Diverticulitis/Inflammatory Bowel Disease
What is Diverticulitis?
Diverticulitis is a common condition of the colon that afflicts about 50 percent of Americans by age 60 and nearly all by age 80. It occurs when diverticula (pockets that develop in the colon wall) become inflamed or develop various complications. When this occurs, it becomes necessary for your physician or surgeon to take action to prevent the diverticulitis from worsening. Mild cases of diverticulitis are usually not associated with symptoms, but in some cases there is bleeding from the colon. Other symptoms may include pain in the lower abdomen (usually left sided, but not always), change in bowel habits as well as bloating, nausea, vomiting and anorexia due to a small or large bowel obstruction.
How is diverticulitis diagnosed?
Always consult your doctor for a diagnosis because diverticulitis symptoms resemble other medical conditions. Your physician will perform an extensive medical history and physical examination prior to any action taken. Generally, doctors perform an abdominal examination, and may order blood work and/or a CT (computed tomography) scan of the abdomen and pelvis.
Who is at risk?
This disease tends to affect men and women equally, but the prevalence of the disorder increases with age. Studies show that individuals with low fiber diets are more at risk than those with high or normal fiber diets.
What are treatment options?
Most mild cases of diverticulitis can be treated with a course of oral antibiotics, dietary restrictions and possibly stool softeners. Surgery becomes necessary if patients develop recurrent episodes or complications, such as abscess, perforation, obstruction or fistula (a communication between the colon and another organ such as the bladder or vagina).
Surgery may be performed in one of two ways: traditional (open surgery) and minimally invasive laparoscopic surgery. Open surgery requires larger incisions while laparoscopic surgery uses several small incisions. Using laparoscopic surgery, many of the same operations performed via open surgery can be completed with smaller incisions. Benefits of laparoscopic surgery include less pain and scarring, and shorter recovery. Dr. Paonessa performs laparoscopic surgery for a majority of her patients requiring surgery for diverticular disease. In dealing with surgery for diverticulitis, her goal is to “restore bowel continuity and for her patients to be free of permanent colostomy bags.”
Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis)
Over two million individuals are affected by Crohn’s Disease or Ulcerative Colitis. These two diseases are known as Inflammatory Bowel Disease (IBD). IBD can attack both the small and large intestines. The large intestine is comprised of the colon and rectum and the small intestine is made up of the jejunum and the ileum. Any area of the intestine can be affected with IBD and the distribution of the disease can vary from patient to patient.
Crohn’s Disease is commonly found in patients ages 16-40 but can also be found to affect other ages as well. This disease is only known to be approximately 20% genetically transferred from siblings and parents who have been diagnosed with some form of IBD. Crohn’s Disease has several symptoms such as abdominal pain, cramping, anal pain, joint pain (arthritis), unexpected weight loss, and/or diarrhea. Fever will usually accompany these symptoms.
There is no cure for Crohn’s Disease and its cause is still unknown. Several theories have centered on the immunological system, which is the body’s defense system, or possible bacterial causes. Although there is no cure currently for Crohn’s Disease, medication can be administered to treat early onsets and/or temporarily relieve the pain and symptoms associated with the illness. The most commonly dispensed medications are corticosteroids, anti-inflammatory agents, and immunosuppressants. In some cases surgery may be needed if the condition becomes severe or complicated. Not all cases require surgery so it is best to schedule a consultation with a colorectal surgeon. A colorectal surgeon in conjunction with your gastroenterologist can best determine treatment for each individual case.
Another form of IBD is Ulcerative Colitis (UC). This causes inflammation of the lining of the large intestine (colon and/or rectum). The onset for developing Ulcerative Colitis occurs during two stages of life: between the ages of 15 to 30 and between the ages of 70 to 80. Like Crohn’s Disease, the cause of Ulcerative Colitis is unknown.
The symptoms of Ulcerative Colitis are similar to Crohn’s Disease and include: abdominal pain, diarrhea, weight loss, fever, and/or rectal bleeding. Some patients may even experience incontinence from the diarrhea. Medications can be administered to control the active disease associated with Ulcerative Colitis. This may keep patients from requiring hospitalization. The most commonly dispensed medications are antibiotics and anti-inflammatory agents. If those medications fail, your physician may prescribe prednisone (steroids), immunomodulators and amino salicylates. Immunomodulators can be used to maintain the disease for a longer period of time.
Surgery may be required for patients suffering from chronic forms of the disease or from life threatening conditions of IBD such as massive bleeding, perforation or infection. Before becoming a candidate for surgery you must have tried medication therapy and experienced no improvement. Patients that suffer for years with Ulcerative Colitis have an increased risk of developing large bowel (colon) cancer. Definitive surgery for Ulcerative Colitis is curative for treating this form of IBD. It is very important to discuss surgical options with your colorectal surgeon because timing of surgery and the procedure chosen are very important to each patient.
Crohn’s and Ulcerative Colitis are serious diseases that require a patient to be closely monitored and to schedule preventative testing to limit his/her risk of cancer. Make sure that if you are experiencing any or all of the symptoms discussed above, that you schedule an appointment with your physician and a colorectal surgeon promptly.
Dr. Paonessa is a fellowship trained colorectal surgeon who has over ten years of experience in treating patients with IBD. She is experienced in the ongoing maintenance care and surgical care of patients with IBD. Additionally she frequently performs laparoscopic (minimally invasive surgery) for those patients who require surgery for IBD and who are candidates for this type of surgery. Call Dr. Paonessa’s office today for a consultation if you are experiencing any of the above symptoms or have IBD and require management.