Diverticular Disease: Greatest Myths and Facts

Myth 1: If you have diverticular disease, you should avoid eating nuts, seeds and popcorn

Fact: This most persistent myth actually contradicts advice doctors give for preventing the condition in the first place. A healthy, high-fiber diet is actually the best medicine against diverticulitis, and seeds and nuts certainly fit the bill.

We used to think that a seed or nut plugged the pocket in the colon, and that’s what caused it to become inflamed or to rupture. But no surgeon has ever seen that, and studies have strongly suggested there’s nothing to that idea.

 

Myth 2: Diverticular disease always requires treatment

Fact: Patients often confuse the related conditions diverticulosis and diverticulitis.

Diverticulosis generally needs no treatment, while diverticulitis is a more serious condition that may require surgery.

Diverticulosis refers to small pockets that protrude through weak muscle layers in the intestinal wall, similar to a bubble in a tire. They’re fairly common. Sixty percent of people have them by age 60. Up to eighty percent of people have them by age 80.

A colonoscopy usually brings this condition to light, and it’s a very incidental finding. Most people don’t even realize they have the pockets, and by themselves, they are little cause for concern. Diverticulosis is like having freckles: It’s only a problem if those freckles turn into a mole. We don’t operate, ever, on diverticulosis.

Diverticulitis occurs when one or more of those pockets are blocked by waste and inflammation or an infection occurs, or when pockets rupture and bacteria that are normally in your stool get outside of the intestines and into the surrounding abdominal area.

When this happens, a variety of complications can arise:

• You may experience pain and/or a fever.
• An abscess, or “walled-off” infection, may result from the bacteria in the abdomen.
• A painful infection of the abdominal cavity, or what we call peritonitis, occurs. Peritonitis is potentially fatal. Also, while it’s very uncommon, it does require immediate treatment.

Not everybody who has diverticulitis needs surgery, but they should see a physician, either in primary care or the emergency room, to get a proper diagnosis.

Myth 3: If you’ve had diverticulosis that developed into diverticulitis in the past, subsequent bouts of diverticulitis are more likely to perforate (and lead to peritonitis)

Fact: Diverticulitis happens in only 10 – 25 percent of those with diverticulosis. Also the great majority, or 75 percent, of those cases are the less serious type – requiring simple outpatient treatment, and perhaps medication.

Research shows the next bout of diverticulitis is most often going to be similar to your first bout. Usually, if your body could handle diverticulitis the first time, then the next time, it’s going to react just as well.

Lots of patients ask, “How do I prevent myself from getting diverticulitis?” Unfortunately, we don’t know why people get it. We think it’s from high pressure in the bowels and being constipated. We suggest eating a high-fiber, healthy diet and avoiding constipation.

Source: Cleveland Clinic

5 Facts You Should Know About Your Poops

There is no normal

People are different. So are bowel movements. The size, shape and consistency of feces will change greatly from person to person.

Instead of looking for “normal,” look for a change. Did you use to move your bowels frequently but now have trouble doing so? Did they use to be solid but now are runny for a long period of time? When you experience a big, noticeable change that lasts, it’s time to see your doctor.

Blood is a warning sign

If there is blood in your feces on a recurring basis, see a doctor. Blood can be a sign of polyps or colorectal cancer. It also can be caused by benign conditions such as hemorrhoids and anal fissures. In any case, it’s worth getting checked out.

If you see blood, keep an eye out for other symptoms: weight loss, fever, chills. When they come together, those are “high-alert” symptoms of bowel disorders.

Sometimes size is a concern

If you used to have sizeable stools but now they are always pencil thin and hard to pass, consult your doctor. In certain types of colon cancer, the bowel gets narrow, and so do your bowel movements.

Thin stools do not automatically mean cancer. But if they last a long time and if going to the bathroom is difficult for you, your doctor may order a colonoscopy to rule it out.

Consistency matters

We all have bouts of diarrhea from time to time. Runny, watery stool over a short period of time can mean mild food poisoning or an infection, for example.

