The Facts about Diverticulosis and Diverticulitis

If you’re struggling with abdominal cramps, gas and diarrhea alternating with constipation, you may be one of many people suffering from diverticulosis.

Diverticulosis, a condition in which small pockets or pouches extend out from the inside lining of the large intestine, is very common in people over age 40. In fact, at least one-third of all Americans over age 45 and more than two-thirds of those over age 60 have this condition. Diverticulosis can be present in the intestines for years and never be discovered unless you have a colonoscopy or barium enema X-ray.  Often, people experience no symptoms from the condition and only discover it when they are having an unrelated medical treatment in or around the intestine. However, well over ½ of people with diverticulosis will experience at least mild symptoms from the disease.

This odd-sounding condition may cause mild lower stomach discomfort which usually is not serious. In severe cases, bleeding may occur from the pouches, but this symptom is not common. However, diverticulosis can lead to a more serious condition, diverticulitis, which occurs when the pouches become infected, causing fever and moderate to severe lower abdominal discomfort.  Diverticulitis can cause diarrhea, abdominal pain and cramping with or without fever — symptoms similar to those experienced with Irritable Bowel Syndrome. Only 20 percent of patient cases with diverticulosis advance to diverticulitis.

The exact cause of diverticulosis is still not completely understood. Doctors suspect that the pouches may be caused when colon muscle spasm creates pressure inside the colon which causes small weak spots in the intestine walls to balloon out (herniate), causing the pouches. The actual diverticulum may measure up to ¼ inch in size so they are small but sometimes significant! The walls of the large intestine grow thicker with age, which may be one reason for the added pressure incurred during a bowel movement. Other contributing factors could be stress, irritable bowel or not enough fiber in your diet, which causes the intestine to work harder during digestion.

Once formed, diverticula are permanent, and treatments are mainly dietary. To reduce the risk of developing diverticulitis, people with diverticulosis should eat a high-fiber diet that includes whole grains, fruits and leafy vegetables. It is also beneficial to drink plenty of water and exercise regularly. Recent research indicates that consumption of nuts, seeds and corn does not increase the risk of diverticulosis or diverticular complications as had been commonly believed. So it is safe to try those foods and if they do not cause symptoms, a small to moderate amount is fine.

Patients experiencing abdominal pain from diveriticulosis may benefit from anti-spasmodic drugs. Medication may also be prescribed to help control stress, reduce bloating and stomach problems or relieve diarrhea and constipation. If the condition advances into diverticulitis, bed rest, antibiotics and even hospitalization may be required.

The symptoms of diverticulosis – gas, stomach cramps, pain and diarrhea alternating with constipation – are also common in other, sometimes serious diseases. If you’re suffering from these symptoms, contact us so that we can properly diagnose and treat the source of your problems.

Most people are diagnosed with Crohn’s at around age 20-30, although it can occur at any age. It also is more common in Caucasians, people with a family history of the disease and people who smoke. Cigarette smoking is the most controllable risk factor for developing the disease. Smoking also worsens symptoms and increases the likelihood that a patient will eventually need to have surgery.

Typical symptoms of Crohn’s include persistent diarrhea (which may be bloody), cramping, abdominal pain, fever, loss of appetite and weight loss.

A colonoscopy is usually required to make a diagnosis of Crohn’s.  Other helpful tests often used in the evaluation include blood tests, stool samples, abdomen x-ray or CAT scan, and video capsule endoscopy (Pillcam).   A colonoscopy involves a sedated examination of the entire colon with a flexible, lighted tube with an attached camera. The procedure also provides an opportunity for your doctor to take small tissue samples for laboratory analysis, which may help confirm a diagnosis.

There is no known cure for Crohn’s, although symptoms can be treated with drugs and sometimes surgery. The disease may also go into remission for years at a time.

Living with Crohn’s can be difficult, but patients can help manage the problem of chronic diarrhea by diet and lifestyle changes. If you have Crohn’s, following these tips may lessen your symptoms:

• Take the medications recommended by your gastroenterologist.
• Limit dairy products.
• Eat low-fat foods.
• Avoid gas-producing foods like beans, cabbage and broccoli.
• Limit your intake of raw fruit juices and fruits (especially citrus fruits), spicy food, popcorn, alcohol and caffeinated beverages.
• Eat several small meals throughout the day.
• Drink lots of liquids.
• Avoid stressful situations.
• Reduce stress by exercising, meditating and/or following relaxation techniques.
• If you smoke, quit

If you are experiencing the symptoms of Crohn’s disease and are concerned that you may have the disease, see your doctor.

There are two types of hemorrhoids: Internal, which occur in the rectal tunnel and are associated with rectal bleeding, itching, pain or skin irritation; and external, which occur in or around the anus and are characterized by a hard spot or painful swelling where the blood clot forms.

