Diverticula of the descending colon and sigmoid colon. Diet for diverticulosis of the intestine and sigmoid colon. Rehabilitation after surgery

Statistics have established that diverticulosis of the sigmoid colon is observed in every 4 inhabitants of the planet. Pathology occurs in the elderly population and develops due to age-related changes. appears due to intense tension at the time of bowel movement. A common location is the lower region of the sigmoid colon, which is slightly larger than a pea.

Description of diverticulosis

Diverticula are such extraordinary protrusions (growths) resembling a hernia, a hemorrhoid based on the walls of the intestine. Able to occur in a person throughout his existence, without manifesting himself in any way. The appearance of diverticula is called diverticulosis. If these growths become inflamed, a pathology such as diverticulitis occurs. There may be intestinal single, multiple protrusions. Diverticulosis affects people over 60 years of age, but there are cases of the development of the disease at an earlier age.

Alcohol abuse, intake of fried, fatty foods, malnutrition can cause the formation of diverticulosis of the sigmoid colon.

The disease is not congenital. Often this is the impact of adverse, irritating factors. The protrusions are not always based on the mucosa, they can go outside, take place on the outer walls of the intestine. Diverticulosis does not carry a significant danger, but if certain rules are not followed, an exacerbation is possible, which threatens not only health in this situation.

The reasons

The very first cause of diverticular disease of the sigmoid colon is age-related changes. The intestinal walls weaken, when filled with feces, increased intra-intestinal pressure occurs, which causes expansion of the walls and bulging of the diverticulum.

In addition, growths in diverticulosis occur due to intestinal spasms that provoke a disorder in blood flow. Dystrophy is formed, which also stretches the walls of the intestine.

The causes of diverticulosis are as follows:

• acquired or inherited connective tissue dysplasia with damage to the synthesis of collagen fibers;
• discoordination of intestinal motility with a disorder in the waste of contents;
• persistent constipation;
• spasm of the intestinal muscles, constriction of its vessels;
• pathology of the cardiovascular system (ischemic disease, atherosclerosis);
• malnutrition (low consumption of foods with vegetable fiber, overeating, high intake of protein foods, flour products);
• flatulence;
• diabetes;
• bad habits (drinking alcohol, smoking) lead to the appearance of protrusion.

Often predisposing factors for diverticulosis are: excessive body weight, little physical activity, sedentary lifestyle.

Symptoms

Diverticulosis can not manifest itself for a long time, but until the inflammatory process appears. The main symptomatology of the diverticulum of the sigmoid colon is intense spasms and pain in the lower abdomen. Sometimes the pain is barely noticeable, but it causes discomfort. However, the symptom can lead to a real shock. But after a bowel movement, it goes away. Most patients assume that the pain is due to diet.

When there is a strong, prolonged feeling of pain, nausea, diarrhea, the initial signs of inflammation of diverticulosis.

A little later, other symptoms of diverticulosis of the sigmoid colon are formed, they are:

• painful fistulas;
• stool disorder (diarrhea, constipation);
• flatulence, heaviness in the abdomen;
• bleeding similar to hemorrhoidal;
• mucus in stool;
• perforation of the sigmoid colon;
• intestinal obstruction in diverticulosis;
• distension, colic, spasms.

Compared to hemorrhoidal bleeding, no pain is noted with diverticular bleeding, this should alert the person. Sometimes there are a lot of growths, so bleeding is often intense, which is life-threatening.

After the onset of intestinal bleeding, the disease is already noticeable. A person is tormented by constant pain, an increase in body temperature occurs, the work of the intestines is upset. This already leads to an exacerbation of diverticulosis of the sigmoid colon, this condition requires urgent therapy.

Diagnostics

With the initial manifestations of diverticulosis of the intestine, you need to go to the doctor. During the examination, the specialist takes into account some factors: symptoms, patient complaints, age, predisposition to constipation, what lifestyle a person leads, how he eats. At the time of the examination, the doctor presses with his fingers on the pathological areas to detect characteristic signs.

Pathology is diagnosed through laboratory and hardware studies.

Diagnosis of the disease involves the following activities:

1. Irrigoscopy - at the time of the study, an x-ray of the colon is produced, which was previously filled with a contrast agent. In the presence of diverticula, they are filled with this substance, they are perfectly visible in the picture.
2. Colonoscopy examination - allows you to examine the condition of the intestine from the inside.
3. Laparoscopy is a method of examination, therapy. The specialist makes 3 punctures in the wall of the peritoneum, inserts a small camera into them, through which the surface of the intestine is viewed. In uncomplicated disease, the diverticulum is immediately removed. Manipulation is performed under general anesthesia.

A blood and stool test is also performed. In more complex situations, it is necessary to differentiate the disease using extensive radiography of the peritoneal cavity or MRI, CT. Ultrasound for diverticulosis of the intestine is not done, here it is not informative.

Treatment of diverticulosis

The doctor prescribes treatment for the diverticulum of the sigmoid colon, based on the stage of development of the disease. When the pathology has an initial form, there are no signs, therapeutic actions will be determined by the observance of prevention, dietary nutrition to prevent constipation. You will also need therapeutic exercises to eliminate stagnation of feces.

Medical treatment

With a complication of diverticulosis of the sigmoid colon, which is characterized by inflammation, the patient will be prescribed medication therapy:

1. Antibiotics (Sumamed, Amoxicillin, Amoxiclav) - treatment is 5 days. After 10 days, the course is repeated, and so 3 times.
2. Antispasmodics, painkillers (No-shpa, Spazmalgon, Drotaverine) - help with spasm and pain, you can not take it for a long time.
3. Laxatives (Duphalac, Normaze, Microlax) - constipation should be avoided, if the feces are delayed, the specialist will prescribe these funds.
4. Prokinetics (Motilak, Motilium) - since with intestinal diverticulosis, digestive motility fails, agents with antibacterial, antidiarrheal, antiemetic effects are used.
5. Probiotics, prebiotics (Lineks, Bifiform) - contribute to the normalization of intestinal microflora.
6. Espumizan, Smekta - relieve flatulence and gas formation.
7. Enzymes (Festal, Creon) - to improve digestion.

With the development of serious complications of diverticulosis (bleeding, abscesses), when the patient's condition has noticeably worsened, treatment takes place in a hospital. Then antibiotics are administered intravenously, this will help to relieve inflammation faster.

When a person has peritonitis, perforation of the diverticulum of the sigmoid colon, numerous growths, then the pathology is treated surgically. After their removal, a long recovery will be required.

Diet

With diverticulitis of the sigmoid colon is considered an important stage of treatment. It allows you to prevent the progression of pathology, the appearance of complications. The main principle of a proper diet is a large meal with a high content of vegetable fiber, which improves digestion, restores peristalsis, and prevents stagnation of feces.

Thanks to dietary nutrition for diverticulosis of the sigmoid colon with frequent consumption of fruits and vegetables, it is possible to prevent such a symptom of the disease as constipation. In addition, dietary fiber has a positive effect on the intestinal microflora.

Useful and prohibited foods for intestinal diverticulosis:

Featured	Forbidden
wheat bran	Various spices, spices
Dried fruits (dried apricots, prunes)	Strongly brewed tea, coffee
Legumes, cereals, rice	Semi-finished products, fast foods
Figs, apricots	fresh bread
Whole wheat bread	Alcohol, soda
Flaxseed, rye, sesame	Sweets, pastries
cabbage, tomatoes	Whole milk
Green peas, dried mushrooms	Chips, croutons

To establish microflora, you should use fermented milk products. To prevent constipation in diverticulosis, it is important to drink plenty of water (at least 2 liters per day).

Products from the prohibited list can lead to bloating, dysmotility.

The diet for diverticulosis should be carefully compiled, food can be eaten boiled, steamed, baked. Avoid fried, fatty, spicy foods. Eat often (5-6 times), but in small portions. This is the only way to quickly cure diverticulosis of the sigmoid colon.

Physiotherapy

Special physical education will help treat diverticulosis. Regular exercise is beneficial even for people who have undergone surgery. They are shown slow walks in the air. Later, the loads slightly increase, more complex gymnastics is performed.

With physical stress, the pressure in the intestine is removed. The blood flow is improved, the intestinal walls are strengthened, this prevents the appearance of a new protrusion. What exercises are suitable for diverticulosis, the doctor should show.

Therefore, diverticulitis of the sigmoid colon can be treated with:

• slow walking (about 5 times a week), however, in accordance with age, physical capacity; later walking is replaced by light running;
• jog, then increase the load a little;
• any exercises designed to strengthen the pelvic muscles are performed on the press.

No need to try to do gymnastics zealously. Fatigue is possible, but not severe. The patient should feel alert, not weak. For those who are stronger, it is advisable to ride a bike, go swimming. Basically, patients with diverticulosis are elderly people, you do not need to strain your body too much. Such treatment at home will speed up the healing process.

Folk methods

In addition to the above methods, additional treatment of diverticulosis of the sigmoid colon with folk remedies will help improve a person's condition.

The following recipes are considered the most effective:

• to eliminate inflammation in diverticulosis, constipation can olive, linseed oil. Used 1 tablespoon of the product before going to bed, can also be added to salads;
• Place 1 teaspoon of finely chopped elm bark in a container, pour a glass of water, keep on the stove for 20 minutes. Then cool, strain, drink half a glass daily;
• combine dried leaves of nettle, motherwort, all in equal proportions, with dill seeds, wild rose, chamomile, place 1 tablespoon of thoroughly mixed product in a thermos, add 200 ml of warm liquid, close, insist for 1.5 hours, strain. Within a month, take 100 ml twice a day - in the morning, at night;
• every day with diverticulosis, use aloe juice at a dosage of 30 drops. It can be supplemented with rosehip infusion or honey;
• place 1 tablespoon in a container of bran, add 1 glass of low-fat kefir, milk, mix, take in the morning and evening. The therapy takes place in ascending order: every day, the portion of bran should be increased by 1 spoon; reach 10 spoons, then reduce back;
• Pour 1 tablespoon of elderberry with 1 cup of boiled liquid, insist, use daily.

