Abdominal pain and nausea due to diverticulum

Diverculitis can cause severe discomfort in the left lower abdomen

01/22/2015

If there is severe pain in the right lower abdomen in combination with fatigue, nausea and fever, the suspicion is usually due to an appendicitis or inflammation of the appendix. However, the clinical picture is less clear when the abdominal pain is on the left side. In this case could be a so-called „diverticulitis“ present, which is an inflammation of outgrowths of the intestinal wall.

Overweight and a low-fiber diet increase the risk for diverticula
As so-called „diverticulum“ are generally medical evaginations in the wall of a hollow organ called, as they occur for example in the intestine (intestinal diverticulum), but also in other organs such as the bladder or in the esophagus. For the emergence of the protuberances experts assume on the one hand a hereditary predisposition, in addition to other risk factors such as obesity and a low-fiber diet. In the intestine, the protuberances occur mainly in the colon, are many of the diverticula heaped before, doctors speak of diverticulosis. This is especially common in the elderly, but in most cases without discomfort, so no treatment is usually required.

Severe pain usually only after inflammation
In other cases, the diverticula but also cause discomfort such as abdominal pain, bloating or digestive problems such as constipation, flatulence or diarrhea, which are often not very pronounced. On the other hand, if inflammation occurs (diverticulitis), significantly more severe symptoms such as severe pain in the left lower abdomen, unpleasant constipation and fever occur. „We assume that about ten percent of all people with diverticula get discomfort, ie inflammation or bleeding with more or less difficult course“, explains Prof. Christoph-Thomas Germer of the German Society for General and Visceral Surgery in Berlin to the news agency „dpa“.

Colonoscopy only in rare cases
The risk of inflammation arises as soon as stool and bacteria collect in the diverticula. If there is a suspicion of diverticulitis, sufferers should accordingly consult a doctor as soon as possible, who undertakes a thorough examination of the abdomen to diagnose - also to be able to exclude a possible irritable bowel: „Then we usually take blood, let determine inflammation and make a scan by ultrasound“, said Wolfgang Burmeister of the professional association Gastroenterologen in Hamburg opposite the „dpa“. Colonoscopy, on the other hand, is only performed in rare cases; instead, imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) are frequently used.

No premature administration of antibiotics
The treatment of diverticulitis depends on the symptoms of the person affected and which structures in the abdomen are affected. „If a patient has only mild discomfort, and he has regular bowel movements and no fever, then you do not have to give antibiotics immediately and can send the patient home overnight“, Burmeister continues. Here the patient should, however, urgently care for protection and accordingly not go to work, also should drink as much as possible and paid attention to a gentle diet so as not to irritate the intestine in addition. However, in more complicated cases, as well as in high-risk patients, the administration of antibiotics is usually necessary: „People with high blood pressure, kidney disease, allergies and a weak immune system have a higher risk of diverticula and complications“, Prof. Ludger Leifeld from the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) in Berlin told dpa.

For complications usually immediate surgery is necessary
In cases of pronounced diverticulitis or complications, a surgical procedure is usually performed in which the damaged intestinal tract is removed - which must be done as quickly as possible in the case of intestinal perforation, for example. However, if the inflammation is without complications, many experts believe that antibiotics should not be used prematurely, because recent studies show that this does not bring benefits in many cases. In addition, according to Germer, it had previously been customary to preventively remove the affected intestinal section after the second inflammatory thrust, in order to avoid possible intestinal perforation. Today, however, it is known that the first thrust here bears the greatest risk, „and a precautionary surgery can not favorably affect the occurrence of complications“, so the expert.

Self-help by changing the diet to high-fiber diet
In addition, diverticulosis does not cause discomfort, so patients can do their part to prevent inflammation. Here, experts recommend, above all, the diet on a fiber-rich diet with plenty of vegetables (such as leaf salad, radish, tomatoes, brussels sprouts, eggplant), whole grains and fruits (plum, pineapple, passion fruit, etc.) change. Legumes such as lentils, chickpeas or red beans are also particularly well-suited, as well as providing lots of fiber and also delaying blood sugar increase after the intake of starch, which also reduces the risk of type II diabetes. (Ag)