Hemorrhoids are common in both men and women. In fact, about half the population has them by age 50. They can be caused by a variety of factors, including abdominal disorders, pregnancy, stress, a lifestyle that includes sitting for extended periods of time, obesity, inadequate intake of fiber, lack of exercise, or genetic tendencies.

While home remedies such as creams, suppositories and warm baths may offer temporary relief from the symptoms of hemorrhoids, they often fail to solve the problem.

Despite the lack of long-term relief, far too many people put off seeking treatment. Some are embarrassed to mention their problem; others mistakenly believe that treatment involves surgery and long recovery periods. The good news is that new medical advances make treatment much easier. We offer non-surgical treatments that are quick, easy and virtually pain-free. Most patients are able to resume their normal lifestyle almost as soon as they leave our office.

A word of caution: Rectal bleeding is a common side-effect of hemorrhoids, but it also can indicate a more serious problem. It is important to seek medical attention if: You are over age 40 or have a family history of colon cancer; your hemorrhoids don’t improve with self-care; you have pain or bleed frequently or excessively; you develop bleeding between bowel movements; and/or the onset of your hemorrhoids occurs along with a marked change in bowel habits.

Celiac disease is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten, which is found in wheat containing foods such as bread, pasta, cookies, pizza crust and many other foods containing barley, rye and possibly oats. When a person with Celiac disease eats gluten, the body responds by damaging the small intestine. This leads to an inability for the body to absorb essential nutrients.

If left untreated through a gluten-free diet, Celiac disease can cause anemia and stunted growth in children; loss of calcium and bone density; lactose intolerance from intestinal damage; intestinal cancers; and even disorders of the nervous system such as seizures and nerve damage.

Celiac disease is often misdiagnosed because the symptoms are common and resemble several other conditions like irritable bowel syndrome, gastric ulcers and Crohn’s disease. Those with Celiac disease may experience intermittent diarrhea, abdominal pain, bloating, upset stomach, irritability, depression, joint pain, muscle cramps or anemia. Dental and bone disorders, unexplained weight loss, or tingling of the legs and feet may also be indicators of malabsorption from Celiac disease.

Although Celiac disease can affect anyone, people with a family history of the condition are at a much greater risk. Also commonly affected are people with diabetes, Down’s syndrome, autoimmune thyroid disease and microscopic colitis.

With a gluten-free diet, people with Celiac disease can effectively manage the condition and live pain-free. It is not always easy; many foods and even some medications contain gluten. But with the growing number of gluten-free products on the market, even pizza lovers can avoid gluten. A registered dietitian who is experienced in teaching the gluten-free diet can offer advice on how to best maintain the nutritional quality of your diet and help sufferers come up with gluten-free alternatives and achieve a healthy lifestyle.

Once gluten is removed from the diet, inflammation in the small intestine subsides, and the organ will begin to repair itself. People generally begin feeling better in just a few days, though extensive damage may require some vitamin and mineral supplements to correct deficiencies.

On March 1, 2010, results of an international study out of London were released indicating scientists have identified new genetic links to Celiac disease. Their findings could speed the search for better ways to diagnose and treat Celiac disease and possibly even related autoimmune diseases like Type 1 diabetes.

If you are experiencing symptoms and suspect Celiac disease, see your doctor. The best treatment is a strictly followed gluten-free diet, but do not begin a gluten-free diet before you see a physician. If you stop eating foods that contain gluten before being tested, the test results may not be accurate.

Heartburn affects many of us. In fact the American Gastroenterological Association reports that more than 60 million Americans experience symptoms at least once each month.

The burning sensation you feel is actually stomach acid splashing up into your esophagus. A valve at the end of the esophagus, called the lower esophageal sphincter (LES), normally prevents this. But factors such as overeating, pregnancy or even stress can keep the valve from shutting properly. When that happens, stomach acid can be pushed back up into the esophagus, causing pain along with a sour or bitter taste in the mouth.

Occasional heartburn is normally nothing to worry about and can easily be treated with over-the-counter antacids. However, frequent heartburn may indicate a more serious problem. Over time, stomach acid can damage the wall of the esophagus and, if left untreated, can lead to narrowing of the esophagus, bleeding and trouble swallowing, a condition called Barrett’s esophagus, and even cancer of the esophagus. Prolonged heartburn may also indicate more serious problems such as acid reflux disease, gastroesophageal reflux disease (GERD), gastritis, hiatal hernia or peptic ulcer.

There are several lifestyle changes you can make to help avoid heartburn:

• Avoid trigger foods such as chocolate; coffee; peppermint; spicy or greasy foods; tomato products; and alcoholic beverages.
• Eat smaller , more frequent meals.
• Don’t go to bed with a full stomach. Give food 2-3 hours to digest before going to bed.
• Stop smoking or using tobacco in any form. Tobacco inhibits saliva, the natural protection for your esophagus and the nicotine in tobacco increases acid secretion and relaxes the LES.
• Shed some pounds. Losing weight can help relieve symptoms.
• Eat high-protein, low-fat meals.
• Drink plenty of water during exercise to keep from being dehydrated.
• Avoid tight clothes and belts.