Treatment of diverticulosis with folk remedies should take place along with drug treatment and only after the permission of a specialist. Self-therapy can worsen the situation, lead to complications.

Therapy of the syndrome of diverticular pathology will become effective only if the patient fulfills all medical recommendations. Diverticulosis itself does not pose a threat to life, but is fraught with complications in the absence of necessary measures.

The information on our website is provided by qualified doctors and is for informational purposes only. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and conducts treatment. Expert of the group on the study of inflammatory diseases. Author of more than 300 scientific papers.

To date, diverticular disease (diverticula) of the sigmoid colon is very common and is considered an acquisition of the civilizational world. In the last decade, pathology has not only medical but also economic significance, as it is increasingly common among working people and makes up one fifth of all gastroenterological diseases. But at the same time, it is difficult to talk about the true incidence of the disease, since in many cases it is asymptomatic. This type of digestive tract disorder is extremely rare in rural Africa and Asia; on the contrary, the highest incidence rates are observed in the USA, Europe and Australia.

Description of pathology

Diverticular disease is a pathological condition in which sac-like protrusions of the mucous membrane and submucosal layer form along the course of the large intestine, and most often the sigmoid section, through a weakened muscular component of the intestine - diverticula. The term "diverticulosis" refers to a plurality of such formations that may not cause discomfort to the patient and are diagnosed randomly. This pathology can also be called sigma diverticulosis.

From Latin, "diverticulum" is translated as "branch" or "road to the side."

Many experts believe that the disease develops in parallel with irritable bowel syndrome, and therefore the treatment of such diseases is similar.

Disease classification

Many points of the classification of diverticulosis are very conditional. For example, the distribution of formations into true and false ones is not fully substantiated, since the prolonged presence of a diverticulum leads to atrophy of the muscular layer of the intestine and the addition of a secondary bacterial infection.

But, nevertheless, true diverticula include congenital protrusions of the sigmoid colon, which have a good connection with its lumen, they are not clogged with feces and rarely become inflamed.

False ones are considered acquired, can lead to serious complications and are also divided into:

• incomplete or extramural - the diverticulum consists of both the mucous layer and the submucosa, it is difficult to empty, which leads to chronic inflammatory processes;
• complete, intramural diverticulum - also affects the muscular layer of the large intestine, due to which active emptying is possible.

According to the number of formations, they distinguish:

• single;
• multiple.

They can be of various shapes:

• cylindrical;
• spherical;
• pear-shaped;
• oval;
• bag-shaped.

Depending on the course, diverticular disease is distinguished:

• asymptomatic;
• diverticulosis with clinical manifestations.

Causes and factors of development of diverticula in the sigmoid colon

To date, it is impossible to talk about reliable causes of diverticulosis of the sigmoid colon. There are a number of anatomical features that are prerequisites for the disease.

1. The structure of the muscular layer of the intestine in the form of 3 strips significantly weakens it in front of external and internal factors of influence.
2. The arteries and veins of the large intestine, intertwining with each other, pierce the muscular wall, which forms “weak” places.
3. Each of the sections of the large intestine has haustra, i.e., protrusions that go along the stake and ensure the passage of feces to the anus. In these anatomical structures, there are high rates of intra-intestinal pressure.

The disease of Western civilization is often provoked by:

• nutritional characteristics - an insufficient amount of plant fibers leads to a decrease in the volume of feces, a slowdown in the passage through the intestines and an increase in intra-intestinal pressure, which causes the formation of diverticula;
• impaired intestinal motility due to advanced age;
• congenital predisposition - children with dolichosigmoid (elongated sigmoid colon, due to weakness of the muscular wall), further suffer from diverticulosis.

Based on this, diverticular disease can be considered a multifactorial pathology, the formation of which is influenced by both external influences and structural features of the intestine itself.

Clinical manifestations of the disease, symptoms

Diverticulosis of the sigmoid colon, as a rule, has a progressive course, and the symptoms of the disease depend on its form, the age of the patient, adherence to dietary recommendations and the presence of comorbidities.

The most common form of the disease is uncomplicated, which may not have clinical manifestations. But, the most common symptoms are:

• pain in the left lower abdomen;
• a feeling of bursting;
• bloating;
• constipation;
• nausea;
• rumbling in the stomach;
• excretion of more mucus along with feces.

Diagnostic measures

The diagnosis of diverticulosis of the sigmoid colon assumes an uncomplicated course and the absence of symptoms of the inflammatory process, therefore instrumental methods are used for a detailed study of the disease.

Irrigography

For a more detailed examination of the sigmoid colon and accurate detection of diverticula, the double contrast method is used: the patient drinks a mixture of barium, and he is additionally injected into the intestinal lumen with air, which expands the formations, and the radiopaque substance additionally contours it.

On the obtained radiograph, they are presented in the form of a protrusion, of a certain shape, with a neck that connects to the intestinal lumen.

The method allows you to determine the number, type and localization of diverticula.

Endoscopy

The introduction of an endoscope into the sigmoid colon helps to distinguish a diverticulum from a polyp, but this diagnostic method requires an experienced specialist to avoid perforation when examining the intestinal lumen.

abdominal ultrasound

The safest diagnostic method, since it does not require intervention in the internal environment of the body.

Abdominal pain can be caused by various pathologies, so an ultrasound study is carried out with:

• suspicion of a neoplasm in the intestine or nearby anatomical structures;
• detection of a seal during a doctor's examination.

With sigma diverticulosis, stool often accumulates in hernial pockets, which acts as a seal, which is clearly visible on the monitor of the apparatus.

Also, in addition, in order to differentiate with other diseases, perform:

• general blood analysis;
• study of feces;
• bacteriological examination of feces.

Differential diagnosis is carried out with:

• Crohn's disease;
• irritable bowel syndrome;
• ulcerative;
• tumors of the sigmoid colon.

Pathology treatment options

The choice of a specialist for the treatment of sigma diverticulosis depends on the variant of the course of the disease, since both gastroenterologists and surgeons (in case of complications) deal with pathology.

If the formation of the sigmoid colon was found randomly, and the patient does not complain about the disruption of the digestive tract, then expectant management, prevention of constipation and correction of nutrition, lifestyle, and physical activity are recommended.

In the case of a pronounced clinical picture, which indicates an uncomplicated course of diverticulosis, a whole arsenal of medications is used, the action of which is aimed both at eliminating symptoms and improving quality of life, reducing the risk of relapses and the occurrence of complications.

1. To prevent the development of pathogenic microflora and inflammation of the walls of the large intestine, antibacterial agents are used - Amoxicillin, Clarithromycin, Norfloxacin.
2. In order to reduce pain, they take drugs that can reduce spasm of the muscular layer of the intestine, for example, Drotaverine, Baralgin, Papaverine, Mebeverine.
3. Prokinetic drugs - Motilium, Domperidone, Raglan - help to improve intestinal motility and the formation of fecal masses.
4. In order to prevent the occurrence of constipation and regulate the patient's bowel movements, laxatives are recommended - the best option for sigma diverticulosis are drugs based on lactulose (Laxarin, Dufalac, Normaze).
5. To improve digestion and breakdown of nutrients, enzymes are used in tablet form - Festal, Mezim, Pancreatin.
6. Help reduce manifestations - Meteospasmil, Trimedat.
7. To restore the intestinal microflora, probiotics are needed in the treatment regimens - Linex, Bifiform, Laktimak.
8. With a recurrent course of diverticulosis of the sigmoid colon, modern treatment regimens use Rifaximin in combination with Salofalk or Mucofalk.

Drugs for the treatment of diseases - photo gallery

Clarithromycin is used to kill pathogens Baralgin relieves spasm of the muscular muscles of the intestine Duphalac is used as a laxative Salofalk prevents the development of relapses of the disease Motilium improves intestinal motility
Mezim - tableted enzymatic preparation Meteospasmil reduces the manifestations of flatulence Linex restores normal intestinal microflora

Surgery and removal

In the event of an increase in the symptoms of inflammation, the gastroenterologist and the surgeon make a joint decision on surgical treatment. The method of surgical treatment depends on the nature of the complication:

• in case of perforation, fistula formation, fecal obstruction - an open operation is performed, directly through the abdominal cavity, after which the incompetent section of the intestine is removed and the intestine is reconstructed in order to resume normal defecation;
• in case of bleeding - it is necessary to carry out endoscopic intervention and "cauterization" of bleeding vessels using optical tubes that are inserted through punctures in the anterior abdominal cavity. The procedure is less traumatic and allows you to replace the abdominal operation.

The rehabilitation period does not take more than a month, during which the patient takes painkillers, performs breathing exercises and, together with the attending surgeon, monitors the condition of the sutures and the postoperative wound.

The result of treatment with folk methods has not been proven, since they are not able to affect the intestinal wall, therefore their use is not recommended for this pathology.

Diet for sickness

The diet should correspond to the needs of the patient's body in calories, and the amount of food consumed at a time should not exceed 200 ml.

The multiplicity of meals 6-7 times a day, in order to avoid a small amount of food masses in the intestines.

