What Are Intestinal Pouches and How Do They Form?
Understand how intestinal pouches form in the colon, a common condition often linked to diet, and the important distinction when inflammation or infection occurs.
Intestinal pouches are small, bulging sacs called diverticula that can develop in the lining of the digestive tract. They are most often found in the large intestine, particularly the lower section known as the sigmoid colon. This condition is common, especially with age, affecting over half of adults over 70. For most people, these pouches cause no symptoms and are often discovered incidentally during examinations for other medical concerns.
The Formation of Intestinal Pouches
The medical condition of having these pouches is called diverticulosis. It is believed to develop from high pressure within the colon, which pushes the inner intestinal lining outward through weak spots in the colon’s muscular wall. Over time, this repeated pressure causes the weak spots to bulge and form sacs. These formations are not cancerous and are distinct from other growths like polyps.
Several factors are associated with developing diverticulosis. A primary contributor is a long-term, low-fiber diet, which can lead to harder stools and constipation, increasing pressure inside the colon. Age is another significant factor, as the condition is more prevalent in individuals over 60. Other contributing elements include genetics, a sedentary lifestyle, and obesity.
While diverticulosis is often asymptomatic, some individuals may experience symptoms. These can include bloating, cramping in the lower abdomen, and changes in bowel habits like constipation or diarrhea.
From Pouches to Infection
When one or more of these diverticula become inflamed or infected, the condition is known as diverticulitis. This occurs when a small tear in a pouch allows bacteria to multiply and cause an infection, which requires medical attention.
The most common sign of diverticulitis is persistent abdominal pain, localized to the lower-left side of the abdomen. This pain can be sudden and intense or may start milder and worsen over several days. Other symptoms include fever, chills, nausea, vomiting, and a change in bowel function.
If left untreated, diverticulitis can lead to serious health problems. An abscess, a contained pocket of pus, can form near the infected pouch. An infected pouch can also rupture (a perforation), allowing intestinal contents to leak into the abdominal cavity and cause a dangerous infection called peritonitis.
Diagnostic Methods
When a patient presents with symptoms of diverticulitis, such as acute abdominal pain and fever, a computed tomography (CT) scan of the abdomen is the most common diagnostic tool. This imaging test is effective at visualizing the inflamed pouches, confirming the diagnosis, and identifying potential complications like an abscess or perforation.
Other tests may also be employed to help diagnose the condition and distinguish it from others with similar symptoms. Blood tests are often performed to check for signs of infection, and an ultrasound of the abdomen can also be used.
A colonoscopy is not performed during an acute attack of diverticulitis because of the risk of causing further injury or perforation. Instead, a colonoscopy is often recommended several weeks after the flare-up has resolved to fully assess the extent of the diverticula and rule out other conditions.
Medical and Dietary Management
Long-term management for diverticulosis focuses on lifestyle and dietary adjustments to prevent future problems. The primary recommendation is to increase dietary fiber intake, which helps soften stool and reduces pressure inside the colon. Staying well-hydrated by drinking plenty of fluids and engaging in regular physical exercise are also encouraged.
When an acute episode of diverticulitis occurs, treatment strategies shift to allow the bowel to rest and heal. For mild cases, a doctor may recommend a temporary clear liquid diet, followed by a slow transition to low-fiber foods. Antibiotics are often prescribed to treat the infection, and over-the-counter pain relievers can help manage discomfort.
Surgery may be considered for individuals who experience severe or recurrent episodes of diverticulitis, or for those who develop complications. This intervention involves removing the affected segment of the colon to prevent future attacks and address serious issues like blockages, fistulas, or perforations.