But if you used to have solid bowel movements and now have diarrhea frequently, it could be a sign of an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis — especially if it comes with other symptoms such as abdominal pain, blood and weight loss.

It could be stress

Your body reacts to things that go on around us. The impact of stress and unresolved issues may show up in your bathroom.

Your bowels may be indicating something that you’re not appreciating consciously. If your bathroom habits have changed drastically and other medical causes have been excluded, life’s stresses may be to blame.

Pay attention to what your bowels are telling you. From stress to medical conditions, they may give you warning sings that will help you improve your health.

Source: Dr Brooke Gurland, MD, Cleveland Clinic

Things You Need To Know About Fistula-in-ano

What Is An Anal Abscess?

An anal abscess is an infected cavity filled with pus found near the anus or rectum.

What Is An Anal Fistula (Fistula-in-ano)?

An anal fistula is frequently the result of a previous or current anal abscess. The small glands just inside the anus occasionally get clogged and potentially can become infected, leading to an abscess. The fistula is a tunnel that form under the skin and connects the infected glands to the abscess. A fistula can present with or without and abscess and may connect just to the skin of the buttocks near the anal opening. Other causes of fistula include Crohn's disease, tuberculosis, radiation, trauma and malignancy.

How Does Someone Get An Anal Abscess Or A Fistula?

The abscess is most often a result of an acute infection in the internal glands of the anus. Occasionally, bacteria, faecal material or foreign matter can clog the gland and create a condition for an abscess cavity to form.

After an abscess drains on its own or has been drained (opened), a tunnel (fistula) may persist connecting the infected anal gland to the external skin. This typically will involve some type of drainage from the external opening and occurs in up to 50% of the abscesses. If the opening on the skin heals when the fistula is present, a recurrent abscess may develop.

What Are The Signs And Symptoms Of An Abscess Or Fistula?

A patient with an abscess may have pain, redness or swelling around the anal area. Fever or chills are also common. In a patient with a fistula, there will be additional symptoms of irritation of the perianal skin or drainage from an external opening.

Is Any Specific Testing Necessary To Diagnose An Abscess Of Fistula?

No. Most of the abscesses or fistula are diagnosed and managed on the basis of clinical findings. Occasionally, a MRI or endoanal ultrasound can assist with the diagnosis of deeper abscesses or the delineation of the fistula tunnel to help guide treatment.

What Is The Treatment Of An Anal Abscess?

Surgical drainage is needed under most circumstances. An incision is made in the skin near the anus to drain the pus. It can be performed under local anaesthesia or general anaesthesia for bigger and deeper abscess. The wound would be left open and let it heal by itself. Hospitalisation may be required in patients prone to more significant infections such as diabetics or patients with decreased immunity.

What Is The Treatment Of An Anal Fistula?

Surgery is almost always necessary to cure an anal fistula. Although surgery can be fairly straightforward, it may also be complicated, occasionally requiring staged or multiple operations. It is advisable to consult a colorectal surgeon to discuss the different types of potential operations.

The surgery may be performed at the same time as drainage of an abscess, although sometimes the fistula does not appear until weeks to years after the initial drainage. If the fistula is straightforward, a fistulotomy may be performed. Other procedures include placing material within the fistula tract to occlude it or surgically altering the surrounding tissue to accomplish closure of the fistula, with the choice of procedure depending upon the type, length and location of the fistula.

What Is The Recovery Like From Surgery?

Pain after surgery is controlled with painkillers, fibers and bulk laxatives. Sitz bath is encouraged and to avoid constipation. You can discuss with your surgeon the specific care and time away from work prior to surgery to prepare yourself for post-operative care.

Can The Abscess Or Fistula Recur?

Yes. Both abscesses and fistulas can potentially recur. Should similar symptoms arise, suggesting recurrence, it is recommended that you visit a colorectal surgeon to manage your condition.

Source:ASCRS