Diverticula can occur in different places in the body but we mostly notice them in the digestive tract (even in the esophagus), mainly in the so-called sigmoid, the S-shaped, last part of the large intestine.
If several diverticula are present here, one speaks of diverticulosis. When the diverticula become inflamed, diverticulitis is present.
Colonic diverticula are pear-shaped bulges/sacs in the intestinal wall. The protrusion does not take place in the interior of the intestine (where the stool is located), but outwards. The intestinal wall turns outwards in those places where there are muscle gaps for the blood vessels.
While diverticula are cavities that are turned outwards, polyps are small growths in the interior of the intestine. Polyps can degenerate and develop into colon cancer. They are therefore also classified as a precursor to cancer and – wherever possible – removed during colonoscopies as part of preventive medical check-ups. Diverticula generally do not degenerate.
Diverticula can be present at any age but generally affect older people more. From the age of 50 every fifth to every tenth person is said to have diverticula. From the age of 60 it is already every third person and from the age of 70 even every second person.
Diverticulitis occurs when one or more diverticula become inflamed. While the mere presence of diverticula does not cause any symptoms, there are clear signs of disease in the case of diverticulitis. If complications arise, diverticulitis may also be fatal, e.g. when there is generalized peritonitis (in the entire abdominal cavity) or sepsis after an intestinal perforation. In the case of sepsis, the immune system turns against its own organs, which can ultimately result in multiple organ failure.
Diverticula themselves do not cause any symptoms. Only when they become inflamed and there is diverticulitis do symptoms such as
Of course, not every diverticulitis patient has all of these symptoms at the same time. But if several of these symptoms appear, it is better to consult a doctor and not bet on temporary gastroenteritis. If the symptoms are very severe, you can go straight to the hospital and be examined there.
If a diverticulosis has to be operated on due to frequent flare-ups of inflammation, this is the responsibility of a visceral surgeon. Its specialty is the abdomen, i.e. the entire digestive system including the liver, pancreas and gallbladder. Visceral surgeons also operate on hernias.
Diverticula that are not inflamed and therefore do not cause any symptoms are usually discovered by chance during a colonoscopy as part of a preventive check-up, which the patient is often not told, since the diverticula are symptom-free and also do not represent a cancer risk factor and therefore no further importance is attached.
If there is a suspicion of diverticulitis with relevant symptoms, then no colonoscopy is carried out, since in this case, the risk of damaging the intestinal wall would be too great. A colonoscopy is not recommended until about eight weeks after the diverticulitis has subsided to check and rule out other intestinal diseases.
For a diverticulitis diagnosis, the patient is thoroughly questioned (anamnesis) and palpated. There is a defensive tension when palpating the abdomen. Furthermore, an ultrasound examination and a CT (computed tomography) can be used.
Elevated inflammation values can usually be detected in the blood (CRP value).
If in the small sacs (diverticula) pressing stool particles get stuck, then the filled diverticulum behaves like a small ulcer that presses on the intestinal wall. The bacteria in the stool particles multiply and the diverticula become inflamed. Another reason to make sure you do not have constipation.
It may be that the inflammation of the affected diverticula subsides on its own after a few days of struggling with pain in the left abdomen and possible fever. However, since there is a risk of complications, you should clarify with your doctor whether you can wait or whether it is better to take measures.
Complications such as abscesses or fistulas can occur. In this case, a fistula is a connection between the inflamed diverticulum and e.g. B. the urinary bladder or another diverticulum. If it is the urinary bladder, there are also symptoms of a bladder infection.
If an inflamed diverticulum bursts, an intestinal perforation can occur and, as a result, potentially fatal peritonitis.
If inflammation occurs again and again, scarring can develop on the intestinal wall, which can lead to narrowing and even to an intestinal blockage.
Diverticula that do not cause any symptoms are not treated. In the case of mild diverticulitis, i.e. if the diverticula have become inflamed, a bland diet (very light, preferably liquid food and drinking a lot) is sufficient in some cases.
