Diverticular disease of large intestine

Diverticulosis of the large intestine is a pathology, which consists in the formation of a number of protrusions outward from the wall( diverticula).Their main negative effect is the defeat of peristalsis, an obstacle to the correct motor activity of the intestine.

It is established that in 80% of cases the process begins in the sigmoid colon, then spreads higher. The disease quickly leads to inflammation( diverticulitis), is accompanied by even more serious consequences. Therefore, timely choice of tactics how to treat pathology helps avoid complications.

Statistical studies show an increased incidence of adult population after 40 years in developed countries. In them, diverticular disease of the colon affects up to 1/3 of the population. And there is a clear dependence on living standards and average duration: the higher they are, the more common pathology.

The risk level rises in elderly and senile age. We do not think that medical assistance, examination and a low level of diagnostics in less developed countries are not sufficiently available. Therefore, comparison of indicators may be incorrect. There was no connection with the patient's sex.

Why do diverticula arise in the intestine?

In the formation of diverticula, the following causes are important:

• dystrophic and atrophic disorders in the muscular fibers of the intestinal wall, the disappearance of collagen and elastin, thinning in old age;
• inhibition of the motility of the large intestine due to changes in the transmission of the nerve impulse, decreased peristalsis;
• absence in the diet of a sufficient amount of fiber, fluid, providing natural stimulation of the intestinal loops;
• chronic constipation, flatulence, causing an increase in internal pressure;
• effects of previous inflammations in foodborne infections, parasitic infestation;
• result of long-term use of drugs with laxative effect;
• thrombosis or compression of small vessels of the mesentery lead to the appearance of ischemia sites with impaired microcirculation and tissue dystrophy;
• lack of exercise, lack of sufficient motor load on abdominal muscles during walking, physical work;
• hereditary connective tissue diseases - a combination with diverticula of other organs( bladder, stomach, esophagus) is typical for congenital forms, in childhood their wall has all layers of the colon, then gradually atrophies.

In humans, provoking conditions are created from one or more of the following factors.

Mechanisms for forming

Scientists explain how the formation of the diverticulum of the intestinal wall is exactly the case with several theories. There is no unanimous opinion on this matter. The theory of analogy with hernias - the main mechanism considers the age-related changes in the intestinal wall, the loss of elasticity against the background of the general limitation of the motor activity of a person, the fall of immunity. In response to increased pressure from the inside, the intestinal wall forms a saccular bulging, since it does not withstand the load in the sites of dystrophy.

The theory of excessive mechanical activity - bowel spasm, caused by increased muscle contractility, divides the bowel into areas with high cavity pressure. It is in these places that the diverticula of the colon gradually form.

Theory of circulatory disorders - its supporters argue that the basis of diverticula is to reduce blood flow and nourishment of the intestinal wall. Genetic theory - binds the disease to a hereditary predisposition due to genetic problems.

Types of diverticulosis

Classification of diverticulum of the large intestine is based on the structure and origin of pathological formations. Distinguish true diverticula - the wall of the bag includes all layers of the intestine, false - formed by the mucous layer, more like a hernia.

Large intestinal diverticulosis can arise as congenital - due to abnormalities in embryonic development, it is often combined with other anomalies of internal organs, acquired - as a result of the effects of causes and factors received by a person during life.

In accordance with the mechanism of formation diverticula divide:

• into pulsational - are caused by hereditary or acquired weakness of the intestinal wall, are provoked by an increase in internal pressure and other causes, are bag-shaped;
• traction - formed by mechanical stretching for a long time( adhesive process, scars), are small in size and funnel-shaped.

Sometimes there are both mechanisms, then the diverticula is called mixed. Depending on the peculiarities of the clinical manifestation diverticula are divided into asymptomatic, with obvious signs, complicated. Localization distinguishes diverticula:

• sigmoid colon - the most frequent location, is considered the initial sign of the disease;
• of the transverse colon - especially common in the left half;
• of the descending part of the large intestine - appear as a result of the generalized process.

Diverticula usually "line up" in two rows along the mesentery on each side of the

. By what signs can the disease be suspected?

Symptoms of diverticulosis may not appear for many years. Patients learn about the existing pathology by accident at the examination or if there are signs of inflammation( diverticulitis).With age, the person accumulates factors of trouble, there are chronic diseases that promote the activation of existing diverticula, their increase.

Symptomatic atypical, similar manifestations occur in many bowel diseases, but it is capable of targeting the patient and the doctor for the need for examination. The probability of diagnosis increases when you see:

• abdominal pain in the left half, lower part with irradiation in the coccyx, perineum, aching permanent character, transition to cramping occurs when defecation, the condition improves after stools and gases;
• of constant bloating, rumbling;
• feelings of incomplete emptying after the act of defecation;
• changes constipation and diarrhea;
• nausea, rare vomiting;
• temperature increase with diverticulitis.

