diverticulosis is defined by the presence of usually several diverticula. If the diverticula cause symptoms, this is referred to as diverticular disease. If one or more diverticula are inflamed, this is diverticulitis.
The presence of diverticula in the intestine and their severity can be divided into different classes. They are important for the therapeutic approach.
If the diverticula are not inflamed, this is type 0, asymptomatic diverticulosis. Inflamed diverticula, diverticulitis, can be divided into types 1 to 4.
Diverticula in the intestinal wall can cause inflammation and the intestine can even rupture © Henrie | AdobeStock
The appearance of diverticula usually has no pathological significance. It only becomes problematic when symptoms or complications occur. 70 percent of people who have diverticula remain symptom-free for the rest of their lives.
In the remaining 30 percent, various symptoms can develop depending on the stage of the disease:
A doctor must be consulted quickly, especially if there are signs of acute diverticular disease. The signs include left-sided lower abdominal pain and a hardening of the abdomen.
The cause of this pain is an extension of the inflammation to the outside of the intestine and to the peritoneum. This results in peritonitis (inflammation of the peritoneum ).
As the diverticular disease progresses, it can lead to
occur. As a result, stool and air can pass from the intestine into the abdominal cavity. Despite surgical treatment and antibiotic therapy, this "fecal peritonitis" can still lead to death today.
If inflammation - even mild inflammation - occurs repeatedly, this is referred to as chronic diverticular disease. Over time, this can lead to shrinkage of the bowel and the development of a narrowing (stenosis) in the bowel.
Diverticula develop with increasing age. While only around ten percent of people under the age of 50 have diverticula, every second 80-year-old has intestinal protrusions.
There is also evidence that some dietary habits can contribute to the development of diverticula: Population groups with traditionally rather high-fiber diets have significantly fewer diverticula than populations in industrialized countries, which more often eat a low-fiber (low-fibre) diet.
This leads to the hypothesis that diverticula are caused by a low-fiber diet. A low-fiber diet, combined with a reduced amount of fluids, means that the intestines process less stool. As a result, the inside of the intestine (intestinal lumen) is less full.
The bowel moves spontaneously, i.e. without any conscious influence from the person. These intestinal movements are controlled by the filling of the intestine or the corresponding stretching of the intestinal wall. Spontaneous motility decreases when the intestinal contents are smaller. A much higher pressure must then be applied for the corresponding movement waves, which can lead to protrusions.
Risk factors for the development of diverticula are therefore a low-fiber diet and the resulting risk of constipation. Low physical activity and being very overweight can also promote the development of diverticula.
Risk factors for diverticular disease and diverticulitis, on the other hand, are primarily
Most diverticula do not cause any symptoms. Asymptomatic diverticula are therefore usually found by chance during a screening examination or when investigating another disease. Only when symptoms occur is a targeted search for their cause carried out.
The basis of every medical diagnosis is the patient interview(medical history). The doctor asks the patient about
In the subsequent physical examination, the abdomen is palpated and listened to. The doctor measures the body temperature and carries out a digital rectal examination (examination of the rectum with a finger). A blood test is usually also carried out. The leukocyte and CRP values are checked in the laboratory. CRP stands for C-reactive protein, a value that generally rises in the case of inflammation.
In imaging diagnostics, the focus is on ultrasound and computer tomography. In the case of diverticular disease, there is a risk of the endoscope perforating (tearing) the bowel. Therefore, a colonoscopy should not be performed in the acute phase.
A colonoscopy is only performed in the event of intestinal bleeding from diverticula in order to find the source of the bleeding and to stop the bleeding if possible. If no source of bleeding can be identified, further imaging examinations(CT angiography, angiography or scintigraphy) are necessary.
If mild and unspecific symptoms persist for more than three to six months, a colonoscopy should be performed. This allows the doctor to rule out other intestinal diseases as the cause.
It is important for the treatment to confirm the diagnosis and exclude other causes. Treatment always depends on the stage.
People with diverticula should
These measures can prevent diverticulitis.
Mild symptoms, such as irregular bowel movements, can often be successfully treated by regulating bowel movements. A high-fiber diet is usually recommended for this.
If the tendency to constipation persists, additional doses of
are recommended. If these measures do not improve the symptoms, stool-regulating medication can be prescribed by the doctor (do not self-medicate!).
Depending on the severity of the disease , treatment ranges from
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