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Diverticular Disease: Caused By Nicotine Not The Microbiome

Tuesday, November 25th, 2025

TESTING THE MICROBIOME
Techniques are available to identify organisms in the gut microbiome by their DNA. This has resulted in a flurry of ideas, research and published papers, popular media articles and also commercial exploitation. There are no standardized testing protocols, making difficult any comparisons or reproducibility of the research. Studying, analyzing and interpreting microbiome data has many pitfalls (30240894), heterogenicity is found in studies (35795855, 36499127) but diverticular disease with its infection problems is an obvious candidate for such research.

The gut microbiome is in the caecum – the first part of the large intestine – in the closed circuits of the digestive system. The only way for microorganisms to get into the caecum is by swallowing them and the only way out is in the faeces. Diet is therefore an integral part of what organisms are found there and their survival depends on them having the right conditions and nutrients. Water supply is an important but forgotten part of diet. Change in diet can change the organisms present in 24 hours (28388917, 21885731). The microbiome composition is dynamic and test results can only apply at the time of testing. Diet supplements with live organisms may only change the microbiome contents if they are take continuously. Recognised diets, for example the Mediterranean diet, have distinct microbiome flora (39009882).

Antibiotics and medications can affect which organisms survive to be found in tests (34225544) but such personal information is not always noted for test volunteers. When researching a disease, the challenge is to distinguishing cause from effect (22356853). Ageing, illness and restricted diets can result in a less diverse microbiome. This is not ‘dysbiosis’ but a natural effect. Advocating a microbiome to be large in number and variety of organisms reflects a varied diet being beneficial for health. Most irritant and toxic strains of organisms, such as from food poisoning, are efficiently evacuated from the colon by diarrhea and are unlikely to be found in volunteers.

SAMPLING THE MICROBIOME
Examination of stool samples or rectal swabs are used to find organisms surviving from the microbiome. Another common means of sampling are biopsies taken during colonoscopies, but the microbiome and faeces have been washed out of the colon for this procedure leaving only species of organisms which adhere to the inner colon walls. The most relevant samples are those taken during operations for the infectious complications of diverticular disease but are less available. All samples are subjected to the conditions between sampling and testing.

DIFFERENT TYPES OF DIVERTICULAR DISEASE
The presence of diverticula observed on the colon or from the inside, i.e. diverticulosis, is the diagnostic evidence of the disease. People with and without diverticula and no symptoms, have been tested to see if different organisms in the microbiome could be responsible for the colon changes. Tests of the microbiome organisms present provided no evidence that they could be responsible for the formation of diverticula. (36775316, 34492052). An array of species can be found in the reports from researchers. The bacteria were mainly anaerobes which grow in the absence of oxygen. No significant differences were found between diverticula located in the left or right side of the body or along the length of the colon after the microbiome (29563543). There was no convincing evidence of microbiome ‘dysbiosis’ (36775316) and diverticulosis was not associated with altered gut microbiome or predictive of future diverticulitis (36987880).

When symptoms are produced in the presence of diverticula it is known as diverticular disease. Symptomatic uncomplicated diverticular disease (SUDD) can give pain and dysfunction without evidence of infection or inflammation. It is often confused with IBS, but research is pointing to the effects of the damaged colon muscles (33594008). Tests on the microbiome organisms of patients with and without SUDD have again provided no evidence of their involvement in this manifestation of diverticular disease (36775316) and no difference found between health, asymptomatic diverticulosis and SUDD in patients (36660603).

Samples from people with uncomplicated diverticular disease have been compared with samples from people with inflammatory bowel disease (IBD) – ulcerative colitis and Crohn’s disease. There were differences in which anaerobic bacterial species predominated but differences in diets and medications should be considered (28683448). An idea that the microbiome alone could be used for the diagnosis of diverticular disease (24894339) was not supported by diversity of the microbiota.

When diverticular disease shows signs of infection present, it is called diverticulitis. This can be confusing because in the past any painful symptoms were often called diverticulitis. Diverticulitis can be a ‘smouldering’ infection or acute, needing antibiotics at home or care in hospital. The condition is not always specified in microbiome tests comparing cohorts with and without diverticulitis. These tests have not shown consistently particular organisms being responsible for the infection. One investigation (36987880) followed up people with diverticulosis and retested them if they developed diverticulitis. A relationship between microbiome organisms and diverticulitis could not be demonstrated (35796855). Unknown in such studies is how often diverticular disease patients are prescribed antibiotics before volunteering.