Complications of inflammation of diverticula

What complications provoke diverticulosis?

If you do not treat diverticulosis, then the risk of dangerous complications increases, which can cause inflammation of the large intestine. These include:

• Abscession - the transformation of the diverticulum into an abscess with the closure of the exit into the intestine.
• Diverticulum( perforation) of the diverticulum with the withdrawal of contents into the abdominal cavity and peritonitis - pain syndrome suddenly amplifies, the nature of internal inflammation, fecal masses and intestinal flora cause a heavy diffuse form of infection, dangerous for the life of the patient.
• Intestinal obstruction - even small in size and number of diverticula can seriously affect the motility of the intestine, weakening in certain areas causes stagnation of fecal masses, the formation of a mechanical obstacle.
• Bleeding - the intensity differs from the hidden to the massive. In feces, with abundant bleeding, fresh blood and clots are found. The patient's blood pressure drops, dizziness, tachycardia, signs of blood loss.
• Formation of fistulous passages to neighboring organs( bladder, vagina in women), omentum bag.
• Polyps and degeneration into a malignant tumor.

Does diverticulosis of the colon occur in children?

Diverticula in childhood are more often observed in the small intestine( diverticulum of Meckel).They develop together with Crohn's disease, congenital anomalies( rectal involvement, atresia of the esophagus), hernia of the umbilical ring. Diverticula in the zone of the descending colon and sigma are rarely detected. Cases in adolescents are described.

By origin they are false. Classified as well as in adults. Most often they are asymptomatic, they are detected accidentally. Children are advised to follow a diet, daily exercises of physical therapy. Parents should observe the terms of the follow-up examination recommended by the gastroenterologist.

Follow the child after adulthood should the therapist

How to identify the disease?

Diagnosis of the disease only on the basis of patient complaints and medical examination is impossible. The doctor suspects a lot of diseases of the intestines, which give a similar picture. Women will be sent to the gynecologist to check the condition of the uterus and ovaries. Chronic adnexitis, fibroids can be accompanied by the same pain.

The connection of inflammation with the intestine is indicated by the analysis of feces for coprology, containing a large number of leukocytes, mucus, pus, erythrocytes. Leukocytosis and the growth of ESR in the blood confirms the inflammatory process in the body. Gergersen's positive reaction helps to detect latent intestinal bleeding. Urinalysis is necessary to exclude pyelonephritis of the left kidney, urolithiasis.

For more targeted examination of the large intestine, there are methods of instrumental diagnostics:

• Irrigoscopy - X-ray method of the study, is performed with preliminary introduction of a liquid barium suspension in the enema for contrasting the lower parts of the large intestine. A series of pictures is taken. They can reveal bulging wall formations, determine the size, localization, other changes in the intestine( inflammation, adhesions, delayed evacuation).
• Colonoscopy is a modern way of visualizing the pathology of the large intestine. It is carried out under general anesthesia, because the procedure is unpleasant and painful. A thin tube with an optical system at the end is carefully inserted into the rectum. The technique is entrusted only to quite experienced doctors because of the danger of perforation of the wall. It is possible to detect diverticula, a source of bleeding, polyps, tumor growth, inflammatory areas of the intestine. Apparatus of the latest generation allows you to simultaneously take a suspicious tissue sample on a biopsy, display on the monitor, obtained as the colonoscope moves forward, take pictures.

It is better to conduct the examination in a specialized clinic where more suitable training conditions and reliable equipment are available. In addition, one should consider the possibility of providing the necessary assistance in case of complications, up to the operation for emergency indications.

Treatment of diverticulosis of large intestine

For asymptomatic pathology, patients should be examined at least once a year to notice the growth, spreading of diverticula, signs of inflammation and complications in time. Uncomplicated diverticulosis is observed and treated in polyclinic conditions by a gastroenterologist. At small sizes of formations the patient is prescribed a diet for regular cleansing of the intestine.

With the help of a change in the irrational movement, enough walking, exercises on the muscle press, it is possible to prevent complications. Drug therapy is indicated in the presence of expressed signs, confirmed diagnosis. Appointed drugs that can restore regular stools, support and activate motor skills, remove inflammation.

An ancient means of cleansing the intestine is better taken at night, mixed with kefir

Of the funds with a laxative effect, those are selected that minimally increase internal pressure and do not cause spasmodic contractions. Rectal suppositories are prohibited. Patients are not suitable for long-term intake of all consecutive laxatives, they can worsen the situation, contribute to the loss of potassium. This negatively affects the state of the heart muscle.