In most cases, however, antibiotic therapy is carried out – in the hospital possibly initially by infusion, then in tablet form. In more difficult cases, one should not eat for a few days. You are then fed parenterally (artificially), i.e. via infusions, until the intestine has calmed down again.
If inflammation occurs more frequently, surgery is suggested to the patient.
Diverticulosis does not require surgery on the diverticula. Only if the diverticula keep inflaming again and again, at the latest after the second diverticulitis, is it discussed whether an operation should not be considered.
Because a flare-up of diverticulitis can have a huge impact on everyday life – and when it happens during a vacation, it’s definitely over for the time being.
The operation is now usually carried out using the keyhole technique, i.e. minimally invasive. The affected section of intestine (the 30 cm long sigmoid) is cut out and the two remaining ends are sewn together again.
Even if only small incisions are evidence of the operation due to the minimally invasive procedure, it is a major intervention in the body, as a good piece of the colon is removed. In order for the internal injuries to heal, a (temporary) colostomy is sometimes necessary.
Antibiotics are usually given, either by infusion or orally, or a combination of both. If the inflammation is severe, anti-inflammatory drugs may also be given, which are also taken for chronic inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. In the case of less complicated courses, a light diet is sufficient. Otherwise, antibiotics are usually prescribed, which must be taken for at least 7 to 10 days.
Even with the best diet and lifestyle, existing diverticula will probably not go away. So they most likely will not regress. However, it is not important that the diverticula disappear, but simply that they no longer cause any problems. Drug therapies also do not cause diverticula to vanish into thin air. They only (temporarily) suppress the inflammatory processes that lead to the symptoms.
Since diverticula are particularly concentrated in the S-shaped sigmoid segment of the intestine, in the vast majority of cases, after removal of this segment of the intestine, diverticula do not form in other parts of the intestine, at least in general no diverticula form which causes problems.
The following causes are officially discussed for the development of diverticula:
In the meantime, some influences are known that can increase the risk of diverticulitis in the case of existing diverticula. At the same time, these possible causes of diverticulitis point to what can be done to prevent further diverticulitis flare-ups.
Because e.g. if obesity is one of the risk factors, this naturally means that losing weight is an important measure to prevent diverticulitis. If a meat-rich diet increases the risk of diverticulitis, then a vegetarian diet offers some protection against diverticulitis.
In the medical journal of January 11, 2017, a study was presented that was published in the journal Gut. It had shown that the risk of diverticulitis increases the higher the more red meat is eaten (steak, cutlet, etc.).
Those participants who ate the most red meat were twice as likely to develop diverticulitis as those participants who ate the least meat. What is interesting about this study is that it was about unprocessed meat, while many other studies have always shown processed meat products (sausages, sausages, smoked products, etc.) to be harmful.
But why does eating meat increase the risk of diverticulitis? The researchers involved in the above study gave several reasons: Meat can increase the inflammatory parameters (CRP value) and negatively affect intestinal flora. In addition, meat-eaters are more likely to suffer from constipation, which increases the pressure in the intestines and thus makes it easier for stool particles to be pressed into the diverticula and become inflamed there.
Meat is known to be fibre-free, which could be one reason for its diverticulitis-promoting effect. Vegetarians, on the other hand, don’t have that many diverticula in the first place – according to a study from 2011. They develop intestinal diverticula 31 percent less often.
A plant-based, wholesome and high-fiber diet is, therefore, one of the most important measures for diverticula and for the prevention of diverticulitis. The dietary fiber content should be around 30 to 40 g per day.
It is extremely important to eat slowly and chew thoroughly. In nutritional counselling, people who have already had diverticulitis and want to avoid another flare-up often receive specific eating and chewing training (e.g. with a stale bread roll). Because the more thoroughly you chew, the easier it is for your meals to be digested, the less stress you put on your intestines, the less often constipation occurs, the healthier the intestinal flora and the lower the risk of diverticulitis.