• eat foods with a high level of fiber (raw vegetables and fruits, cereals, hard pasta and bran);
• lean meats (chicken, beef, rabbit, turkey) and all types of fish;
• exclude store-bought pastries, yeast-based flour products, sweets, smoked foods, salty and spicy foods, as well as legumes, strong tea and coffee, alcoholic drinks from your diet;
• fast food is strictly prohibited;
• in the morning, be sure to take a tablespoon of flaxseed oil on an empty stomach, which prevents the development of constipation and reduces the inflammatory process in the intestines.

Nutrition for diverticulosis - photo gallery

Fiber improves digestion Lean meats are recommended for sigma diverticulosis
Beans stimulate gas formation in the intestines Fast food is bad for health Flaxseed oil prevents constipation

Therapeutic gymnastics and physical education

With sigma diverticulosis, exercises are recommended that improve blood flow and venous outflow in the intestine, stimulate peristalsis and do not harm other organs and systems. Therefore, exercise options and exercise therapy schemes should be selected by a specialist strictly based on the variant of this pathology and the presence of concomitant diseases.

This method of treatment is additional to the main therapy, and also significantly reduces the rehabilitation time after surgery.

Prognosis and complications

Most cases of diverticulosis of the sigmoid colon ended favorably.

If the pathology is complicated, then the clinical picture corresponds to the disease that has developed a second time.

1. Acute diverticulitis - inflammation of the diverticulum, which is accompanied by increased pain, severe palpitations and shortness of breath.
2. Diverticulum perforation or rupture - often provokes the development of an abscess, which manifests itself in the form of jumping fever, soreness throughout the abdominal surface and changes in the general blood test.
3. The formation of fistulas between the diverticulum and neighboring organs - the bladder, vagina, other intestinal loops.
4. Bleeding from a diverticular mass.

Statistical data suggest that the development of the first case of diverticulitis is successfully treatable, and, on the contrary, in the third - only 5%.

Every third bleeding in diverticulosis recurs after a few years.

Preventive measures

The purpose of prevention in the diagnosis of diverticulum in the sigmoid colon is to prevent the development of complications. To do this, it is necessary to increase the volume of the stool by:

• fluid intake of at least 3 liters per day;
• make a diet that includes 75% fiber-rich foods;

is a disorder in which a hernia-like formation appears on the walls of the intestine. They are called diverticula. Growths can be present in the intestine for many years, but do not manifest themselves. In this case, the disease is called diverticulosis. When an infection enters the large intestine, the diverticula become inflamed - the disease is called diverticulitis. Growths are single and multiple, have different sizes - depending on the stage of the disease. The pathological process is localized in the sigmoid or descending.

The sigmoid colon is a portion of the large intestine. More often, the disease affects the sigma due to structural features. When exacerbated, this significantly worsens the quality of life. With severe neglect and untimely treatment, the disease is dangerous, often taking an unpredictable course.

Diverticular disease is diagnosed mainly in the elderly. The most common reason is aging. Sometimes it develops up to 40 years, but it is asymptomatic. With age, immunity weakens, infections enter the body, which provoke inflammation of the diverticula. Unpleasant symptoms appear that require treatment.

Diverticulitis is caused by three main causes: dystrophy of the muscular tissues of the intestine, vascular abnormalities, and a disorder of peristalsis. The appearance of the disease can be provoked by both hereditary factors and lifestyle.

hereditary factors. Common causes are weak organ walls, underdeveloped connective tissue, lack of collagen fibers. This disease is characterized by a genetic predisposition. If someone in the family is already sick, then the likelihood of developing pathology increases. Careful prevention is required to protect the body.

Improper diet, alcohol. With an irrational diet, stool masses stagnate in the intestines, greatly stretching the tissues of the organ. Peristalsis is disturbed, spasms and constipation appear, as a result, the sigma wall cannot withstand the load. Hernias, bundles, fistulas, bleeding appear.

Symptoms

This pathology does not manifest itself for a long time. There are often subtle symptoms. Patients ignore them and do not attach importance. Taken for poisoning or irritable bowel syndrome. This complicates the correct diagnosis and delays the necessary treatment. Symptoms and treatment of diverticulosis depend on the stage of the disease and differ in stages.

Signs of the initial stage:

• Pain in the lower left side of the abdomen. It goes away on its own or after a bowel movement.

• The stool contains mucus.
• Constipation or diarrhea.
• Feeling of fullness in the abdomen.
• Bloating.
• Flatulence.

A characteristic symptom is pain in the left lower abdomen. It goes away after going to the toilet.

Signs of complications:

• Severe pain in the abdomen, often unbearable. Does not pass after a chair.
• Severe constipation, diarrhea.
• Bleeding like hemorrhoids.
• Increase in body temperature.
• General weakness, tremor.
• Nausea, vomiting.

Complications of diverticulitis: bleeding, perforation of the diverticulum, abscess, intestinal obstruction. An aggravation can cause bleeding so severe that the person loses consciousness. The pain intensifies and does not subside for several days. At the first symptoms, you should immediately consult a doctor.

Since the picture of the disease is similar to other pathologies, a thorough examination is necessary.

Diagnostics

The diagnosis is made by an experienced proctologist. Important complaints, lifestyle, hereditary factors, eating habits of the patient. To detect diverticula, instrumental studies are used:

• Irrigoscopy - X-ray of the intestine. The organ is filled with a special substance. The picture will clearly show hernias and protrusions.
• Colonoscopy is an internal examination using a camera on a long tube. It is considered an informative method, but is used only after irrigoscopy because of the danger of damage to the growths.

• Biopsy - obtaining tissue samples with special forceps. Often combined with a colonoscopy.
• Manometry is the measurement of pressure in the intestines.
• Laparoscopy is a diagnostic and treatment method. A probe with a camera is inserted into the body through punctures. As a result, the doctor will assess the condition of the diseased organ on the monitor screen and remove a small diverticulum.

Laboratory studies are considered secondary, but necessary to make an accurate diagnosis and identify complications.

Due to the universality of symptoms, it is necessary to exclude other diseases - cancerous tumors, colitis, Crohn's disease. The doctor will prescribe the necessary studies, make an accurate diagnosis and determine the tactics of treatment.

Treatment

With diverticulosis, it is important to normalize stool and intestinal motility. The patient is prescribed a strict diet with a lot of fiber, prebiotics for microflora, laxatives, antispasmodics, remedies for diarrhea and flatulence. Diverticulitis is treated on an outpatient basis with regular monitoring by a specialist.

Diet

In the initial stages of the disease, diet is the main component of treatment. It prolongs the uncomplicated period, prevents the development of the disease. An individual diet should be compiled by a gastroenterologist. After studying the clinical picture, he will write recommendations.

Those suffering from diverticulosis are advised to consume foods with a lot of fiber, lactic acid drinks, and plenty of fluids. Fractional nutrition is of particular importance. The menu should not contain sweet, spicy, salty dishes. Strong tea and coffee, sweet flour products and alcohol are prohibited.

Drug therapy

In case of complications, antibiotics, hemostatic drugs are prescribed. To eliminate the symptoms of intoxication, enemas and infusion therapy are used. In severe cases, frozen plasma is used.

High-quality therapy alleviates the condition, eliminates most of the symptoms, and prevents complications.

Surgical intervention

Surgical treatment is prescribed in the most severe cases:

• Damage to diverticula.
• Internal flow.
• Peritonitis.
• Abscess.
• Tumor growths.
• Fistulas.

During the operation, not the growths are removed, but part of the damaged organ - the segmental intestine is removed. First, the affected segment is cut out, and then the continuity of the entire intestine is restored, sewing together the healthy parts of the organ. The size of the removed segment depends on the severity of the disease. Surgery for diverticulitis is inevitable, but it does not pass without a trace, and the patient will have to carefully monitor his diet all his life.

Prevention

You can avoid the formation of diverticula by following simple recommendations. Proper nutrition and an active lifestyle minimize the risk of developing the disease.

Physiotherapy. Physical education helps to restore intestinal motility, increase body tone. Regular exercise is especially important for patients who have undergone surgery. Recommended exercises to strengthen the muscles of the body, back and abs. Useful walking and running. Any physical exercise should be performed after consulting a doctor. He will determine the degree of load and intensity of training. Therapeutic exercises are becoming an integral part of the treatment and prevention of sigma diverticula.

Proper nutrition

Small meal. You need to eat 5-6 times a day in small portions. Separate meals are recommended so that food is digested as thoroughly as possible.

Proper preparation. Fried, smoked, salty dishes are prohibited. Suitable methods for preparing diet food are stewing, baking, steaming, boiling, languishing.

Only useful products. Food should be as natural and easily digestible as possible. Anything that overloads the digestive system is contraindicated.

• Bran, raw vegetables, dried mushrooms, whole grains, cereals - they contain a large amount of fiber and vitamins.
• Lean meat and fish, seafood.
• Kefir, yogurt, cottage cheese, sour cream will provide beneficial microorganisms. If the disease already exists, they are prescribed after consulting the attending physician, as they can cause fermentation and gas formation.
• Pure water. It is necessary to drink 1.5-2 liters of fluid - to prevent constipation.
• Herbal teas and compotes. They are natural laxatives.
• Vegetarian soups.

Limit or Exclude:

• Fatty meats and fish.
• Potato.
• Spices and spices, marinades.
• Salted, smoked, fried foods.
• Carbonated, sweet drinks, concentrated juices.
• Coffee, alcohol.
• Flour, confectionery, sweets.

