Published: February 11, 2008 10:40 pm         

Eat fiber to avoid diverticulosis

You probably wouldn’t trade places with someone living in a developing country. Your doctor might tell you, however, that you’d probably be healthier if you were eating a third-world diet.

Diverticulosis is a condition in which small pouches develop in the colon, bulging outward as the contents inside press against weakened spots in the bowel wall. About 10 percent of American adults develop diverticular pouches by the age of 40; by age 60, more than half are believed to be affected.

While these pouches may not cause any dramatic symptoms right away, waste matter can become trapped in them, making them vulnerable to becoming infected and causing a fairly serious condition known as diverticulitis.

Diverticulitis may lead to bleeding, tears or blockages in the bowels. About 15 to 25 percent of persons with diverticulitis eventually develop complications serious enough to require surgery. And among patients with serious complications such as pelvic abscesses or peritonitis, one study found a mortality rate of 7.7 percent.

Probably because of diet, diverticular disease is a phenomenon peculiar to developed countries. A similar prevalence to that of the United States can be found in England, Western Europe and Australia. In third-world countries of Asia and Africa, on the other hand, the disease is rare, with a prevalence of only .2 percent.

In the United States, the disease was first diagnosed in the early 1900s, at a time when new milling technology allowed a reduction of the fiber content of grains and the introduction of refined food products.

Diverticular pouches can develop anywhere in the gastrointestinal tract but they are most common in the large intestine. The most likely explanation is that weak spots in the bowel wall give way due to increased pressure — usually because of hard stools and constipation. Smoking and regular intake of NSAIDs (nonsteroidal anti-inflammatory drugs) are other risk factors.

A high-fiber diet keeps stools soft and moving rapidly through the bowels. Drinking plenty of fluids and exercising also helps.

The recommended goal to prevent or treat diverticulosis, however, is 25 to 30 grams of fiber a day, and that’s not easy with the typical American diet. A medium apple has 3.3 grams; a cup of cooked oatmeal, 4 grams; a slice of whole wheat bread, 1.95 grams. Most Americans would feel virtuous eating that much fiber, even though it’s less than a third of what they really need.

With aging, intestinal walls may become weaker, but diverticulosis can occur at any age. Early signs may include cramps, bloating and constipation. But the pouches themselves generally are no problem except as a possible source of infection.

The first sign of diverticulitis may be rectal bleeding — which can also be a symptom of hemorrhoids or colon cancer. The bleeding may come from rupture of a blood vessel in the diverticular pouch and, even if it seems rather severe, may stop by itself. But any bleeding is reason to see a doctor and persistent bleeding could be a medical emergency.

Other symptoms of diverticulitis, such as pain, tenderness or cramping, vary according to where they occur in the colon and are easy to mistake for other medical problems, such as appendicitis, peptic ulcer, pelvic inflammatory disease or inflammatory bowel syndrome. To make a diagnosis, a doctor usually relies on a blood test and imaging scans as well as a history.

A simple infection may clear up with oral antibiotics. Other treatment includes: bowel rest, at first, followed by a high fiber diet, sometimes combined with a fiber product such as Citrucel or Metamucil.

If infection is neglected too long or becomes severe, an abscess may form with pus, swelling and destruction of tissue. When small holes develop in the bowel wall, pus can leak into the abdominal cavity. At times, it’s necessary for a doctor to drain an abscess with a needle inserted through skin or through surgery.

If an infected or inflamed pouch ruptures, intestinal waste is released into the abdominal cavity, leading to peritonitis — a life-threatening emergency. About one of five patients with diverticulitis requires surgery — either on an emergency basis or to treat recurrent attacks.

Although diet is believed to be the primary cause, heredity may also be involved. When a person younger than 40 gets diverticulitis, the disease usually is more severe. Sometimes with aggressive treatment of infection surgery can be avoided. Patients should have regular colonoscopies to screen for cancer and other possible bowel problems. It is also advised to “eat like you’re living in a third world country” — fewer steaks and hamburgers and plenty of fruits, vegetables, beans and whole grains.





Rupp is information and assistance case manager with the Northern Oklahoma Development Authority Area Agency on Aging.