A kidney stone causes rectal pain
In diverticulitis, protuberances in the intestinal wall (diverticula) are inflamed. Sometimes the inflammation is confined to the area around the diverticulum, but it can extend beyond the intestinal wall. Inflammation of the peritoneum or an intestinal obstruction can then result. There is no way of predicting whether diverticulitis will occur and how likely it is.
Diverticulitis is particularly widespread in the elderly. 30 percent of those over 60 and 65 percent of those over 85 are affected. An estimated 14 million Germans have diverticula, but mostly without symptoms. In over 90 percent of the cases, these protuberances occur in the lower section of the large intestine. Except in the rectum, however, they can occur in the entire large intestine.
The disease occurs in people with protuberances in the intestinal wall (diverticula). If there are several of these diverticula next to each other, doctors call this diverticular disease or diverticulosis. Scientists suspect a low-fiber diet is the main cause. As a result, the stool is often very hard, which is why those affected often suffer from constipation.
The hard bowel movements and constipation increase the pressure in the intestines. This in turn weakens the connective tissue of the intestinal wall and the mucous membrane bulges outwards. Remnants of stool can get stuck here and cause inflammation. This is initially limited to the diverticulum, but can also affect the entire intestinal wall. Around 12 to 25 percent of all people with diverticula develop inflammation once or regularly.
Because diverticulitis causes symptoms similar to appendicitis - only on the left side - it is also known by the following synonyms:
- Appendicitis of the Elderly
- Left appendicitis
The following typical digestive problems usually occur:
- Dull pain in the left lower abdomen (sometimes radiating to the right side)
- Pus or mucus in the stool
- Fever (sometimes)
If you experience pain when urinating, your doctor will first suspect a bladder infection. If the symptoms do not improve even after taking antibiotics, diverticulitis may be present. Also, if air leaks from the urethra when you urinate, this can indicate the condition. Then a pathological connection has formed between the intestine and the urinary bladder.
Pain in the left lower abdomen, especially combined with fever: This is a clear indication of diverticulitis. Especially if you have already been diagnosed with diverticula. The doctor is interested in how long your pain has existed, where and when it is strongest, and whether you have ever had comparable symptoms. Any other symptoms may also be important (e.g. painful urination). The following steps are important for diagnosis:
- The doctor can feel the partially fused diverticula as a kind of "roller" in the left lower abdomen.
- The diverticula that are felt are painful when pressed.
- The anus is examined with a finger (digital rectal examination).
- A blood test usually shows increased signs of inflammation (sedimentation rate, CRP, leukocytes).
- A precise assessment can be carried out using imaging methods (ultrasound, CT, MRT).
- An x-ray can detect air in the abdomen under the diaphragm. This is the case when inflammatory diverticula have broken through the intestinal wall to the outside.
Treatment & Therapy
The therapy depends on the stage of the disease. In mild cases, surgery can often be dispensed with. Surgery is often unavoidable when faced with complications. In severe cases, they have to go to hospital for treatment. There they are initially not given solid food, but rather liquid food or intravenous nutrition.
Stage I as well as IIa and IIb
In stage I and an initial inflammation in stages IIa and IIb, an intervention can be dispensed with. They receive e.g. the following antibiotics:
- Gyrase inhibitors
If your symptoms can be alleviated, you will switch back to normal diet after two to three days. In the case of repeated inflammation of stage IIa / IIb, the inflamed section of the intestine should be removed. This happens in an inflammation-free interval, usually six to eight weeks after the start of antibiotic therapy. If the pain persists despite the medication, surgery can be performed seven to ten days after the infusions have started.
Stage IIc is considered an emergency, and surgery is carried out immediately. In this case, several diverticula have already burst and there is a risk of spreading to the entire peritoneum. If the diverticulitis recurs (stage III), an operation is also promising.
The surgeon removes the inflamed section of the intestine and then connects the ends of the healthy ends. The operation can either be open through an abdominal incision or by means of laparoscopy. In contrast to the removal of the gallbladder, a small incision is also necessary with the latter variant (mini-laparotomy). If diverticula have ruptured, open surgery is often necessary. In such an emergency, an artificial anus (anus praeter) is placed to relieve the new connection between the pieces of intestine. This can be moved back in a second operation. Sometimes, however, the natural course of the intestine cannot be restored.
Prevention & Forecast
Diverticulitis can only develop if diverticula are also present. Therefore, preventing diverticula from developing is the best prophylaxis. A high-fiber diet and regular exercise are particularly crucial for this. Most of all, high-fiber foods are:
- Whole grain bread
If inflamed diverticula rupture (perforate), there is a risk of accumulations of pus (abscesses) in the abdomen. Diverticulitis can also spread to the peritoneum (peritonitis). Around five percent of patients suffer from bleeding. The affected intestinal sections can also be compressed in such a way that the intestinal contents can no longer be transported. Then there is a risk of an intestinal obstruction (ileus).
Connection ducts (fistulas) between intestine sections, intestine and bladder or intestine and vagina are also possible. These are often very uncomfortable and time-consuming to treat. After the first diverticulitis, the risk of getting the disease again is 30 percent. The younger they are when they first appear, the more likely they will need surgery at some point.
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