FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

INFECTED DIVERTICULI COMMON CAUSE OF RECTAL BLEEDING

Question: I had an episode of abdominal pain and blood in my stools about six months ago. I was diagnosed with diverticulitis and had part of my colon taken out. I still have terrible problems with constipation. Now I've started having a bit of blood in my stools again, but I don't have that abdominal pain like I did before. What should I do?

Answer: The quick and simple answer is that you should see your doctor again. However, I think you and other readers should know more about diverticulitis and related conditions of the colon.

The colon is part of your digestive tract. When partially digested food leaves your stomach, it first travels through a tube called the small intestines, where nutrients are absorbed into the blood. It then passes into the large intestines, or colon, where water is absorbed and the waste products of digestion are stored until they are eliminated by a bowel movement.

A cross section of the colon wall reveals three layers an outer covering, a layer of muscle tissue that produces contractions and an inner layer that absorbs water and performs other functions. A diverticuli is formed when the inner layer and its associated blood supply push like a balloon through the muscular and outer layers. This protrusion disrupts the smooth "tube-like" contour of the colon.

Diverticulosis, the presence of many individual diverticuli, is usually without symptoms. This silent form is very common, affecting at least 50 percent of individuals over the age of 70.

Diverticuli can become infected, which produces the diverticulitis you referred to. This condition can cause abdominal pain, and at times, rectal bleeding. Depending on the location of the bleeding diverticuli, the blood may appear bright red or become incorporated into very dark colored stools. Since diverticuli are so common, it isn't surprising that 50 percent of colon bleeding is due to infected diverticuli.

Most individuals whose diverticuli aren't infected (diverticulosis) have no symptoms whatsoever. In those who develop infection (diverticulitis), medications usually provide relief from the symptoms. For some unfortunate few, like yourself, surgery to removed the involved area of the colon is necessary. This is usually only done when the infection is not controlled by antibiotics, when bleeding is extensive and can't be stopped by other measures, or when the colon becomes blocked by extensive inflammation. Also, when a diverticuli ruptures and spills the contents of the colon into the abdomen, an operation may be necessary to combat this life-threatening emergency.

Your complaint of constipation is often associated with diverticulosis. Some authorities think that chronic hard stools are the primary cause of this condition. Their reasoning is that the extra pressure necessary to propel hard stools ultimately weakens the colon wall and thereby creates the diverticuli.

The proper treatment for your constipation can also prevent diverticuli from forming. Eat high-fiber foods in abundance. We should all have 30 grams of fiber each day. Fresh fruits and vegetables along with whole-grain foods are the best sources.

It is also necessary to drink adequate liquids. If one doesn't drink enough, once the colon removes most of the moisture from the colon contents, the stools will be hard. The best way to judge liquid consumption is by the color of the urine. A very light color indicates sufficient liquids, while dark yellow indicates that more fluids are desirable.

Regular physical activity is good for overall health and also helps promote regular, soft bowel movements. Each of us should have at least 30 minutes of sustained activity each day.

Here's my advice: see your doctor with every episode of rectal bleeding. The cause is often simple such as bleeding hemorrhoids but it could be another episode of bleeding diverticuli, or colon cancer.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.