Folk methods

Together with drug treatment, it is permissible to use the advice of traditional medicine. Phytotherapy has a beneficial effect - treatment with pharmaceutical herbs. The doctor may prescribe hemostatic, anti-inflammatory, wound healing herbs and combinations thereof. In combination with the main treatment, phytopreparations give a good result. Folk remedies treat the disease in the initial stages. In the acute period, phytotherapy is ineffective.

The prognosis for uncomplicated diverticulitis is good. Most often, a person returns to his usual way of life even after excision surgery - as if he had always lived without diverticulitis. It is recommended to maintain a proper diet, exercise and undergo a medical examination in a timely manner.

Diverticulosis of the large intestine ranks 5th among other diseases of the digestive system. However, it is difficult to name the exact number of people suffering from this pathology. The reason is the frequent asymptomatic course or mild non-specific clinic, which does not allow to suspect the true cause of suffering. But the undeniable fact is that with age, the prevalence of the disease increases dramatically. Diverticulosis of the large intestine occurs only in 10% of patients younger than 40 years old, but in people older than 80 years this pathology is diagnosed in 50-60% of cases. Diverticular disease, which has clinical manifestations, significantly reduces the quality of life, and 10–25% of patients experience complications, including life-threatening ones (bleeding, intestinal obstruction, diverticulum perforation).

What are diverticula

Diverticular disease of the sigmoid colon is a special case of diverticulosis of the large intestine. A distinctive feature of the disease is the presence of diverticula, protrusions of the intestinal wall. They can be single or multiple, congenital or acquired. Depending on which structures of the intestinal wall are involved in the pathological process, there are true and false (complete and incomplete) diverticula.

True diverticulum	False diverticulum
The anatomical structure of the protrusion wall is similar to that of the intestinal wall, that is, it includes the mucous membrane, submucosal layer, muscular and serous membranes.	The wall of the formation contains only the mucous membrane and the submucosal layer. A false diverticulum that penetrates into the muscular membrane of the intestine, but does not go beyond it, is called incomplete. A false diverticulum that extends beyond the intestinal wall is called a complete diverticulum.
It is a congenital anomaly.	It is an acquired pathological formation.
The emptying of the diverticulum was not disturbed.	Emptying is difficult.
It is localized more often in the right parts of the colon.	It is localized more often in the left parts of the colon.

In the vast majority of cases, diverticula are found in the left half of the colon (descending colon and sigmoid), accounting for 90% of cases of diverticular disease. In 10% of patients, a total lesion of the large intestine is observed. The favorite localization of diverticula is the sigmoid colon (50–65% of cases).

Classification

According to the recommendations of the World Organization of Gastroenterology in 2005, diverticulosis of the large intestine is divided into uncomplicated and complicated forms. The first can be asymptomatic or with clinical manifestations, the second includes such options as diverticulitis, diverticulum perforation, abscess, peritonitis, sepsis, intestinal obstruction, bleeding.

Diverticulosis of the sigmoid colon is the most common variant of diverticular disease of the large intestine.

Why do diverticula appear?

Leaving aside congenital protrusions of the intestinal wall, let us dwell on the factors that contribute to the formation of acquired sigma diverticula:

• Anatomical features of the sigmoid colon:
  • The muscle layer is uneven. Circularly located fibers are developed throughout the large intestine, but the longitudinal layer completely covers only the appendix and rectum, while in the rest of the areas it is represented by three ribbons (tensions).
  • Vessels, penetrating through the muscle layer, create additional weak spots in the intestinal wall. Subsequently, diverticula may form there.
  • The sigmoid colon forms 2 loops, which creates conditions for slowing down the movement of the contents through it and contributes to an increase in pressure in its lumen.
  • The presence of gaustra (extensions), which also do not contribute to the acceleration of the evacuation of intestinal contents.
• Congenital developmental anomalies. Dolichosigma - lengthening of the sigmoid colon. Normally, its length is 24-46 cm. With an increase in its length, conditions are created for the retention of feces.
• The nature of nutrition. It is known that plant fiber contained in food stimulates peristalsis. A diet depleted of these components slows down the evacuation of intestinal contents.
• Age changes. As the body ages, muscle tone weakens, which impairs intestinal motility.

The etiology of diverticular disease is not fully known, but the leading role is given to the peculiarities of the diet. The lack of vegetable fiber in the diet, coupled with anatomical features, contributes to the accumulation of feces in the large intestine, mainly in its distal section. In order to "push through" the intestinal contents, the muscle layer hypertrophies, that is, thickens. However, this contributes to the formation of pronounced folds between the haustra, which only worsens the evacuation of feces and contributes to an increase in pressure in the intestinal lumen. As a result, conditions are created for the protrusion of the mucous membrane through the weak points of the muscle layer.

Clinical picture of uncomplicated diverticulosis

Diverticular disease often goes unnoticed by the patient and is diagnosed by chance or with the development of complications. However, in some patients, diverticula in the large intestine significantly affect the quality of life. Symptoms of diverticulosis include:

• Abdominal pain. Usually aggravated after eating due to motor stimulation. The passage of stool and flatus brings relief. With diverticulosis of the sigmoid colon, pain is localized in the lower abdomen on the left, can be given to the lower back, sacrum, and groin.
• Bloating.
• Change in the nature of the stool. Diverticular disease is characterized by chronic constipation, but it is possible to alternate with diarrhea.
• With sigma diverticulosis, tenesmus (painful urge to defecate), repeated emptying of the rectum are also noted. At the same time, however, the feeling of incomplete liberation of the intestine from feces remains.

According to the features of the clinic, diverticular disease is distinguished with a predominance of pain, flatulence, or constipation. This subdivision influences the choice of treatment tactics.

Symptoms of a Complicated Illness

Diverticulitis is inflammation of the wall of a diverticulum. The provoking factor is the violation of emptying and the delay in it of intestinal contents. This contributes to the traumatization of the mucous membrane, the introduction of infectious agents and the development of inflammation.

The main symptom of diverticulitis is pain. In contrast to the usual exacerbation of diverticular disease, palpation of the abdomen often causes muscle tension. The patient's body temperature also rises and inflammatory changes appear in the general blood test: acceleration of ESR, an increase in the number of leukocytes and the predominance of stab forms among them.

The transition of inflammation from the diverticulum to the surrounding tissues is called peridiverticulitis. Clinically, this complication differs little from that described above. However, it should be remembered: the spread of inflammation increases the likelihood of perforation.

Perforation - the formation of a defect in the wall of the diverticulum with the release of intestinal flora into the abdominal cavity. This complication has several outcomes: intestinal abscesses, fistulas, peritonitis.

An abscess is a localized area of ​​inflammation in the abdominal cavity. Clinically, it is manifested by intense abdominal pain. Localization of painful sensations depends on the location of the abscess. At the same time, signs of impaired intestinal motility are noted: flatulence, constipation. The patient's body temperature is elevated, the signs of inflammation described above are detected in the blood. The abdomen is tense in the area of ​​the abscess.

The opening of the abscess may result in the formation of a fistula or the development of peritonitis. However, an unopened abscess poses a serious danger, since it can compress the intestine and provoke the development of intestinal obstruction.

A fistula is a pathological fistula between the intestinal lumen and the cavity of an adjacent internal organ. Such a connection may occur between intestinal loops; intestines and bladder, uterus, vagina. In some cases, the fistula opens on the skin of the abdominal wall, connecting the intestine with the external environment.

The most common are the connections of the intestine affected by diverticula with the bladder in men and the vagina in women:

• An enterovesical fistula can be suspected by frequently recurrent urinary infections. The diagnosis is confirmed by an x-ray taken after the injection of contrast into the bladder or intestines. The x-ray will show the outflow of the drug outside the studied organ.
• Enterovaginal fistula causes severe vaginitis. The allocation of feces and gases through the vagina allows you to quickly establish the correct diagnosis. However, this does not always happen. If the formed fistula is narrow, the described symptoms may not occur. In this case, the woman will complain of purulent discharge, pain, burning and itching in the genital tract. Identification of the intestinal flora in the vaginal discharge will allow to suspect the cause of the disease. The diagnosis is confirmed by X-ray examination with contrast.

Peritonitis is characterized by a serious condition of the patient. The pain in the abdomen is diffuse in nature, the anterior abdominal wall is sharply tense. Severe fever and intoxication are noted. Peritonitis is an extremely dangerous complication that can lead to death.

Another life-threatening condition in diverticulosis is intestinal obstruction. Its reasons are as follows:

• Compression of the intestine by an abscess or inflammatory infiltrate resulting from diverticulitis or perforation.
• Adhesions in the abdominal cavity (the outcome of inflammation of the diverticula).
• Cicatricial changes in the intestinal wall, which have arisen as a result of frequent recurrences of diverticulitis, contribute to deformation and narrowing of its lumen.

Symptoms of this complication are delayed stool and gas, bloating, nausea and vomiting, and abdominal pain. The obstruction is often incomplete and can be resolved with conservative methods. However, if the intestinal lumen is completely closed, surgery may be required.

Bleeding in diverticulosis is rarely severe. A characteristic sign of this complication is the appearance of blood in the stool. At the same time, melena (black liquid stool) is not observed. When bleeding from the lower part of the large intestine - the sigmoid colon - unchanged blood is detected, sometimes in the form of clots, evenly mixed with feces. The patient may experience weakness and dizziness, a decrease in hemoglobin levels is observed in the general blood test.

