INTRODUCTION

Many people have small pouches in the lining of the colon,

or large intestine, that bulge outward through weak spots.
Each pouch is called a diverticulum. Multiple pouches are
called diverticula. The condition of having diverticula is
called diverticulosis. Diverticula are most common in the
lower portion of the large intestine, called the sigmoid
colon. When the pouches become inflamed, the condition
is called diverticulitis. Diverticulosis and diverticulitis
together are called diverticular disease.

Diverticular disease is common at the age of 60.

Approximately 10%-25% of people with diverticular
disease develop diverticulitis.

A diet low in fiber can create hard stools, and lead to

constipation. With frequent and repeated straining during
bowel movements, pressure inside the colon increases
and contributes to the formation of diverticula. Adding
more fiber to the diet can help prevent constipation and
may decrease the risk for diverticular disease.
 ANATOMY AND PHYSIOLOGY

To better understand the health of the digestive system and colon, it is

helpful to first understand the different parts of the colon and their specific
functions. This article will help you become a stronger advocate for your own
health and may grant you detailed insight into how your colon, and your
body, works.

To better understand the health of the digestive system and colon, it is

helpful to first understand the different parts of the colon and their specific
functions. This can help you become a stronger advocate for your own health
and may grant you further insight into how your body works.

The colon is made up of 6 parts all working collectively for a single purpose.
Their purpose is ridding the body of toxins that have entered the body from
food sources, environmental poisons, or toxins produced within the body.
The colon’s role is to transfer nutrients into the bloodstream through the
absorbent walls of the large intestine while pushing waste out of the body. In
this process, digestive enzymes are released, water is absorbed by the stool,
and a host of muscle groups and beneficial microorganisms work to maintain
the digestive system.

Overview of the Colon’s Anatomy

The colon is approximately 4.5 feet long, 2.5 inches wide, and is a muscular
tube composed of lymphatic tissue, blood vessels, connective tissue, and
specialized muscles for carrying out the tasks of water absorption and waste
removal. The tough outer covering of the colon protects the inner layer of
the colon with circular muscles for propelling waste out of the body in an
action called peristalsis. Under the outer muscular layer is a sub-mucous
coat containing the lymphatic tissue, blood vessels, and connective tissue.
The innermost lining is highly moist and sensitive, and contains the villi- or
tiny structures providing blood to the colon.

The colon is actually just another name for the large intestine. The shorter of
the two intestinal groups, the large intestine, consists of parts with various
responsibilities. The names of these parts are: the transverse colon,
ascending colon, appendix, descending colon, sigmoid colon, and the rectum
and anus.

Transverse, Ascending, and Descending Colons

The transverse, ascending, and descending colons are named for their
physical locations within the digestive tract, and corresponding to the
direction food takes as it encounters those sections. Within these parts of the
colon, contractions from smooth muscle groups work food material back and
forth to move waste through the colon and eventually, out of the body. The
intestinal walls secrete alkaline mucus for lubricating the colon walls to
ensure continued movement of the waste.

The ascending colon travels up along the right side of the body. Due to waste
being forced upwards, the muscular contractions working against gravity are
essential to keep the system running smoothly. The next section of the colon
is termed the transverse colon due to it running across the body horizontally.
Then, the descending colon turns downward and becomes the sigmoid colon,
followed by the rectum and anus.

Ileocecal and Cecum Valves

The ileocecal valve is located where the small and large intestines meet. This
valve is an opening between the small intestine and large intestine allowing
contents to be transferred to the colon. The cecum follows this valve and is
an opening to the large intestine.

