MEN IN THE BATHROOM: DIVERTICULAR DISEASE
A 72-year-old nurseryman was enjoying his retirement and reeling in very good health when he noticed that his urine had turned brown. On closer examination he realized that it also contained little particles which, on one occasion, looked remarkably like seeds. Feeling curious and concerned, he collected the seeds and planted them in sterile potting mix. To his utter amazement, a tomato plant grew.
Doctors at the Maid stone Hospital in Britain confirmed his suspicion. A link had formed between his bowel and his bladder allowing faecal matter to escape into his urine. Without any pain or discomfort, he had developed an uncommon complication of the common condition known as diverticular disease of the colon (diverticulosis).
This disease occurs when small pouches (diverticula) form in the wall of the large bowel. These are usually about the size of a pea, but can be larger, and form in weakened areas of the bowel, mostly in the lower part of the colon.
It is thought that diverticulosis is related to aging. In some people the pressure inside the colon increases and the colon wall thickens. Little protrusions or blowouts (pouches) form in response to the increased pressure.
Under the age of thirty, this disease is rare, but by sixty, at least 33 per cent of people have it. Between the ages of eighty and ninety, about 50 per cent have it.
Doctors who reported the nurseryman’s case in the British Medical Journal said that during this time the man’s bowels worked well, with no bleeding or other changes, and that he had no other symptoms.
He did, however, have a history of diverticular disease, and investigations showed that a small connection (fistula) had formed between a pouch in the colon and his bladder. His colon was surgically repaired and the man made an uneventful recovery.
A number have abdominal pain and changes in bowel habit, while others do not. The reason why only some people with diverticular disease complain of such symptoms is not known.
These symptoms are similar to those of irritable bowel syndrome (IBS) and the two conditions may coexist. IBS is thought to be a motility disorder of the bowel – a problem with the way the bowel muscles contract. It is important for people with these symptoms to seek medical advice so a firm diagnosis can be made and more serious conditions excluded.
Diverticular disease usually becomes a problem when complications arise, but these are not always initially obvious. There can be a paradoxical element to this disease. Quite a mild form of the disease may cause significant discomfort, and quite a severe form may be associated with minimal discomfort, as in the nurseryman whose disease flourished undetected. An abscess formed in a pouch in his colon and quietly festered away, eventually tunnelling into his bladder.
Similar fistulae have been seen involving the small intestine and the large bowel. Fistulae may also go through the abdominal wall to the surface of the abdomen.
Diverticulosis is usually discovered when a pouch, or diverticulum, becomes infected and inflamed. Once this happens, the disease changes to diverticulitis. The symptoms of this are pain, fever and abdominal tenderness. The inflammation may remain localised and disappear in a few days, at times requiring antibiotics. But it may also worsen. In severe cases the sufferer may have to be admitted to hospital for intravenous antibiotics, fluids and bowel rest, which means not eating for several days. In rare cases the infection may break through the bowel wall and cause an abscess alongside the bowel or cause peritonitis, an infection of the abdominal cavity. Peritonitis may be life-threatening and surgery is necessary.
Other complications of diverticulosis include rectal bleeding and bowel obstruction. The bleeding is usually bright red and may be heavy. It is essential that all types of rectal bleeding be investigated to determine the cause. The most important disorder to exclude is cancer of the large bowel.
If the diverticulosis has progressed, the bowel may become thickened and narrowed and more readily obstructed. Surgery may be needed to relieve this obstruction by removing the narrowed portion of bowel.
It is generally recommended that people known to be suffering from diverticular disease increase the amount of fibre in their diet. One theory suggests that low-fibre diets contribute significantly to raised intracolonic pressure and therefore to the formation of pouches.
Symptomless diverticular disease seems to occur less often among vegetarians than non-vegetarians. The latter had an average daily dietary fibre intake about half that of the vegetarians.
By the way, it is not known whether the nurseryman’s tomato plant supplied him with any fruit for his new high-fibre diet.
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