Diagnostic methods

On x-ray, diverticula are seen as sac-like protrusions connected to the intestinal lumen. When performing a colonoscopy, it is possible to detect the mouths of diverticula opening into the intestinal lumen. Computed tomography allows you to see not only diverticula, but also inflammatory changes in the intestinal wall and surrounding tissues, abscesses, etc. (The arrow indicates the diverticulum of the sigmoid colon)

The clinic of diverticulosis is nonspecific. In addition, the symptoms of the disease are similar to those of other colon pathologies: Crohn's disease, colorectal cancer, irritable bowel syndrome. Therefore, to find out the true cause of the patient's suffering, they resort to instrumental diagnostic methods:

• Irrigography (irrigoscopy) - performing an x-ray after the introduction of contrast into the large intestine. Diverticula are visualized as saccular protrusions associated with the intestinal lumen. They are especially well seen with double contrasting, i.e., the introduction of not only a contrast agent into the intestine, but also air. It is possible to detect leakage of contrast into neighboring organs in the presence of fistulas or the abdominal cavity with perforation.
• Colonoscopy reveals the orifices of diverticula. However, this method is less accurate than barium enema and requires experience from the doctor performing the examination. The entrance holes of the diverticula are clearly visible at the stage of insertion of the device, when the intestinal loops are not yet straightened. There is swelling and redness of the mucous membrane around the mouths.
• ultrasound. This study allows you to detect diverticula, inflammatory thickening of the intestinal wall and adjacent structures. The method requires high professionalism from the diagnostician. The degree of flatulence has a significant effect on the accuracy of the result. A large amount of gas in the intestine makes it difficult to visualize the internal organs.
• Computed tomography (CT) with contrast is a highly informative method that allows you to judge the number, location, size of diverticula, the condition of the intestinal wall and its surrounding structures. During the study, you can see inflammation, abscesses, including intraparietal, narrowing of the intestinal lumen.
• Virtual colonoscopy is a non-invasive procedure for obtaining a 3D image of the large intestine based on CT data. It is a good alternative to conventional colonoscopy. Allows you to assess the condition of the intestinal walls and identify pathological formations in its lumen.

Attention! Irrigography and colonoscopy are not performed for diverticulitis, as they can provoke complications such as perforation or bleeding. In this case, CT becomes the method of choice, in the absence of the possibility of its implementation - ultrasound.

How to help the sick

Treatment is carried out by a general practitioner or gastroenterologist. In an uncomplicated asymptomatic course, medication is not required. The main attention is paid to the prevention of complications: the nature of nutrition and lifestyle (more details below). If diverticulosis has clinical manifestations, drug therapy is used.:

• In case of diverticular disease with a predominance of pain, antispasmodics (No-shpa, Duspatalin) are prescribed for 7-10 days; for the relief of inflammation - Salofalk course of 5-10 days; to stimulate motility and improve the evacuation of intestinal contents - Mucofalk, a preparation containing dietary fiber. Physiotherapy gives a good effect: electrophoresis with antispasmodics.
• In case of diverticular disease with a predominance of flatulence, Mucofalk, antispasmodics, Espumisan, the antibiotic Alfa Normix for 5-7 days are prescribed to prevent the reproduction of pathogenic flora and prevent diverticulitis. Particular attention is paid to the exclusion from the diet of products that enhance fermentation: cabbage, legumes, spinach, grapes, etc.
• In diverticular disease with a predominance of constipation, Mucofalk, laxatives (Duphalac) are prescribed; microclysters with chamomile infusion, oil solutions. The diet includes foods rich in plant fibers (see below for more on nutrition).

Acute diverticulitis without signs of inflammation of the peritoneum, i.e., not accompanied by a protective tension of the abdominal wall, can be treated on an outpatient basis. In other cases, the patient should be referred to a hospital.

In outpatient treatment, food intake is prohibited in the first 2-3 days. The patient can only drink water. Then the diet is gradually expanded. Preference is given to foods rich in fiber. To improve motor skills, Mucofalk is prescribed, to eliminate pain - antispasmodics and analgesics. To combat inflammation, Salofalk and broad-spectrum antibiotics in tablets are used: Alpha Normix (drug of choice), Metronidazole, Ciprofloxacin, Amoxiclav, Augmentin. The duration of the course of antibiotic therapy is 7-10 days.

During treatment in a hospital, a diet is also observed with the exclusion of solid food. In severe cases, the patient can be transferred to parenteral nutrition, i.e. intravenous administration of nutrient solutions. Expansion of the diet with the appointment of Mucofalk is possible only after the inflammation subsides, the body temperature and blood test parameters normalize. The following antibiotics are prescribed in the hospital: Alfa Normix, Gentamicin, Ceftazidime, Ciprofloxacin, Metronidazole. The preferred route of administration is by injection.

The lack of effect from conservative therapy is an indication for additional studies aimed at finding complications. A consultation with a surgeon is also required.

Treatment of abscesses usually begins with conservative methods. Diet and antibiotic therapy according to the same principles as in the treatment of diverticulitis are indicated for small intramural abscesses. Large abscesses can be emptied through a puncture of the anterior abdominal wall. Manipulation is performed under the control of ultrasound or CT. If the abscess cannot be drained by puncture, then surgery is necessary.

Depending on the general condition of the patient, as well as the severity and prevalence of inflammation in the abdominal cavity, the affected area of ​​the intestine is removed with the creation of a primary anastomosis or removal of the colostomy. In the first case, a message is formed between healthy intestinal loops. Such an operation is possible if conservative methods have significantly reduced the severity of inflammation. Otherwise, they resort to the second option: the creation of an artificial external fistula - a colostomy. After achieving remission, a reconstructive operation is performed: the hole on the abdominal wall is closed and an anastomosis is formed between the intestinal loops, thereby restoring the natural passage of intestinal contents.

Peritonitis excludes the possibility of creating a primary anastomosis. In this case, the part of the intestine affected by diverticula is removed, and a colostomy is placed on the anterior abdominal wall. The abdominal cavity is thoroughly washed. Drainage tubes are mandatory. This allows you to perform sanitation in the postoperative period, and also contributes to the removal of inflammatory exudate from the abdominal cavity.

Fistulas are treated only surgically. The volume of the operation is the removal of a section of the intestine with a diverticulum, the creation of an anastomosis and the closure of the fistula.

Bleeding in diverticulosis is rarely massive, so the treatment is carried out by conservative methods: the appointment of hemostatics, drugs that accelerate thrombus formation. All patients with this complication should undergo a colonoscopy.. In this case, not only the source is revealed, but also hemostasis is performed (bleeding stops). Massive bleeding requires an emergency operation with excision of the part of the intestine affected by diverticula.

With intestinal obstruction, surgical intervention is performed in case of complete narrowing of the intestinal lumen and the absence of the effect of conservative treatment.

Summing up, we note that the absolute indications for the operation are:

• Acute intestinal obstruction.
• Perforation of the diverticulum with the development of peritonitis.
• Abscesses of the abdominal cavity with the impossibility or inefficiency of their percutaneous drainage.
• Continued intestinal bleeding.
• Fistulas.

Relative indications for surgery:

• Frequent recurrences of diverticulitis: 2 exacerbations in the last year or 3 in the last 2 years in the absence of the effect of conservative treatment.
• Recurrent bleeding from a diverticulum.
• After relief of exacerbation in young patients (up to 40 years).

Attention! Therapy regimens are given for review, but are not a guide to action. Treatment can only be prescribed by a doctor.

Features of nutrition in diverticulosis of the large intestine

The main principle of the diet is the prevention of constipation. For this you need:

• Eat foods that stimulate peristalsis.
• Avoid foods that increase fermentation.
• Drink enough liquid (at least 1.5-2 liters).

It is recommended to eat bread with bran, whole grain cereals, some fruits and vegetables (pears, plums, carrots, beets, zucchini), dried fruits (prunes, dried apricots, raisins). Sweet confectionery, white bread, sauerkraut, legumes, grapes, various spices and spices, convenience foods and fast food should be excluded.

Approved Products

Whole grain cereals stimulate intestinal motility Dried fruits have a positive effect on peristalsis Fruits and vegetables are a valuable source of fiber

Physical activity should be treated with caution, as they can provoke an exacerbation of the disease and even contribute to the development of complications: rupture of the diverticulum, bleeding. However, we should not forget that hypodynamia is one of the factors that negatively affect intestinal motility. Therefore, it is impossible to completely abandon physical activity.

With diverticulosis, light physical activity is allowed: walking, swimming, gymnastics without exercises for the abdominal muscles. Outdoor games (for example, football), running, jumping, lifting weights are strictly contraindicated.

Attention! With an exacerbation of the disease, any physical activity is prohibited.

Treatment of diverticulosis with folk remedies

Bran is used to improve bowel function:

• The minimum daily dose is 1 tbsp. spoon, maximum - 30–40 g.
• Pour bran with kefir or liquid yogurt, leave for half an hour.
• Eat during the day. Can be mixed with other dishes (soups, cereals).

To combat flatulence, an infusion of carrot seeds is used:

• Steep one tablespoon of carrot seeds in a glass of hot water.
• Wait until infused, 15 hours.
• Drink in 3 doses.

Collection to reduce pain and inflammation:

• Mix pre-crushed dill seeds, rose hips, chamomile flowers, motherwort, nettle in equal proportions.
• Brew one tablespoon of the resulting mixture in a glass of hot water.
• Leave for 1.5-2 hours.
• Take half a glass 2 times a day for a month.

The use of alternative medicine methods is permissible only in the uncomplicated course of the disease and should be combined with the implementation of dietary and lifestyle recommendations. Treatment of exacerbation with folk remedies without taking the drugs prescribed by the doctor is dangerous and can result in the development of severe complications.