If you still experience heartburn, antacids usually give fast, short-term relief. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide to reduce the chance of diarrhea or constipation. If your symptoms worsen when lying down, raising the head of your bed so that your head and chest are higher than you feet may help.

If symptoms persist or occur frequently, speak to your doctor. Continuous heartburn may indicate a serious problem, and sudden chest pain may be mistaken for heartburn when it is really a sign of heart disease. Your physician may suggest prescription medication or testing such as x-rays to check for ulcers, pH tests to check for acid in the esophagus, or endoscopy to look for other conditions. Seek medical attention when the following symptoms occur:

• Difficulty or pain when swallowing
• Vomiting blood
• Black or bloody stools
• Shortness of breath
• Lightheaded or dizziness
• Neck or shoulder pain
• Heartburn more than 2-3 times per week for more than 2 weeks.

If heartburn is becoming a more frequent problem, keep a heartburn record. Track how often you experience the symptoms, what time of day and what you are eating or doing when the symptoms occur. That will help you get a clearer picture of when it is time to seek medical care and help your doctor more effectively diagnose and treat your condition.

The gallbladder is a storage tank for bile produced in the liver until the body needs it for digestion. Problems occur when the bile hardens into little pebble-like substances called gallstones and block the release of bile into the digestive system. Gallstones can be as big as a golf ball or as small as a grain of sand. Many people with gallstones don’t even know they are there.

When gallstones block the bile ducts, pressure increases in the gallbladder and may result in a gallbladder “attack.” An attack may follow a “fatty” meal, causing pain in the abdomen or in the back either between the shoulder blades or under the right shoulder.

Sometimes the pain subsides after an “attack” because the gallstone has moved. However, infection and rupture can still occur. People with prolonged pain; nausea and vomiting; fever or chills; yellowish coloration of the skin or eyes; or clay-colored stools should see a doctor immediately.

Over one million patients are diagnosed with gallstones each year. The good news is that the gallbladder is one organ you can live without, and surgery to remove the gallbladder is one of the most common surgeries performed on adults in the United States. It can often be done on an outpatient basis and may be performed laparoscopically, or with tiny incisions through the abdomen.

Although anyone can develop gallstones, the following tips can help prevent gallstones or their recurrence once treated.

• Don’t avoid eating or fast. Eating at least three balanced meals each day helps prevent the build-up of bile.
• Watch your diet. A diet that is high in fiber and calcium and low in saturated fats helps prevent the formation of gallstones.
• Maintain your target weight. Obesity increases your risk for gallstones, but so does rapid weight loss. Strive for an overall health plan to achieve a normal weight for your age and height.

Because gallstone symptoms may be similar to those of a heart attack, appendicitis, ulcers, irritable bowel syndrome (IBS), pancreatitis and hepatitis, an accurate diagnosis is very important. Don’t let this little problem become a big issue.

Symptoms of IBS include diarrhea, constipation, abdominal cramps and bloating. For some people, symptoms are mild; many don’t even seek treatment for the condition. For others it can be very distressing and make it difficult to carry on normal daily activities.

Though the specific cause is unknown, many attribute the condition to stress. It is not unusual for people to respond to stress with some sort of physical reaction, often centering in the gastrointestinal system. With IBS, the muscles of the intestines don’t move as they should. And this “gut” reaction to stress can be annoying, uncomfortable and even painful.

When someone complains of these symptoms, the first thing we do is rule out other underlying causes such as Crohn’s disease, ulcerative colitis or cancers of the colon. The absence of another disease can indicate that the problem is IBS.

The most important thing to remember is that though it can be uncomfortable, it is definitely not serious and does not lead to more dangerous diseases. Even so, the symptoms should not be ignored. While there is no precise cure for IBS, a modified diet, lifestyle changes and medications can alleviate the pain and discomfort and help those with the condition lead a more normal life.

Dietary changes can be effective, especially when specific foods that provoke the symptoms are eliminated. For example, increasing dietary fiber and avoiding items that stimulate the intestines such as caffeine may stop chronic diarrhea. Lifestyle changes including regular exercise and improved sleep have also been shown to reduce anxiety and relieve symptoms.

When diet and lifestyle changes produce no improvement, there are some medications such as smooth (intestinal) muscle relaxers and low-dose antidepressants that may help relieve intestinal pain.

There is no single solution for IBS, since the condition affects each person differently. And there is no surgical remedy.

However, there’s no need to live with chronic diarrhea, constipation and pain. Consult a physician and see what you can do to help you get your intestinal tract back on track.