Chemotherapy treats various cancers by targeting rapidly dividing cells. While effective, it can also affect healthy cells, leading to a range of side effects. Patients often wonder how chemotherapy impacts their digestive system, including conditions like diverticulitis. This article explores the relationship between chemotherapy and diverticulitis.
Understanding Diverticulitis
Diverticulitis occurs when small, bulging pouches, called diverticula, form in the digestive system, usually in the large intestine. These pouches develop when pressure in the colon causes weak spots in the intestinal wall to bulge. The presence of these pouches is called diverticulosis and often causes no symptoms.
Diverticulitis arises when one or more diverticula become inflamed or infected. Symptoms include abdominal pain, often in the lower left side, fever, nausea, and changes in bowel habits like constipation or diarrhea.
The Link Between Chemotherapy and Diverticulitis
While chemotherapy does not directly cause diverticula, it can significantly increase the risk of diverticulitis in individuals who already have these pouches. Chemotherapy can also lead to more severe episodes. Several mechanisms contribute to this increased risk.
One primary mechanism is chemotherapy-induced neutropenia, a reduction in neutrophils, white blood cells crucial for fighting infection. This weakened immune system makes the body less capable of combating bacterial infections within diverticula, increasing the likelihood of inflammation and infection. This immune suppression can lead to a higher risk of complications.
Another factor is mucositis, inflammation of the mucous membranes lining the digestive tract. Chemotherapy drugs damage these rapidly dividing cells, weakening the gut lining and impairing its barrier function. This allows bacteria to enter surrounding tissues, contributing to infection and inflammation in existing diverticula.
Chemotherapy can also disrupt the balance of beneficial gut bacteria, known as the gut microbiota. This imbalance (dysbiosis) can lead to increased intestinal inflammation. The gut microbiota plays a role in regulating inflammatory factors, and chemotherapy-induced changes can promote inflammation.
Chemotherapy side effects such as severe constipation or diarrhea can place added stress on the colon. Constipation can increase pressure within the bowel, potentially worsening diverticular disease, while severe diarrhea can also irritate the intestinal lining. These bowel habit changes can create an environment conducive to the development or worsening of diverticulitis.
Recognizing Symptoms and Seeking Medical Attention
Recognizing the symptoms of diverticulitis is especially important for individuals undergoing chemotherapy, as their immune system may be compromised. Symptoms include persistent abdominal pain, often localized to the lower left side, which may be sudden and intense or gradually worsen. Fever, chills, nausea, vomiting, and notable changes in bowel habits, such as new onset constipation or diarrhea are also common.
Given the compromised immune status of chemotherapy patients, immediate medical attention is crucial if these symptoms appear. The body’s reduced ability to fight infection means that complications like abscess formation, fistula, or perforation are more likely and can progress rapidly. A perforation can lead to peritonitis, a severe infection of the abdominal lining, which requires emergency intervention. Immunocompromised patients may also present with less obvious symptoms, making prompt evaluation important to prevent serious outcomes like sepsis.
Managing Diverticulitis During Chemotherapy
Managing diverticulitis in a patient receiving chemotherapy requires a careful and coordinated approach due to the underlying immune suppression. Treatment often begins with antibiotics to address any bacterial infection, which may be administered intravenously, particularly for more severe cases or in immunocompromised individuals. This approach aims to control the infection effectively.
Bowel rest is typically recommended, often involving a temporary clear liquid diet to reduce strain on the inflamed colon. Pain management is also a component of care to ensure patient comfort during recovery. Hospitalization is frequently necessary for close monitoring and to facilitate intravenous treatments, especially when the patient’s condition is more severe or if they cannot tolerate oral intake.
Close communication between the oncology team and gastroenterology specialists is important to ensure that diverticulitis treatment plans are integrated with ongoing cancer therapy. In some severe instances, surgical intervention may be considered to remove the affected portion of the colon, though this is a complex decision in a chemotherapy patient due to higher risks of complications and mortality in immunocompromised individuals. Non-operative management is often preferred whenever possible in these patients.