Prevention and prognosis

To prevent the occurrence of diverticula in the large intestine, it is necessary to eliminate provoking factors:

• The diet must contain foods rich in vegetable fibers.
• Sufficient fluid should be consumed. This improves peristalsis and reduces the chance of constipation.
• To live an active lifestyle.
• If you are concerned about chronic constipation, consult your doctor. This disorder contributes to the appearance of diverticula.

The prognosis for diverticular disease is often favorable. Severe complications occur only in 3-5% of patients. However, this does not mean that diverticulosis is not a health hazard. All patients, even those who are asymptomatic, should follow dietary and lifestyle recommendations. This reduces the likelihood of an adverse outcome of the disease.

Briefly about intestinal diverticulosis: symptoms, causes and treatments

Diverticulosis of the large intestine is a disease caused by a sedentary lifestyle and dietary habits that impair peristalsis. The delay in the evacuation of intestinal contents contributes to an increase in pressure in the intestinal lumen and the appearance of protrusions - diverticula.

These formations give the patient a lot of discomfort, can become inflamed, become a source of bleeding, etc. The basis for the treatment of pathology is recommendations on diet and physical activity, as well as conservative methods: taking laxatives, antispasmodics, physiotherapy, etc. Surgical intervention involves the removal of part intestines and is a traumatic and difficult procedure for the patient, and therefore is usually used only for urgent indications.

Treatment of diverticulosis is a laborious process that does not guarantee the absence of relapses in the future. For this reason, special attention is paid to preventive measures.

diverticulitis is an inflammatory bowel disease. Sac-like protrusions resembling hernias form in the intestinal wall. They are called diverticula. Sometimes the contents of the intestine get stuck in them, where bacteria multiply, causing inflammation of the diverticulum. This pathological process is called diverticulitis.

The disease is manifested by fever and pain in the lower abdomen, often on the left side. The person suffers either from constipation or from diarrhea. In 10% of cases, inflammation of the outgrowth of the intestine causes bleeding. Its manifestations are hard to miss: blood in the feces, spotting from the anus on linen and toilet paper.

Diverticulitis is 1.5 times more common in women than in men. Sometimes this disease is found in children, but people over 40 are especially susceptible to it. According to statistics, non-inflamed diverticula have 50% of people over 65 and 10% of forty-year-olds. But only in 10-20% of cases, inflammation begins in the diverticulum, and symptoms of the disease appear.

Over the past 100 years, the number of patients with diverticulitis has increased 5 times. Doctors explain this by changing the diet. We began to consume more meat and flour products, fewer vegetables and fruits. But it is plant foods that contain fiber, which facilitates the work of the intestines and significantly reduces the risk of diverticula formation.
Everyone knows that Europeans and Americans prefer easily digestible food and meat dishes, while Asians traditionally eat healthier food. Therefore, the number of patients with diverticulitis among Asians does not exceed 0.2%.

Diverticulitis is a reason to urgently consult a doctor, because its complications are very dangerous. If the inflamed outgrowth bursts and its contents enter the abdominal cavity, then peritonitis may begin - inflammation of the abdominal organs, which is life-threatening. Sometimes fistulas form at the site of the diverticulum, through which the contents of the intestine enter the stomach, bladder, or vagina. Adhesions that occur after inflammation cause intestinal obstruction. And the most unpleasant: if the body is exposed to carcinogenic factors, then the diverticulum can degenerate into a cancerous tumor.

But doctors are in a hurry to reassure: diverticulitis is well treated with antibiotics. If you notice a problem in this delicate area, then discard unnecessary modesty. Dozens of people come to the doctor every day with the same complaints. Don't start the disease. The sooner you start treatment, the faster and easier you will regain your health.

Anatomy and Physiology of a Diverticulum

A diverticulum is a hernia-like outgrowth, the walls of the intestine look like a pocket. Its size is from 5 millimeters to 10 or more centimeters. The diverticulum has a narrow neck, 2–4 mm long, and an enlarged cavity that can be about the size of an apple. The diverticulum may be single or there may be several. Then they talk about multiple diverticula.

Diverticula are a very common problem. In old age, more than 50% of people have such intestinal outgrowths. This phenomenon is called diverticulosis or diverticular disease. But most people are unaware of this feature of their intestines until the diverticula become inflamed. When feces get stuck in the pocket, the wall of the diverticulum becomes thin and weak, inflammation and bleeding begin. This inflammatory process is called diverticulitis. So, do not confuse two diagnoses: "diverticulosis" - there is an outgrowth-diverticulum, but it is not inflamed, but "diverticulitis" – outgrowth inflammation.
What are diverticula?

It is customary to separate congenital and acquired diverticula.

Congenital (true) diverticula is a developmental anomaly. An outgrowth appears in a person during fetal development. In this case, protrusion of all layers of the intestine occurs.

Acquired (false) diverticula appear with age. They usually form where blood vessels enter the intestinal wall. In these places, the intestine is thinner. In this case, only the mucous and submucosal layers of the intestine protrude. The outer shell of connective tissue remains unchanged.

Where can diverticula be found? Most often, diverticula form in the large intestine. 70-85% in the sigmoid colon and the left half of the colon. For this reason, the most common diverticulitis of the sigmoid colon .

In the small intestine, these formations appear much less frequently. There are also diverticula of the esophagus, stomach, bladder, urinary tract and bile ducts.
How are diverticula formed?

congenital diverticula- the result of a developmental disorder in the embryo.

Acquired diverticula in the large intestine are associated with a violation of its work. Let's consider this mechanism in more detail.

The large intestine is made up of many chambers, each of which contracts in turn. At the same time, pressure increases in it and the digested food is pushed towards the anus. After cleaning the chamber from the contents, the pressure in it is normalized. This work is called intestinal peristalsis.

But if the mass is too dense or several chambers are reduced at the same time, then a congestion is obtained and pressure increases significantly in this area. It can reach 90 mm Hg. The contents of the intestine strongly presses on its wall. The first lesions appear where the vessels penetrate the walls of the intestine or where there is a disintegration of the muscle layer. First, recesses are formed. They gradually increase in size and turn into diverticula.

If the diverticula can be freely cleared of the contents, then there are no problems. But if the pressure is high, and the feces are dense, then they fall into the pocket and stretch it. As a result, it is poorly cleaned. The mucous membrane is covered with erosions and ulcers, inflammation begins.

Causes of diverticulitis

As you already know, many people have diverticula, but only 10-20% of them develop diverticulitis. Now we're trying to figure it out what causes inflammation .

1. Fiber-poor foods that cause constipation. If you consume less than 30 g of fiber (dietary fiber), then you are at risk. Note that most of our compatriots receive only half the norm. In this case, the movement of food through the gastrointestinal tract slows down. The contents of the intestines become drier and harder and get stuck in the chambers of the colon - constipation develops. The intestine strongly compresses the stool, and the pressure rises strongly. This leads to blockage and inflammation of the diverticula.
2. Inflammatory processes in the large intestine. The cause of diverticulitis can be: ulcerative, spastic or ischemic colitis, infectious enterocolitis, intestinal infections. These diseases cause inflammation of the intestinal mucosa. If in the intestinal lumen it is possible to quickly cope with the bacteria that caused the disease, then in the diverticula they continue to multiply. A weakened local immunity and a violation of the microflora in the intestine contribute to the development of diverticulitis.
3. Age. With age, the tone of all muscles decreases, intestinal motility is disturbed, and constipation occurs. The intestinal mucosa becomes thinner, and the immune system is weaker. In older people, diverticula are more likely to form, they are less cleared and therefore more likely to become inflamed.
4. hereditary predisposition. By inheritance from parents, the structural features of the intestine and the weakness of its connective tissue are transmitted. In this case, the child is born with diverticula or they appear at an early age and are often numerous. With dysbacteriosis or a decrease in immunity, after intestinal infections, diverticula become inflamed.
5. Infection with worms. Helminths living in the intestine damage the mucosa, disrupt the microflora and reduce its protection against bacteria. In such conditions, pathogenic bacteria multiply rapidly, which like to settle on the erosion-covered surface of the diverticulum.

Symptoms of diverticulitis

The disease does not have characteristic signs, according to which the doctor could unambiguously say: “This is your diverticulitis!”. The disease is often mistaken for an attack of appendicitis, gynecological diseases, or renal colic. But still, there is a set of symptoms of diverticulitis that you need to know in order to seek help in time.

1. Abdominal pain diverticulitis has several characteristic features:
   • Pain occurs in the lower abdomen;
   • In most cases, it hurts on the left side. Here are the descending and sigmoid colons, which are most often affected;
   • The pain is felt at one point and does not go away for several days. If the pain is caused by spasm or swelling, then it is felt intermittently. Inflammation of the diverticulum causes monotonous pain that does not go away.
   • The pain intensifies during physical activity, coughing, laughing. In this case, the abdominal muscles tense up, the pressure in the abdominal cavity increases and the surrounding organs put pressure on the inflamed area of ​​the intestine;
   • When you press on the inflamed area of ​​​​the intestine, the pain intensifies. And the abdominal muscles on the affected side reflexively tighten to protect the vulnerable spot.
   • There is no relief after going to the toilet. After all, by freeing the intestines from gases and processed food, you have not eliminated the cause of the pain. On the contrary, during emptying, you tightened your stomach, which caused new discomfort.
2. Chair disorder. Manifested by alternating constipation and diarrhea. Stool retention is due to the fact that a spasm occurs in the affected area, and the intestinal lumen narrows sharply. When the intestines relax, diarrhea occurs. This is because water is usually absorbed in the large intestine. With diverticulitis, this function is impaired and the feces become more liquid than usual. In addition, the irritated and inflamed intestines are intensively cleared of the contents.
3. Blood in stool. Inflammation in the diverticulum is accompanied by the appearance of bleeding erosions and ulcers in its cavity. In this case, the bleeding will be insignificant. They are observed only in 5%-10% of patients with diverculitis. Traces of blood can be seen after going to the toilet or when straining. But there are cases when the inflamed diverticulum bursts and its contents break through into the intestinal lumen. Then bleeding is preceded by acute short-term pain. Traces of blood are abundant, they can be seen on the linen.
4. Temperature rise. Inflammation in the intestines is accompanied by the release of special substances into the blood - pyrogens. They get to the thermoregulatory center in the brain, and it raises the body temperature. Fever leads to the activation of the body's defenses to fight inflammation.
5. Nausea, vomiting, loss of appetite, lethargy- these are signs of intoxication, poisoning of the body with substances that are formed during inflammation.