After getting up, drink a large glass of water (at least 500 ml). It hydrates the body and stimulates metabolism and stool elimination. The risk of stool residues being deposited in the diverticula is reduced.
Medications such as non-steroidal anti-inflammatory drugs, e.g. B. ibuprofen, diclofenac, ASA or similar are among the risk factors for diverticulitis. So use them sparingly, especially if you already know you have diverticula.
Since smoking and alcohol increase the risk of diverticulitis, not smoking and abstinence from alcohol are an important protection against further flare-ups.
Lack of exercise can increase the risk of numerous diseases, including diverticulitis. Therefore, make sure you exercise every day, e.g. daily a brisk one-hour walk and additionally two to three times a week endurance and strength training in the gym, swimming pool or similar.
It is not uncommon for people to be asked whether they can do sports if they have diverticulosis. So not only can you do it, you should definitely do it!
Overweight and obese people are more likely to develop diverticulitis, so it makes sense to aim for a normal weight if you want to avoid further attacks of diverticulitis.
If you have severe acute diverticulitis, you may be in the hospital receiving parenteral nutrition (artificially fed) to give the digestive system time to regenerate.
In mild cases, you can fast for two to three days or at least limit yourself to liquid food, such as. B. tea, fat-free vegetable soups (made from carrots, parsnips, sweet potatoes , pumpkin or zucchini), vegetable broths such as the typical fasting broths (homemade without stock cubes) and potato soups.
You can then usually switch to a light, low-fat diet that you keep for at least the tenth day or until you feel better. With a light diet, you can add e.g. eat these dishes:
Bread or rice cakes, in particular, are very good for practising slow eating and careful chewing. Chew each bite of bread 40 times, a measure that alone will improve your gut health.
Dairy products are often recommended as part of a light diet. However, when they are not well tolerated (which many people don’t realize because they don’t attribute their discomfort to dairy products), they can be involved in the development of diverticula and diverticulitis. It’s best to test it out on yourself to see if you might be doing much better without dairy products.
It is usually said that after surviving diverticulitis you do not have to follow any special dietary rules – a tip that will lead straight to the next diverticulitis. Because diverticula and diverticulitis are diseases of civilization caused by diet and lifestyle, which arose precisely because no particular dietary rules were observed.
If you start to feel better, you can change your diet step by step from a light diet to a healthy alkaline diet rich in vital substances and fibre.
For decades it has been preached anywhere and everywhere that one should not eat nuts, seeds and grains with diverticula, as these can settle in the diverticula and become inflamed there. Admittedly, that sounds very plausible, which is why almost every doctor still makes this recommendation today.
Of course, you do NOT eat these foods with acute diverticulitis, since bland food or a fasting period is indicated here. In the case of non-inflamed diverticula, however, a diet rich in nuts and seeds can even protect against diverticulitis – as a study from 2008 showed, especially since these foods are among the most nutritious and vital-rich foods of all and therefore a good one overall can contribute to health.
Nuts and seeds not only provide high-quality proteins and fats, but also fiber, which promotes rapid digestion and can counteract diverticulitis in this way alone.
Over 47,000 participants between the ages of 40 and 75 were scientifically accompanied in the study mentioned for 18 years. It was found that those who ate nuts and grains regularly (at least twice a week) were less likely to develop diverticulitis than those who ate little of these foods (less than once a month).
This study can also be found in the current guidelines for the treatment of diverticula and diverticulitis (2014, Journal of Gastroenterology ), so it is surprising that doctors continue to advise against nuts and seeds.
Anyone who eats healthily and changes their lifestyle (no smoking, no alcohol, more exercise, etc.) after their first diverticulitis at the latest often remains free of further flare-ups, which shows that an operation is not always necessary.
A healthy diet and lifestyle can reduce the risk of diverticulitis for many reasons. Ultimately, it has an extremely positive effect on the entire organism and also improves the chronic lifestyle complaints that are common today, such as high blood pressure, increased blood fat levels, high uric acid levels and cardiovascular diseases, all of which, interestingly, can also increase the risk of diverticulitis.