Medically Reviewed by Dr. David Costa Navarro
Diverticulosis is a disorder due to the formation of small sacs (diverticula) along the walls of the colon, which from the intestinal lumen expel towards the abdominal cavity. The bags can be present in extremely variable numbers, and their dimensions are usually between three 5-10 mm, but they can exceed 2 cm.
The exact cause is unknown, but the mechanism by which diverticula are formed is thought to be the increase in pressure within the intestinal lumen due
muscle spasm, with extrusion of the mucous membrane in the weakest points.
It is considered a typical disease of the geographical areas with “western” lifestyles: few dietary fibers are accompanied by a slowdown of intestinal transit with the formation of dry and hard stools that require greater effort to be expelled.
The increase in intestinal lumen pressure resulting from this effort would favor, according to a widespread hypothesis, the formation of diverticula.
However, the link between low-fiber diet and diverticulum formation is not well established and there are probably more than one causes. For example, it has been seen that a diet rich in red meat and a sedentary lifestyle also favor its formation. In most cases the presence of diverticula does not cause any disturbance and is only discovered following diagnostic investigations for other problems. In about 20% of people, however, it can cause annoying symptoms, such as abdominal pain, without fever or other signs of inflammation, swelling, constipation or diarrhea, the presence of mucus in the stool.
In some cases then, fortunately less than 5%, the diverticula become inflamed and the diverticulosis develops into diverticulitis, which typically presents with sudden pain in the abdomen, generally in the lower left part, with fever, diarrhea or constipation, reduced appetite, nausea and fatigue. It is not clear why this happens. The main cause seems to be
be the nesting and stagnation of hard feces inside the diverticulum, with erosion of the small vessels and consequent presence of bright red blood in the feces. In most cases, bleeding stops spontaneously by resting the intestines, but sometimes hospitalization may be necessary.
Diverticulitis can also face several other complications such as infections (abscess), obstruction, fistula formation between the intestinal lumen and neighboring organs, such as bladder or vagina, all problems that always require a medical evaluation.
A high fiber diet is recommended as the first form of treatment for the symptoms of diverticulosis. In Italy, the recommended daily dose of dietary fiber for adults is at least 25 g; foods that are naturally rich in it are whole grains, legumes, fruit and vegetables. The fiber contained in whole grains is slightly soluble and promotes intestinal transit, while pectin, present mainly in the apple and pear peel, is a soluble fiber that increases the volume of the stool. To avoid annoying intestinal problems due to fiber such as belly swelling and flatulence, it is good to gradually increase the amount of fiber introduced with food.
On the advice of the doctor, it may be useful to supplement the diet with soluble fibers, such as psyllo mucilars (eg Psyllogel), which form a gelatinous mass that softens the stool and increases its volume, facilitating its expulsion with less effort. In order for these products to have full effect it is important to take them regularly, every day, dispersing the powder in a large glass of water. Another important rule to remember is to take them at least a couple of hours away from other medicines, to avoid interference with their absorption. For a long time people with diverticula were advised not to eat nuts, fruits with small seeds (e.g. strawberries and blueberries) or popcorn, in the belief that parts of indigestible material could lurk in the diverticula and promote inflammation. A study conducted a few years ago in the United States has dispelled these fears, so that these dietary restrictions are no longer considered necessary. There is evidence that a diet high in fiber, in addition to reducing the symptoms of diverticulosis, can also have a protective effect against diverticulitis, with a reduction in hospitalization. In the acute phase of diverticulitis, when the symptoms become particularly intense and a fever appears, it is necessary to contact the doctor to evaluate the possible use of antibiotics and to start a low-slag diet, to allow a short period of “rest” ‘intestine. During this period, meat broths, fruit juices without pulp (eg apple juice), tea are recommended; gradually then you can introduce low-fiber foods (white bread, white meat, fish and cheeses) and then return to a diet rich in fiber.
Finally, to complete the picture of the factors that are considered protective against diverticulitis, it should be remembered the importance of a low-fat diet, abstention from! smoking and exercise. A risk factor is represented by the regular consumption of drugs such as acetylsalicylic acid, non-steroidal anti-inflammatory drugs (eg naproxen, diclofenac), opiates and corticosteroids.