Remember, prolonged abdominal pain accompanied by fever is a serious reason to visit a doctor. Do not postpone the visit to the clinic in order to prevent the development of complications. At the initial stage, diverticulitis is quickly and effectively treated with antibiotics.

Diagnosis of diverticulitis

Which doctor should I contact in case of bowel problems?

For bowel problems, see a gastroenterologist. This specialist deals with the treatment of all digestive organs. He will prescribe the necessary examinations for you. After the results of the tests become known, he can send you to narrower specialists. If the diverticulum is located in the rectum, then you need to contact a proctologist. If the symptoms are pronounced and you have been diagnosed with acute diverticulitis, then you need to consult a surgeon. He will determine if surgery is needed.
Your doctor may refer you to a urologist or gynecologist to rule out pathologies of the genital and urinary organs.

At the doctor's (surgeon's) appointment

The main task of the doctor is to correctly diagnose, because many diseases cause abdominal pain and fever. You can help your doctor by answering his questions as accurately as possible and by describing your feelings clearly.

Colonoscopy

Colonoscopy is the examination of the inside of the large intestine using an endoscope. This device is a narrow, flexible tube that is inserted into the anus. A camera is attached to its end, which transmits the image to the monitor screen. With the help of this equipment, the endoscopist can detect the slightest changes in the intestinal mucosa and take material for a biopsy.

Indications for a colonoscopy

• suspected diverculitis, tumor, ulcer;
• unexplained causes of intestinal bleeding;
• intestinal obstruction;
• persistent constipation;
• inflammation of the colon.

With the help of colonoscopy, various symptoms of diverticulitis are detected: deformed orifices of diverticula with an area of ​​inflamed mucosa around them. The surface of the intestine around the holes is reddened, dilated vessels are visible. Colonoscopy allows you to determine which part of the intestine is bleeding, and determine the intensity of bleeding.

X-ray contrast examination of the intestine

Irrigoscopy or radiopaque examination of the intestine- a procedure that allows you to see the outline of the large intestine on an x-ray. It is carried out in special diagnostic rooms.

Under normal conditions, the contours of the internal organs are not visible on the x-ray. To obtain an image of the intestine, a solution of a contrast agent, barium sulfate, is injected into it. This is usually done with an enema, but in some cases the solution is given to drink. As your bowel fills up, you will have several standing and lying down shots taken.

Indications for irrigoscopy

• bloody discharge from the anus;
• pain in the intestines;
• purulent or mucous discharge from the intestine;
• it is impossible to perform a colonoscopy or it gave questionable results.

An x-ray examination of the intestine can reveal a variety of symptoms of diverticulitis. Diverticula in the form of rounded formations on the intestinal wall measuring 0.5-5 cm in diameter. These are single or multiple protrusions that go beyond its contour. Inflamed diverticula have jagged, jagged edges.

When a diverticulum ruptures, a fistula may form. In this case, the x-ray will show a cord through which the contrast agent is poured from the intestine to another organ. The inflammatory process can cause the appearance of adhesions from the connective tissue, which cause a sharp narrowing of the intestine, visible in the picture.

abdominal ultrasound

Ultrasound examination of the abdominal organs is the safest and most painless. Ultrasound waves pass into the body and are reflected from the organs. Dense "dry" fabrics reflect them well. And those areas that are saturated with liquid absorb ultrasound. After analyzing the reflected ultrasound waves, the device creates an image of the internal organs on the monitor screen.

Indications for the use of ultrasound

• abdominal pain;
• suspicion of a tumor or inflammation of surrounding organs;
• seals found during inspection.

With intestinal diverticulitis, ultrasound shows a thickening of the intestinal walls. A diverticulum filled with feces is seen as a sac-like protrusion of the wall, in which there is a solid inclusion. The inflammatory process leads to the fact that a small amount of fluid accumulates in the abdominal cavity, which is noticeable on ultrasound.

Despite all the advantages, some experts consider ultrasound to be an insufficiently reliable method. Ultrasound waves reveal only well-filled diverticula.

Laparoscopy

Laparoscopy is a method for diagnosing and treating diverculitis. During the procedure, the surgeon makes 3 holes about 1 cm long in the abdominal wall. Through them, a miniature camera is inserted into the abdominal cavity, which allows you to view the outer surface of the intestine. Thanks to a 40-fold magnification, this diagnostic method is very accurate and helps to notice the slightest changes. If necessary, the doctor can immediately remove the diverticulum. The procedure is performed under general anesthesia

Indications for laparoscopy

• suspected ectopic pregnancy in women;
• suspected bowel tumor;
• pain arising for unknown reasons;
• suspicion of acute intestinal obstruction;
• suspicion of bleeding into the abdominal cavity caused by rupture of the diverticulum.

During the study, the doctor discovers a rounded bag-like outgrowth on the outer wall of the intestine. The diverticulum is dense, dilated blood vessels are clearly visible on its surface.

Treatment of diverticulitis

Treatment of diverticulitis can be carried out at home or in a hospital in the proctology department. The choice depends on the patient's condition and the risk of complications.

Indications for hospitalization for diverticulitis:

• exacerbation of chronic diverticulitis;
• severe pain;
• signs of irritation of the peritoneum (when probing, the pain intensifies at the moment when the doctor quickly takes his hand after pressing);
• high temperature 38-40°C;
• increased number of leukocytes 15x10 9 /l;
• inability to take food through the mouth;
• age over 85 years or severe comorbidities.

Treatment in the hospital will last 10-12 days. After discharge, you will have to continue to drink drugs for 2-3 weeks.

Medical treatment of diverticulitis

Drug group	The mechanism of the treated action	Representatives	How is it prescribed
Broad spectrum antibiotics	Antibiotics disrupt the processes of protein formation in bacteria, prevent them from multiplying and destroy their shell. After the death of bacteria, the inflammation in the diverticulum disappears, and its cavity is cleared of pus and feces.	Cefoxitin	Administer intravenously at 2 g every 6 hours.
		Timentin (protected penicillin)	Administer intravenously at 3.1 g every 6 hours. With moderate inflammation (temperature below 38 ° C, no signs of peritoneal irritation), the same antibiotic is prescribed in tablets of 875 mg every 12 hours. After 7-10 days of treatment, the drug is changed to Imipenem, Metronidazole or another antibiotic that can affect the intestinal microflora.
Antimicrobial and anti-inflammatory funds	It is a derivative of salicylic acid. Destroys bacteria, relieves inflammation of the intestinal wall. Helps to avoid recurrence of the disease.	Mesalazine (Salofalk)	2 times a day, 400 mg for 8 weeks. In people prone to the recurrence of diverticulitis, for the prevention of relapse, they are prescribed 7 days a month for a year.
Desensitizing antihistamines	The drugs make cell receptors less sensitive to histamine. Thanks to this, it is possible to reduce the swelling of the intestinal wall.	Suprastin,	1 tablet 2-3 times a day with meals.
		Tavegil	1 tablet 2-3 times a day before meals with plenty of liquid.
Laxative medicines	Increase the volume of intestinal contents. The masses become more loose and moist and move through the intestines more easily. When taking "soft" laxatives, the pressure in the intestinal lumen does not increase. It is possible to reduce the load on the inflamed area.	Syrup Normaze	The first 2-3 days take 15-45 ml per day, the maintenance dose is 10-30 ml per day. The remedy is taken in the morning in one dose.
		Plantain seed peel (Mukofalk)	Assign 1 sachet 2-6 times a day. Dissolve the powder in a glass of cold water and drink immediately. Then drink another glass of liquid.
Antispasmodics	Relax the smooth muscles of the intestine, relieve intestinal spasms, relieve pain.	Meteospasmil	Take 1 capsule 3-4 times a day before meals. The components included in its composition relieve spasm, and relieves excess gas formation.
		No-shpa	Adults take 40-80 mg 3 times a day, regardless of food intake.

When treating diverticulitis, doctors try to avoid strong laxatives and enemas. These drugs increase the pressure in the intestines and can cause the diverticulum to rupture.

One of the most important steps in the treatment of diverticulitis is diet. In some cases, the first 2-3 days will have to completely refuse food. It will be replaced by a solution of glucose and electrolytes.

From the diet it is necessary to exclude foods that cause bloating: legumes, grapes, whole milk. You will also have to give up those foods that cause constipation: rice, blueberries, pomegranates, white bread. Vegetables and fruits that contain very coarse dietary fiber are not recommended: radish, turnip, radish, persimmon, pineapple.