The Rectum and the Anus

The rectum is essentially a storage place for waste and is the final stop
before elimination occurs. The "tone" of the muscles of the anal sphincter
and a person’s ability to control this skeletal-muscular system are vital for
regulating bowel movement urges. When elastic receptors within the rectum
are stimulated, these nerves signal that defecation needs to occur. In other
words, these muscle and nerve groups convey when a bowel movement is
necessary but allow a person to control when waste will actually be removed,
as the final step in the digestive process. The anus is the last portion of the
colon, and is a specialized opening bound with elastic membranes, sensitive
tissues, and muscles and nerves allowing it to stretch for removing bowel
movements of varying sizes. If, for example, you suffer from constipation,
these tissues can become damaged and lose their ability to function
normally if waste has to be forced out or remains in the body for prolonged
periods. So it’s definitely good practice to keep things moving along at a
regular pace. Ideally, you should have two bowel movements per day but at
least once a day is pretty good; anything less than that could spell trouble
for not only your digestive health but general health as well.

Physiology of the Colon

To summarize, approximately 500 ml (milliliters) of food pass through the
colon daily. The various sections of the digestive tract absorb and remove
water, propel waste throughout the long system of muscular tubes, work to
keep the body alkalized, and accommodate the colonization of billions of
beneficial microorganisms to aid us in breaking down waste matter.
Regardless of the depth of your knowledge regarding the colon’s functions,
please realize the importance of its functions for promoting overall health. Be
good to your body on the inside as well as out by following a healthful diet,
drinking ample of water, and keeping all your biological systems well
maintained with stimulating exercise and by getting plenty of rest.

DISEASE PROCESS

A diverticulum is a small bulging sac pushing outward from the colon wall. More than one bulging
sac is referred to as diverticula.
When a diverticulum ruptures and becomes infected, the condition is referred to
as diverticulitis.

The condition of having diverticula in the colon is called diverticulosis.

SIGNS AND SYMPTOMS
DIVERTICULOSIS
>ABDOMINAL CRAMPING
 >BLOATING

>CONSTIPATION

>IRRITABLE BOWEL SYNDROME

DIVERTICULITIS
>SEVERE ABDOMINAL PAIN

>TENDERNESS OF ABDOMEN

>NAUSEA

>VOMITING

>FEVER

>CHILLS

Pathophysiology
Diverticula are small mucosal herniations protruding through the intestinal layers and the smooth muscle
along the natural openings created by the vasa recta or nutrient vessels in the wall of the colon. These
herniations create small pouches lined solely by mucosa. Diverticula can occur anywhere in the
gastrointestinal tract but are usually observed in the colon. The sigmoid colon has the highest intraluminal
pressures and is most commonly affected. Diverticulosis is defined as the condition of having uninflamed
diverticula. The cause of diverticulosis is not yet conclusive, but it appears to be associated with a low-
fiber diet, constipation, and obesity.
Diverticulitis is defined as an inflammation of one or more diverticula. Its pathogenesis remains unclear.
Fecal material or undigested food particles may collect in a diverticulum, causing obstruction. This
obstruction may result in distension of the diverticula secondary to mucous secretion and overgrowth of
normal colonic bacteria. Vascular compromise and subsequent microperforation or macroperforation then
ensue. Alternatively, some believe that increased intraluminal pressure or inspissated food particles cause
erosion of the diverticular wall, resulting in inflammation, focal necrosis, and perforation. The disease is
frequently mild when pericolic fat and mesentery wall off a small perforation. However, larger
perforations and more extensive disease lead to abscess formation and, rarely, intestinal rupture or
peritonitis.
Fistula formation is a complication of diverticulitis. Fistulas to adjacent organs and the skin may develop,
especially in the presence of an abscess. In men, colovesicular fistulas are the most common. In women,
the uterus is interposed between the colon and the bladder, and this complication is only seen following a
hysterectomy. The uterus precludes fistula formation from the sigmoid colon to the urinary bladder.
However, colovaginal and colocutaneous fistulas can form but are uncommon.
Recurrent attacks of diverticulitis can result in the formation of scar tissue, leading to narrowing and
obstruction of the colonic lumen.
Race
Genetics are believed to play a role, in addition to dietary factors. Left-sided diverticula predominate in
the United States. Asians, including Asian Americans, have a predominance of right-sided diverticula.
Sex
Prevalence is similar in men and women.
Age
Diverticular disease increases in incidence with age, reaching a prevalence of greater than 65% in those
older than 85 years. The mean age at presentation with diverticulitis appears to be about 60 years.