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Diverticular disease of the colon. Many health- conscious men can recite their cholesterol counts, blood pressure readings, and PSA levels without even glancing at their medical records.

But few of these well- informed gents can tell you if they have diverticular disease of the colon, even though it's an extremely common condition. That's understandable, since the most prevalent form of the problem, diverticulosis, produces few if any symptoms. Still, when complications develop, blissful ignorance about diverticulosis abruptly gives way to an unwelcome education about the pain of diverticulitis or the bleeding of diverticulosis. It's a learning experience that's particularly unfortunate, since diverticular disease is largely preventable.

Your colon. The colon is a 4 1/2- foot- long tube that constitutes the final portion of the intestinal tract. The food you eat is mostly digested in the stomach and small intestine. Residual material enters the colon, or large intestine, in the cecum, which lies in the right lower portion of the abdomen (see Figure 1). From there, digested material travels up the ascending colon, across the transverse colon, and down the descending colon to the final portion, the sigmoid colon, in the lower left part of the abdomen. The intestinal contents take about 1.

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When healthy, the colon is a smooth cylinder lined by a layer of epithelial cells. The wall of the colon contains two groups of muscles, a circular muscle that rings the colon and three long muscles that run the entire length of the tube. Like all tissues, the colon requires a supply of blood; in part, it's provided by the many small penetrating arteries that pass through the colon's muscular wall to carry blood to its inner layer of epithelial cells. Figure 1: The colon. Diverticular disease. Most folks who think about the colon worry about the polyps and cancers that may develop from epithelial cells. But problems can also develop in other areas.

Diverticula are sac- like pouches that protrude from the normally smooth muscular layer of the colon (see Figure 2). They tend to develop where the muscles are weakest, at the places where penetrating vessels cross through the muscles. And in Western societies, the great majority of diverticula develop where the colon is narrowest, in the sigmoid. Figure 2: Diverticulosis. Who gets diverticulosis — and why? Age is a major risk factor.

Diverticulosis is uncommon before age 4. Americans will develop the condition by age 6. That makes diverticulosis one of the most common medical conditions in the United States. It wasn't always this way. Diverticulosis was uncommon in the United States 1. What accounts for the difference?

The principal factor is diet, especially the refinement of carbohydrates, which has deprived the typical American diet of much of its fiber content. Diverticulosis is a disease of Western civilization. Dietary fiber is a mix of complex carbohydrates found in the bran of whole grains and in nuts, seeds, fruits, legumes, and vegetables, but not in any animal foods. Because humans cannot digest these complex carbohydrates, dietary fiber has little caloric value — but it has plenty of health value.

Among other things, the insoluble fiber found in wheat bran, whole- grain products, and most vegetables (see table) draws water into the feces, making the stools bulkier, softer, and easier to pass. Dietary fiber speeds the process of elimination, greatly reducing the likelihood of constipation. Some sources of dietary fiber. Food. Serving size. Fiber content(to nearest gram)Cereals.

Fiber Onecup. 14. All Brancup. 10. Shredded Wheat. Oatmeal. 1 cup (cooked)4.

Grains. Barley. 1 cup (cooked)6. Brown rice. 1 cup (cooked)4. Baked goods. Rye Krisp. Bran muffin. 13. Whole- wheat bread. Legumes. Baked beans. Kidney beanscup (cooked)7.

Lima beanscup (cooked)7. Vegetables. Spinach. Broccolicup. 3Brussels sproutscup. Carrot. 1 medium.

Tomato. 1 medium. String beanscup. 2Fruit. Pear (with skin)1 medium.

Apple (with skin)1 medium. Banana. 1 medium. Dried fruits. Prunes.

Raisinscup. 1Nuts and seeds. Peanuts. 10 nuts. Popcorn. 1 cup. 1Supplements. Wheat bran (crude)1 ounce. Wheat germ. 1 ounce.

Psyllium. 1 tsp. or 1 wafer. Methyl cellulose. A low- fiber diet has the opposite effect. But constipation is the least of the problems. Without enough fiber, the stools are small and hard, and the colon must contract with extra force to expel them. That puts extra pressure on the wall of the colon — and, as you may remember from Physics 1. Law of La. Place explains that the pressure in a tube is highest where the diameter is smallest.

In the colon, that's the narrow sigmoid. A Harvard study of 4. Men who consumed the most fiber were 4. And the protective effect of fiber remained strong after the scientists took age, physical activity, and dietary fat into account.

Over time, a low- fiber diet increases the risk for diverticulosis and its complications. Because connective tissues tend to weaken over the years, age itself may compound the effect of diet. Other possible risk factors include a high consumption of fat and red meat, obesity, cigarette smoking, and the use of nonsteroidal anti- inflammatory drugs.

On the other hand, a Harvard study found that regular physical activity appears to reduce risk by up to 3. Why worry? Diverticulosis is so common in Americans that it may hardly seem like a disease. Indeed, about 7. 5% of men with the condition never develop serious problems from it, though some of them have occasional abdominal cramps that may or may not stem from diverticulosis. But some 1. 5% to 2. In all, diverticular disease of the colon accounts for 3,4. Watch Def-Con 4 Download Full. United States each year while draining our economy of over $2. That's quite a toll for a disease you may never have heard of.

Diverticulitis: Symptoms. Inflammation puts the "itis" into diverticulitis, which is the most common complication of diverticular disease. The bacteria that are packed into feces by the hundreds of millions are responsible for the inflammation, but doctors don't fully understand why some diverticula become infected and inflamed while many do not. A current theory holds that the wall of the diverticular sac becomes eroded by pressure, trapped fecal material, or both. If the damage is severe enough, a tiny perforation develops in the wall of the sac, allowing bacteria to infect the surrounding tissues.

In most cases, the body's immune system is able to contain the infection, confining it to a small area on the outside of the colon. In other cases, though, the infection enlarges to become a larger abscess, or it extends to the entire lining of the abdomen, a critical complication called peritonitis. Pain is the major symptom. Because diverticulosis typically occurs in the sigmoid colon, the pain is usually most pronounced in the lower left part of the abdomen, but other areas may be involved. Fever is also very common, sometimes accompanied by chills. If the inflamed sigmoid is up against the bladder, a man may develop enough urinary urgency, frequency, and discomfort to mimic prostatitis or a bladder infection.

Other symptoms may include nausea, loss of appetite, and fatigue. Some patients have constipation, others diarrhea. Diverticulitis: Diagnosis. A physician's exam may reveal tenderness over the inflamed tissues, typically in the lower left abdomen; less often, the doctor may feel swelling. As in other infections, the white blood cell counts are usually elevated. But because these findings are non- specific, further testing is required to establish the diagnosis. The best test is a CT scan of the abdomen, ideally performed after the patient receives contrast material both by mouth and intravenously.

And a month or two later, after treatment has quieted things down, the patient should have a colonoscopy, both to evaluate the diverticular disease and to be sure that no other abnormalities are lurking. Diverticulitis: Therapy.

Since bacteria are responsible for the inflammation, antibiotics are the cornerstone of treatment.