The menu includes dishes and nutritional supplements that contain fiber: muesli, cereal, wholemeal bread, flaxseed, psyllium seeds, seaweed, peaches, pears, avocados, berries. Be sure to drink more than 2 liters of water. Tea and coffee are not included.

After recovery, you will have to visit a doctor once a year and undergo an examination in order to prevent the recurrence of the disease.

Surgical treatment of diverculitis

Surgery for diverticulitis necessary if complications of the disease pose a threat to life. There are 2 types of operations:

1. Planned operation carried out 3 months after successful medical treatment of diverticulitis. Its goal is to prevent re-inflammation.
2. emergency operation carried out if there is severe bleeding or the risk of rupture of the diverticulum. Emergency surgery is done immediately after diagnosis, as delay can be life-threatening.

Indications for surgical treatment of diverticulitis:

• suppuration of the diverticulum;
• bleeding that cannot be stopped with medication;
• peritonitis with rupture of the diverticulum into the abdominal cavity;
• the risk of degeneration of the diverticulum into a malignant tumor;
• fistula formation;
• intestinal obstruction;
• the presence of infiltrate in the diverticulum;
• frequent exacerbations of diverticulosis.

There are practically no contraindications for emergency surgery. But a planned operation can be postponed for several weeks or canceled in some cases.

Contraindications for elective surgery:

• old age;
• severe diseases of the heart, lungs, liver and kidneys;
• chronic diseases in the acute stage;
• acute infectious and inflammatory diseases.

Preparing for the operation carried out very carefully. The better the body is prepared, the less likely it is to develop dangerous complications.

Before the operation to remove the diverticulum, it is necessary to undergo an examination. It includes the following steps:

1. General and biochemical analysis of blood.
2. blood clotting test,
3. Determination of the blood group.
4. Determination of glucose and hemoglobin levels in the blood.
5. Coprogram (general study of feces);
6. Analysis of feces for occult blood;
7. Examination by a gynecologist, in women of childbearing age - a pregnancy test;
8. X-ray of the chest;
9. Ultrasound of the abdominal organs;
10. X-ray examination of the colon with a barium enema;
11. Colonoscopy. If there is a danger of diverticulum rupture, then they prefer an expensive, but safer method - computed tomography.

During preparation for the operation, all identified foci of inflammation are treated. Otherwise, bacteria with blood can enter the intestines and cause suppuration of the internal and external seams. Also during this period, it is necessary to normalize blood pressure and heart function. For this, antihypertensive drugs and beta-blockers are prescribed.

Diet before surgery. Nutrition at the preparatory stage should be rich in vitamins A, B, C, K, P and iron. During this period, you should consume them 2 times more than normal.

The menu is selected so as to avoid constipation and strengthen the body. It is based on eggs, fish, cottage cheese, lactic acid products, vegetables and fruits.

In overweight people, it is desirable to eliminate this problem. The fact is that subcutaneous fatty tissue heals worse than other tissues. To reduce weight, it is advised to give up fatty, fried and smoked foods, pastries and confectionery.

The last week before the operation, you will have to refrain from plant foods that contain coarse fiber and cause the formation of gases: whole milk, nuts, legumes, corn, cabbage.

If there are no contraindications, a laxative is prescribed on the day before the operation to cleanse the intestines. 100 ml of Dufalac are dissolved in 3 liters of water. Half a serving is drunk in the morning and the other half in the evening. Immediately before anesthesia, the intestines are cleansed with an enema.

Rehabilitation after surgery

The most important role in rehabilitation after surgery is played by proper nutrition. Perhaps the first 2 days they will not be allowed to eat, so that the seam on the intestine heals. In the future, for 3 weeks, you must adhere to a sparing diet, consisting of three stages.

The first 3-4 days you need to eat 8 times a day, but the amount of food should not exceed 200-300 g per serving. Food should be liquid or jelly-like: tea, compote, jelly, jelly. The temperature of the dishes is 35-40 degrees.
The next 3-4 days take food 6 times a day. At one time, you can eat up to 400 g of food. All of it should be in liquid or mashed form. Weak broths, pureed cereals on water with the addition of milk and butter, steamed meat and fish soufflés are allowed. The temperature of the food should also be around 40°C.

The third stage lasts about 2 weeks. Fractional meals 5 times a day are necessary. Food also pureed or semi-liquid, warm, steamed, boiled or baked without a crust. The range of dishes can be gradually expanded. Semi-liquid pureed cereals and soups, steamed scrambled eggs, baked apples, boiled meat and fish are allowed.

It is very important that after the operation the stool is soft and daily. This can be achieved with the help of a diet and mild herbal laxatives: decoctions of rhubarb root, buckthorn bark. The daily rate of fluid during the rehabilitation period is 2.5-3 liters.

In some cases, during the operation, the intestine is brought out through an opening in the abdominal wall - a colostomy is formed. At first, this creates psychological difficulties for a person. It is important to understand that this feature will not interfere with your family life and work. You will have to wear a special elastic belt with a pouch, but it will not be visible under your clothes. In addition, with a properly selected diet, the intestines are emptied once a day and the rest of the time, feces are not excreted from the colostomy.

Treatment of diverticulitis with folk remedies

Infusion of fume medicinal. Take 2 tablespoons of dried medicinal fumes. Pour into a thermos, pour 500 ml of boiling water and leave to infuse overnight. Drink 100 ml before meals 3 times a day.

The medicinal fume has a carminative effect, improves intestinal motility, strengthens its muscular layer, relieves spasms and pain, heals ulcers and erosions on the mucous membrane of the digestive organs. Due to these properties, the infusion helps to relieve inflammation of the diverticula.

Oatmeal jelly. To prepare jelly, pour 2.5 liters of boiled water, cooled to a temperature of 40 degrees, 500 g of oatmeal and 150 ml of kefir into a three-liter jar. Cover with cheesecloth and leave in a warm place for two days. When the mixture bubbles and starts to separate, strain it through a colander. Drain the liquid into a clean jar and leave for a day.

The next day you will see that 2 layers have formed in the jar. Carefully drain the liquid, and a thicker sediment is the basis of oatmeal jelly. Pour 10 tablespoons of this gruel with 2 cups of cold water and cook until thickened. It is necessary to eat jelly in the morning with black bread made from wholemeal flour. For taste, you can add salt or honey and a teaspoon of vegetable oil.

Oatmeal jelly with diverticulitis helps to normalize stools, eliminate constipation and bloating, increases intestinal tone, helps to quickly cleanse diverticula and normalize intestinal flora.

Folk remedies have proven themselves as a prevention of inflammation of diverticula and as an addition to drug treatment. But don't try to get rid of acute diverticulitis accompanied by high fever and severe pain. In this case, you need the qualified help of a specialist.

Prevention of diverculitis

What do we have to do?

Do sport. Moderate physical activity helps to improve blood circulation in the intestines, normalize its tone and avoid constipation. Due to this, the muscle layer is strengthened, and diverticula are not formed. If they nevertheless appeared, then active movements lead to the fact that the diverticula are well cleared. Fecal masses do not stagnate in them, and inflammation does not occur. For the prevention of diverticulitis are best suited: jogging for 40 minutes a day, walking for 1 hour a day, Pilates and yoga classes 2 times a week.

Consume 25-30 grams of fiber daily. Fiber normalizes bowel function, accelerates the movement of its contents, helps reduce pressure in the intestinal lumen, relieves constipation. In addition, insoluble dietary fiber is necessary for the development of beneficial bacteria - our microflora. Fiber is found in fruit peels, asparagus, spinach, squash, carrots, broccoli, bran, whole grains, seeds, and nuts.

Use the "rule of three". Eat 3 fruits daily, 3 servings of 100g vegetables, 3 slices of whole grain bread, and 300g of oatmeal or brown rice cereal. With such a diet, you will receive a norm of fiber.

Drink at least 2 liters of water per day. Water is essential for normal bowel function. Otherwise, its contents become too dense. The intestines cannot move it from chamber to chamber, and constipation occurs. In addition, if you are taking dietary fiber supplements, you need to drink half a liter more. Otherwise, fiber will thicken the contents of the intestine, absorbing water from it, and cause constipation.

Seek medical attention promptly. Do not disregard poisoning, enterocolitis and other intestinal inflammations. These diseases thin the intestinal wall. Its mucous membrane atrophies, erosions appear. Thus, favorable conditions are created for the formation of diverticula. Timely prescribed treatment helps to avoid these unpleasant consequences.

Maintain immunity. It is important to have strong general and local immunity. The body's defenses are strengthened if you eat well, lead an active lifestyle and harden. You can strengthen local intestinal immunity by regularly consuming fermented milk products and vitamin supplements. In this case, even if a diverticulum is formed, inflammation will not occur in it.

Eat vegetable oils. 3 times a week in the morning before breakfast, eat a tablespoon of olive or linseed oil. This remedy will relieve you of constipation and help cure intestinal inflammation at an early stage.

What should be avoided?

Avoid injury to the colon. Intestinal injuries can occur as a result of improperly performed medical procedures, non-traditional sex, hydrocolonotherapy, which is carried out for weight loss and body cleansing. During such manipulations, the mucous and submucosal layers of the intestine are injured, and conditions are created for the formation of a diverticulum.

Avoid constipation. Age-related changes, malnutrition and a sedentary lifestyle lead to constipation. In this case, the pressure in the intestinal lumen sharply increases, local immunity decreases and the balance of microflora is disturbed.

Fight inflammation and dysbacteriosis. Intestinal diseases reduce its protective properties and smooth muscle tone. Diverticula become inflamed most often after illness.

No one is immune from disease. But if you are attentive to your health and take care of it, you can easily cope with any ailments.