A more direct way of looking for microorganisms which may be responsible for infections in diverticular disease is the sampling of colon parts removed in the surgical treatment of ‘complicated’ diverticulitis. An infected or perforated diverticula or abscess are sample sources for tests. Antibiotics and colon preparation for surgery are likely confounders of this type of study. Different range of organisms have been found between infected and uninfected parts of the same colon (36856684). Also reported are different organisms in a perforated diverticula compared with a healthy adjacent one (36556494). These authors considered that faeces in a diverticula promoted the development of specific microbial communities. There was more diversity of organisms in diseased parts than healthy tissue in one research report on complicated diverticulitis (40401932).

WHAT WAS IN THE MICROBIOME?
The research into the microbiome of DD has not revealed any particular organism to be responsible for its pathology or symptoms (37243442). The large and variable range of organisms found, which are listed in the many research papers and reviews, have little information on their individual activity or statistical significance. However, one report showed that microbiome composition explained 1.9% variation in the diseased state of SUDD but age was responsible for 10% (39180058).

Most of the organisms found in the colon are anaerobic, which means they can grow and ferment diet residues without oxygen. Before the current DNA testing techniques such organisms were very difficult to study in the laboratory (30240894). Now they have been found in both healthy people and people with DD in its various manifestations. Variation in an individual’s microorganisms are related to the speed at which they are passed out of the body (36171079). DD was not specifically mentioned in this report which indicated that these anaerobic organisms can continue to grow during their transit out of the body (and trapped in a diverticula ?) A study (27129485) found that the amount of the gas methane in breath tests was an independent predictor of finding diverticula on colonoscopy, due to faecal entrapment in diverticula (18936652).

WHAT NEXT FOR DIVERTICULAR DISEASE?
The recent studies have indicated that microbiome organisms are not the primary cause of DD and its symptoms. The problem is the damaged colon with its dysfunctional muscles and diverticula traps where faeces organisms can proliferate (26989376). The suggestion (40401932) that probiotics and faecal transplants are the answer does not seem appropriate. Probiotics have been tried and tested for a long time without any convincing evidence for use (33919818, 27014757). Somebody else’s transplanted microbiome organisms could equally get trapped in your diverticula unless this treatment is used against a persistent toxic microorganism.

There is a lot of research into DD but still no recommended drug except paracetamol for pain. Treatment by diet manipulation, antibiotics or surgery for the various symptoms have been available for a long time. Ideas and theories during that time still persist, particularly that a high fibre diet is necessary for prevention and treatment of DD. However, constipation and a low fibre diet are not always associated with diverticulosis (23891924). Many lifestyle and dietary risk factors persisting from the ‘fibre’ era have been questioned (22062360). Hydration level and water supply are not considered in diet surveys but are important for colon function with dietary fibre.

In 1910 diverticula on the colon were of obscure origin and rarely seen (20764923 page 378). About 60% of 80 known cases then had had clinical symptoms. The changes in the sigmoid colon wall were described. The contraction of the longitudinal muscles and the concertina shape of the circular muscles only in the area where diverticula were present has been a consistent finding ever since. The author also considered that the forward passage of intestinal contents was nearly impossible. Much later research showed that this more rigid colon wall, due to collagen changes, did not allow compensation for internal pressure from faeces and gas, producing blow-out diverticula in the weakest places, nor could the longitudinal muscles easily relax to push out further contents in the colon. Are fibre-bulked faeces with seeds the best option for this situation with its biomechanical element (33937291, 34599376?). Colon wall thickening is also found with diverticula in the right side colon but constipation is not a prominent symptom with this.

Based on chemically induced animal models of colitis, (16885693), colon damage in DD was thought to occur only after diverticulitis (25703217). Increasing research is now investigating and demonstrating the permanent nerve/muscle damage but symptoms without infection are only slowly being accepted and its cause is still unsure (37013200, 26458921). Research concentrates on surgical or antibiotic treatment and lifestyle influences. Colon muscle and neurotransmission are areas were drugs might help (22572680), but firstly, what causes this colon damage is key to prevention.

Worldwide epidemiology strongly points to cigarette smoking as the cause of DD. Increase in incidence and mortality during the 20th century correlates with known smoking related diseases such as lung cancer. The damage to the colon muscles, nerves and collagen by long term nicotine use reflects its pharmacology, with differences in nicotine metabolism with sex and ethnicity affecting its presentation. There is no doubt that every clinical progression of DD is made worse by smoking in many reports. DD started early in the 20th century and reached epidemic proportions with smoking in Western countries. Now, many alternative sources of nicotine are available supposedly to reduce smoking but do not address nicotine addiction. We have yet to find their effects on another generation’s colons but DD is already being found in younger people.

