Diverticulitis involves the inflammation or infection of small pouches, called diverticula, that can form in the wall of your large intestine. While many individuals with these pouches, a condition known as diverticulosis, experience no symptoms, diverticulitis can arise when one or more of these pouches become inflamed. A common complication that can occur with diverticulitis, or even with diverticulosis alone, is bleeding.
Understanding Diverticular Bleeding
Diverticular bleeding occurs when blood vessels located near these pouches rupture. The colon wall, where diverticula form, is weakened in these areas, allowing small blood vessels (vasa recta) to become exposed. Increased pressure within the colon, from straining during bowel movements, can cause these vessels to erode or rupture, leading to bleeding into the intestinal lumen.
This type of bleeding often presents as painless rectal hemorrhage. The blood can range in color from bright red to dark maroon, sometimes appearing with clots, and can be significant in volume. A majority of diverticular bleeding episodes resolve spontaneously. It is a frequent cause of lower gastrointestinal bleeding.
When to Seek Medical Attention
Any instance of gastrointestinal bleeding warrants medical evaluation to determine its cause and severity. It is particularly important to seek immediate medical attention if you experience large amounts of blood in your stool, especially if it is accompanied by symptoms such as dizziness, weakness, or fainting. These signs can indicate significant blood loss and may lead to a drop in blood pressure or other complications.
Other concerning symptoms that necessitate prompt medical care include severe abdominal pain, persistent bleeding that does not stop, or any signs of shock, such as confusion, rapid heart rate, or cold, clammy skin. While many diverticular bleeding episodes resolve on their own, a healthcare professional can assess your condition, rule out other potential causes of bleeding, and provide appropriate management to prevent serious health issues.
Diagnosis and Treatment Approaches
Diagnosing diverticular bleeding involves identifying the source of the hemorrhage and ruling out other potential causes of lower gastrointestinal bleeding. Medical professionals begin with a physical examination and a review of your medical history. Diagnostic procedures can include a colonoscopy, which visualizes the colon lining to locate the bleeding site. If bleeding is active or too rapid for a colonoscopy, imaging techniques such as CT angiography or a tagged red blood cell scan may be used to pinpoint the bleeding vessel.
Treatment for diverticular bleeding varies depending on the severity and persistence of the hemorrhage. Initial management focuses on stabilizing the patient, involving intravenous fluids and, in cases of significant blood loss, blood transfusions. If the bleeding continues, endoscopic interventions performed during a colonoscopy, such as injecting medication (e.g., epinephrine) around the bleeding vessel, applying clips, or using electrocautery to seal the vessel, can be effective. If endoscopic methods are not successful or feasible, angiographic techniques like selective embolization, which blocks the bleeding vessel, may be employed. Surgical removal of the affected part of the colon is reserved for rare, severe cases where other treatments have failed or if bleeding is uncontrollable.
Preventing Future Episodes
Implementing specific lifestyle and dietary changes can help reduce the likelihood of future diverticular bleeding episodes and manage diverticulosis. A high-fiber diet is recommended, as it promotes softer, bulkier stools that pass more easily through the colon, lessening pressure on the intestinal walls. Foods rich in fiber include whole grains, fruits, vegetables, and legumes.
Adequate hydration is also important, as drinking plenty of water helps fiber function effectively and keeps stools soft. Regular physical activity, such as walking or running, can also contribute to consistent bowel movements and may help reduce pressure within the colon. Avoiding certain medications like nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, is advised, as they can increase the risk of gastrointestinal bleeding.