Many people who experience diverticulosis fear the worst. However if ignored should fear the worst.
This is indeed a wonderful world we live in and those of us who are privileged to live at the present time can gain much comfort from the fact that the profession of medicine, with the aid of science, has been able to conquer many of the dreaded diseases of yesteryear. Smallpox, typhoid, diphtheria, and a host of other terrible threats to life, are no longer problems throughout the civilized world. These and many others have definitely been conquered!
Strangely enough, however, new diseases such as diverticulosis seem to appear almost as quickly as the old ones are mastered.
You will note I have said that they seem to appear. The fact of the matter is, of course, that many of the so-called newly found diseases have simply escaped detection heretofore. With better means of observation and diagnosis the unfamiliar features of certain conditions such as diverticulosis have now come to light. What was once considered a rare disease is now known to have been a rarely recognized disease.
Somewhere around the time of World War I, the study of the human body by means of the x-ray achieved widespread acceptance by the medical profession. Development of radiography led to the discovery of many curious, hitherto unsuspected defects of the inner man.
Prominent among these new discoveries was a condition which has come to be known as diverticulosis. Ever see the soft inner tube of a tire? In general, it looks like the colon, although of course, it is of much larger diameter. In looking over one of these inner tubes, you may have seen a place in it that had developed, through weakness, a little pouch. The weakness was not sufficient to permit a blowout, but it did produce a little sac bulging out under pressure of the air in the interior of the inner tube.
Now your colon, too, is a tube. Normally it is not subjected to much pressure, but when you allow constipation to occur and recur and then hurl down into the colon high powered cathartics, pressure does develop. And under this pressure weak spots tend to give way. A small weak spot in the wall of the colon puffs out into a bubble-like sac, or diverticulum. Actual blowouts do not occur very often. Your nerves take care of that.
If the pressure approaches the bursting point rapidly, your nerves send urgent signals to the brain and the resulting pain makes you do something about it. When, however, the pressure is more gradual and continuous, the process of sacculation is not acutely painful. It is for this reason that actual perforation or blowing out of the wall of the colon rarely occurs, and then seldom as a result of pressure. It actually does occur all too frequently in a manner which I shall describe later.
Let’s see, now, what happens after the little pocket in your colon has been established.
Having a “small change” pocket in your colon, you now proceed, like a little boy, to collect things in that pocket. Small things, like seeds, which come through the upper intestinal tract undigested, or small particles of undigested material, hard feces, lodge themselves in the sac or diverticulum. Over a period of time, particles of mucus and feces become adherent. Sometimes undigested fibers of food get entangled in this.
It is then, because of the bacteria that are normally present, that active trouble starts. Putrefaction in this little sac gives products that are irritating to the lining of the sac and also to the lining of the colon when poured out into the large bowel. Through this irritation, the lining of the colon becomes irritated and reflexly, the organ contracts at various places into spasms.
At this point, the injury is compounded. The spasm interferes with the normal flow of material through the digestive tube. In ordinary language we call this symptom constipation.
A stagnation of bowel content, aided and abetted by the spasm, increases the pressure in the colon. More and more weak spots give way. Instead of one, we now have a number of little pouches or sacs which, of course, present increased opportunity for putrefaction and infection.
The condition is now known to doctors as diverticulosis. In itself, this condition is not a dangerous one. However, it is far more serious than is usually realized, since it always presents the possibility of perforation and is almost invariably associated with a greater or lesser degree of colitis. If the sacs themselves are acutely inflamed, they constitute what is known as diverticulitis, a condition that can give many symptoms identical with appendicitis.
Should perforation occur, the problem is immediately a surgical one, since peritonitis is an immediate danger. Many cases diagnosed as appendicitis are found, upon operation, to be in truth ruptured diverticula.
Even before getting that far, diverticulosis is still a matter of the gravest concern and merits deepest attention. If neglected, colitis is the almost certain result and cancer is always a possible result!
How can this state of affairs be determined? Firstly, by means of a rectosigmoidoscopic examination, the existence of these diverticula can often be proved by viewing them through the instrument. Secondly, even where they are not visible through the rectosigmoidoscope and their presence is suspected, they can be definitely demonstrated by means of what is known as a barium enema study of the colon.
This is a relatively simple and painless procedure. A certain solution is given as an enema and the colon is examined during the passage of the material up the colon. Subsequently, the colon is examined when half the material is expelled; later when all of it is presumably expelled. In such cases, if diverticula are present, they may be very clearly outlined in shadow on the x-ray plate.
What is to be done when the existence of the condition is so determined? The patient must realize that his diet has to be under constant watch, lest he eat something which, on passing through the intestinal tract undigested, might find a resting place in one of these diverticula. Still further, the patient should be put on notice that he is to abstain forever from using cathartics, since anything which would increase pressure in the colon would invite extermination by way of perforation and peritonitis. Under these circumstances, the same thing may be said of so-called high calonic irrigations.