Therefore, only drugs with irritating effect are recommended( castor oil, Sterkulin, Mukofalk, Methylcellulose).Seed of plantain seeds are plantain, flax, sea kale. It is recommended to drink at least 1.5 liters at the same time.

If a patient has frequent diarrhea, then temporarily absorptive and astringent agents are prescribed, foods with fiber are limited in food. Smecta, white clay, Carboline, Calcium carbonate, preparations based on bismuth) have a suitable action.

One of the conditions for reducing intestinal pressure is suppression of gassing. In addition to excluding certain foods from food, they are important:

• support acidity of gastric juice( Plantaglucid);
• enzymes of the pancreas( Pansinorm, Creon, Festal);
• sorbents( activated charcoal).

In pain, spasmolytics are shown( No-shpa, Mebeverin).For the removal of the inflammatory process, a course of broad-spectrum antibiotics with Metronidazole, Sulfasalazine is prescribed. The dysbacteriosis that has arisen must be corrected by the restoration of the intestinal microflora with probiotics( Bifidumbacterin forte, Linex).

If the examination shows no signs of bleeding, then patients are shown physiotherapy procedures, warm baths of mineral springs. Special gymnastics allows to establish the allocation of gases, to activate peristalsis. All medications are prescribed courses. It is possible to replace, but do not take medications constantly.

The properties of the drug delay the absorption of other drugs, therefore, if you need to take other medications, you should observe an interval in time about an hour before or after Smecta

When are surgical procedures used?

Surgical treatment of diverticulosis of the large intestine is used in case of complications( bleeding, rupture of the intestine) or suspected of a cancerous degeneration. It is necessary to resect( remove) the affected area of ​​the intestine, to join the remaining ends. It has been established that up to 15% of patients with diverticula in the large intestine need surgery. They have applied conservative treatment and diet are ineffective.

Features of the diet

The goals of dietary treatment of diverticulosis of the large intestine:

• restore the regularity of bowel evacuation with constipation;
• to reduce intestinal pressure;
• clean the cavity of the diverticulum;
• maintain the necessary intestinal flora.

This action is achieved by introducing into the diet foods enriched with dietary fiber, fiber. The daily ration should contain:

• not less than 200 g of fresh fruits and vegetables( salads, juices);
• bread from coarse varieties of flour, bran, dietary;
• wheat bran is added to cereals, refueling soups( nutritionists are advised to gradually increase the dosage from ½ teaspoon per day to 5, so as not to cause an increase in flatulence).

The diet demands to exclude from food all products:

• promoting gassing( legumes, porridge of lentils, grapes);
• affecting stool retention( dishes from rice, blueberries, bananas, chocolate, strong tea and coffee);
• coarse fiber, contained in seeds, nuts, radish, cabbage, turnip, radish, pineapple, persimmon;
• irritating intestines drinks( alcohol, kvass, beer, aerated water), whole milk;
• containing refined ingredients( sweets, cakes, fast food, fresh pastries, flakes, semi-finished products).

The menu must contain:

• whole-grain cereals from cereals;
• a sufficient amount of liquid( up to two liters) due to water, juices, compotes, decoctions, green tea;
• sour-milk products( cottage cheese, low-fat kefir, yogurt, yoghurt);
• vegetable salad with vegetable oil dressing;
• garlic( as a natural bactericidal means of preventing inflammation);
• broth and berries prunes, dried apricots.

Nutritionists advise to enter the rule of separate nutrition, i.e. do not combine protein foods with carbohydrates( meat dishes with garnishes from cereals, potatoes).You can eat them separately with an interval of 2 hours. To the meat to practice only a vegetable garnish.

Diagram of separate food products helps to make a diet

If diverticulosis causes diarrhea, then the restrictions apply to foods with fiber. When stopping diarrhea, they are recommended, but in a crushed form, boiled, in small portions.

Can I be treated with folk remedies?

To support drug therapy, vegetable decoctions with similar healing properties are suitable. Their reception should be discussed with the doctor. Traditional medicine suggests brewing in a thermos:

• on a tablespoon of dill seeds, rose hips with a small amount of nettle leaves, it should be taken before meals twice a day;
• the crushed elm tree should be boiled for at least 20 minutes, after cooling, filtered, drink 1-3 times a day.

Flaxseed and olive oil helps in regulating bowel movements. They should be taken at night or on an empty stomach on a tablespoon. In the diet is recommended not to forget about salads from undercooked beets with garlic, steamed berries dried apricots and prunes.

What to do for prevention?

To prevent complications, you must abandon the "sedentary" lifestyle, move more, do physical work, follow the rules of nutrition, control the cleansing of the intestines, take vegetable decoctions. As you can see, diverticulosis of the large intestine can be attributed to diseases of civilization in many ways. Save health is possible and if there are changes. It is necessary to follow the advice of a doctor, do not risk in vain.