Diverticulosis is a condition in which diverticula (small, bulging pouches) protrude inward anywhere along the digestive tract.  Although diverticula can occur in the esophagus, stomach and small intestine, they are most common in the large intestine.  It is thought that diverticula form as a result of spasms of the muscles in the intestinal wall.  Spasms cause the lining of the intestines to bulge through the weakest area of the muscle, much as a weak, bulging spot might develop in a defective tire or basketball.  Diverticulitis is a condition that occurs when these diverticula become inflamed or infected.

Diverticulosis affects half of the U.S. population over the age of 60 and becomes common in adults over 40.  It is thought that diverticula may be caused by lack of fiber in the diet as their occurrence is very rare in developing countries where grains, fruits and vegetables are the main foods consumed.  The theory is that adding bulk to the stool gives the muscles a mass to work against, decreasing the likelihood of spasm in the same way that well-toned skeletal muscles are less likely to cramp than those that are not exercised regularly.

Symptoms

• Pain that’s often sudden, severe and located in the lower left side of the abdomen
• Less commonly, abdominal pain that may be mild at first and become worse over several days, possibly fluctuating in intensity
• Change in bowel habits
• Abdominal tenderness
• Fever
• Nausea and vomiting
• Constipation
• Diarrhea
• Bloating
• Bleeding from your rectum (less common)

Self Help

Conventional medical treatment for diverticulosis is to consume more fiber and to take psyllium supplements.  Serious complications can accompany diverticulitis in patients who develop lower abdominal pain with spasm or fever and should consult a physician in these cases.

Current Western Treatments

Routine cases are treated with bed rest, a liquid diet and and antibiotics.  The symptoms of colon cancer and appendicitis are similar to those of diverticulosis or diverticulitis, and anyone with acute abdominal pain should seek out a physician for a definitive diagnosis.  A case of diverticulitis that requires the help of a physician will usually be treated with bed rest, a liquid diet for several days, and antibiotics.  If the patient is experiencing intense pain, the doctor may prescribe an over-the-counter pain reliever such as acetaminophen.  If the pain is severe, a more potent pain reliever may be used, but as these sometimes cause constipation, they may aggravate the problem.  Hospitalization maybe required if the patient is at risk of bowel obstruction or peritonitis.

If an abscess is developed, it must be drained.  This can be done with a needle through the skin that is guided by an ultrasound or CT.  A catheter will then be used to drain the abscess.  A bowel resection maybe required after this procedure.

A doctor may recommend surgery in the case of an abscess, fistula, or reoccurring diverticulitis in order to remove the diseased part of the colon.  Two surgeries are possible.

• Primary Bowel Resection - This procedure involves removing the diseased part of the colon and reconnecting the healthy sections.  This will allow for normal bowel movements in the future.  The procedure can be done traditionally (open surgery), or laparoscopically.  In open surgery, one long incision is made in the abdomen while laparoscopic surgery requires three or four small incisions.
• Bowel Resection with Colostomy – This procedure maybe required if there is not enough healthy tissue to reconnect the colon with the rectum.  With a colostomy, a surgeon makes an opening in the abdominal wall (called a stoma) through which waste will pass into a bag.  After months of healing, it maybe possible for an additional operation to then reconnect the colon and rectum.

A Case Study in TCM Treatment

A 60-year-old woman had abdominal cramping and constipation due to diverticulitis.  Traditional Chinese diagnosis found her pulse to be thin, wiry, and tongue pale with a red border, suggesting heat in the liver.  She also said she felt hot in the afternoon although the weather was usually cold.  She was prescribed a mixture of herbs that included isatis extract leaf and root, codonopsis root, oyster shell, bupleurum root, Black Walnut hulls, terminalia fruit, ginger rhizome, and mume fruit among others.  She was also advised to have three cups of chamomile tea per day.  After two weeks, the patient noticed less abdominal pain.  Since the hot signs had also abated, her herbal prescriptions were reduced but continued for several months.  As the weather began changing and she showed signs of developing a cold condition, she added White Atractylodes rhizome, poria sclerotium, Baked Licorice root and citrus peel.  The patient was very satisfied with her herbal therapy as her abdominal pain has been alleviated and her bowel movements have become more normal.