Today’s post is an adapted version of a recent research paper on Diverticulitis I wrote for school. I had been thinking of posting this for sometime now, and strangely, during this time someone I know very well had a diverticulitis attack, fortunately there was no need for surgery and recovery is going well. It’s weird how coincidences in life work sometimes…or…maybe there are no such thing as coincidences! That’s a topic for another day I guess.
Today’s post will discuss what diverticular disease is and how to prevent/assist in recovery from diverticulitis.
What is Diverticulitis and Diverticular Disease
Diverticulosis is a term used to describe a condition of a colon where diverticula are found. Diverticula are small sac-like outpouching of the intestinal wall. Diverticulitis is when one or more of the diverticula are inflamed or infected, causing symptoms. Diverticulitis is a progression/complication of diverticulosis; however, they are both connected by the presence of diverticula and are combined under the umbrella term Diverticular disease (1).
Clinical symptomatology outlines 4 stages of diverticular disease as follows (1):
- Stage 0: Diverticular disease (the presence of diverticula identified)
- Stage 1: Asymptomatic
- Stage 2: Symptomatic disease
- Single episode
- Recurrent episode
- Chronic symptoms
- Stage 3: Complicated
Uncomplicated diverticulitis causes symptoms similar in nature to irritable bowel syndrome including abdominal pain, bloating, and bowel movement inconsistency, while complicated diverticulitis can have severe symptoms and outcomes including abscesses, bowel obstruction, colonic bleeding, and bowel perforation, all requiring serious intervention.
Conventional Medical Treatment for Diverticulitis
New scientific evidence is providing a better understanding of the underlying causes of diverticular disease, leading to new treatment possibilities; however, conventional treatments remain limited and inconclusive (1, 3).
For diverticulosis and minor diverticulitis, the only treatment recommendation is increasing dietary fibre, reducing nut/seed consumption, and increasing physical activity (1, 2, 3). There are still limited treatment options for acute uncomplicated diverticulitis, mainly involving antibiotics and increasing dietary fibre after the resolution of acute inflammation (1, 2, 3). If such treatments fail and chronic uncomplicated symptoms persist, anti-inflammatory drugs (mesalamine), drugs to regulate intestinal motility (anticholinergic & antispasmodic), and probiotics may be prescribed (1, 3).
The main treatment for complicated diverticulitis is surgery and antibiotics (1, 2). Surgical intervention differs based on the type of presenting complications. If large abscesses have formed, surgical drainage is indicated. For more serious complications such as perforation, obstruction, fistula, or the presence of chronic complicated symptoms, surgical intervention may include primary bowel resection or bowel resection with colostomy.
Aside from increased dietary fibre and probiotic supplementation, the above outlined treatments have many negative side effects and are not curative. Chronic antibiotic administration side effects include, but are not limited to, reduced beneficial bacteria, bacterial antibiotic resistance, systemic immune dysfunction and mitochondrial dysfunction (4, 5). Furthermore, the pharmaceutical interventions noted come with their own list of side effects outlined on the product websites and packaging. Finally, surgical intervention has the highest side effect risks including loss of colonic function, leading to significantly reduced quality of life, as well as the general risks associated with any major surgery.
Diverticulitis Pathophysiology (ie. What it is the cause)
While the allopathic and holistic approach to addressing diverticular disease differs, the underlying science surrounding pathophysiology remains constant. Therefore, prior to discussing holistic/natural treatments, this will be explored.
Findings reviewed from the early 20th century propose that the major factors leading to diverticula was the adoption of a Western/Industrialized diet because it included the following (6):
- Less fibre content leading to decreased transit time, dryer stools, narrow colon, and increased colonic pressure.
- Western lifestyle causes the suppression of stool passage (not passing stool due to other obligations), leading to increased transit time, dryer stools, and increased colonic pressure.
While a low fibre diet still stands as one of the suggested underlying causes more recent evidence has discovered that diverticular disease is a chronic gastrointestinal condition with evidence of chronic inflammation, pathogenic bacterial overgrowth, and altered intestinal motility due to sensory motor nerve damage (1, 3, 7).
The colons of individuals with symptomatic, uncomplicated diverticular disease exhibit evidence of chronic low-grade inflammation (1, 3, 7, 8), indicating that inflammation has been present for an extended period of time, possibly prior to symptom onset (1).
Further evidence indicates that abnormal colonic motility may underlie diverticular disease (7). Alterations in colonic motility, described as a spastic colon, have been identified in patients with diverticular disease (7). Furthermore, the term spastic colon is another name for the common condition Irritable Bowel Syndrome (IBS). Symptoms of IBS not only include constipation, but also diarrhea and other abnormal bowel activity. Additionally, the chronic inflammation seen in IBS and diverticular disease is very similar, along with many overlapping symptoms (1). In light of this evidence, altered bowel habits, not just constipation, may contribute to diverticular disease. In fact, recent finding suggest that above normal bowel movement frequency and diarrhea are also associated with diverticular disease (1, 3). Such findings could imply that the frequency of bowel movements may be less important than other underlying causes such as inflammation and bacterial dysbiosis.
Pathogenic bacterial overgrowth is also present in diverticular diseased colons, theorized to be due to slow colonic transit time and fecal stagnation, leading to colonic inflammation (1). Other evidence indicates that pathogenic bacterial overgrowth in the small intestine (SIBO) is another contributor to diverticular disease via bacterial colonization and recolonization from the small intestine to the colon (9).
In light of recent scientific evidence, the simple cause of diverticular disease being low fibre intake, and subsequent slow transit time, is being challenged. Aside from above average bowel movements and diarrhea being associated with diverticular disease, some studies even show that fibre intake has little to no impact on diverticular disease (1). Given the above presented evidence, it is clear that there is no single definitive cause of diverticular disease, leading to the understanding that the disease is multifactorial and may require treatment specific to each individual.
In part 2 of this post I will discuss and outline a natural/holistic approach to the prevention and management of diverticular disease.
The Barefoot Golfer