© Mary Griffiths 2025

REFERENCES
The numbers in the text are PMID references. PubMed is a free resource supporting search and retrieval of biomedical and life science literature with the aim of improving health both globally and personably. It is available at https://www.pubmed.ncbi.nlm.nih.gov

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Diverticular Disease: Men and Women

Wednesday, February 9th, 2022

 

Diverticular disease (DD) is an acquired disease that was first demonstrated early in the 20th century. Its appearance and increasing importance occurred in cigarette-smoking western countries, particularly the USA and UK, where the habit and nicotine addiction was widespread in the population. These countries are the main source of reports and statistics. DD can no longer be considered the inevitable diet related disease of the elderly. DD can be a long term (26872402), progressive (13444546) and chronic disorder (22777341) as well as the acute infection of diverticulitis and its complications. Differences between males and females have always been apparent in hospital and mortality statistics where females predominate.

Diverticula – the small grape-like hernia – need to be seen on the colon before the disease can be diagnosed. Once they are present they are there for life. The data used to describe DD is in effect a measure of investigations, where and when they took place in the disease progression. For example, the same person could figure in post-mortem, mortality and hospital admission data but the diverticula could have been there for 40 -50 years. Similarly, ‘risk factors’ are for symptoms resulting in investigations revealing DD but are not the cause of DD. The current interpretation of data show DD in more men than women up to the age of 50 – 60 years, then proportions are reversed with more women in surveys measuring investigation of DD. No explanation has been offered for this effect (33727769) except hormone differences which of course cannot be disputed.

Eastwood (873339) considered factors which might influence a decision to investigate symptoms for a diagnosis of DD. Does a complicated selection process operate for a family doctor’s referral to a hospital consultant for an investigation? The presentation of symptoms or the seeking of medical advice, or social or geographical factors may affect data. Other influences mentioned in reports are costs and hospital capacity.

Because of low risk of colon cancer, internal examination, now usually by colonoscopy, are not considered necessary below the age of 50 years unless there are potentially dangerous symptoms. However, both diverticulosis, where diverticula are found without symptoms, and their infection ie diverticulitis, are found before the age of 50 years (15882243, 20604970). CT scanning for suspected appendicitis revealed 14% of the under 20 yrs. And 40% of those between 20 and 39 yrs. had evidence of diverticulosis. (33727769). Anybody with diverticulosis could get diverticulitis infection and nobody knows why. Symptoms of pain and dysfunction in males is more conspicuous than in females where it is part of their biology Males get investigation and diagnosis and earlier surgical treatment for DD than females (9860333).

Women with abdominal pain and bowel dysfunction are diagnosed quickly with Irritable Bowel Syndrome (IBS) (9262978). IBS is based on symptoms, but women have many symptoms peculiar to them that are not included in the research criteria for IBS (9096434). There are many potential causes of abdominal pain unique to females (31943595) that without relief can prompt repeated consultations more than males – a characteristic of IBS. Females can be told they have IBS as young adults, until after the menopause and even in old age. IBS will include people with diverticulosis and diverticulitis (19861955) but if found this does not change the diagnosis of IBS, some researchers think that only infected diverticula can cause pain (16678561). Data on the number of people with DD up to the age of 50 to 60 yrs. will show more males than females because more males are investigated and diagnosed.

Around the age of 50 yrs. screening for colon cancer by colonoscopy occurs. Finding diverticulosis is common and does not show different rates for males and females although females are slightly older. In older patient groups without significant symptoms, there is again no difference between the sexes (22573184). Symptoms such as constipation related to colon ageing at 60 to 70 yrs. old also appear to be the same. Differences between males and females appear if and when symptoms of DD become problematic and potentially serious. Females outnumber males when investigations are needed for episodes of diverticulitis or chronic complications of DD. This can be the first diagnosis of DD and younger age and female gender are independent risk factors (30647541). Frequently the female patients were found to have previously been diagnosed with IBS. Females and a preoperative diagnosis of IBS were also independent risk factors for persistent symptoms after sigmoidectomy (32077416).

For decades since the 1960s DD was considered a diet related disease of the elderly. Eating a low level of dietary fibre for at least 40 years produced diverticula. Adding wheat bran to meals was recommended to prevent the constipation then later any type of dietary fibre. This was supposed to prevent diverticula and diverticulitis development – now disproved. DD research concentrated in detail on diet and on hospital treatment for severe diverticulitis and life – threatening complications needing surgery. If and when dietary fibre was not helpful there were no other effective treatments for persistent, recurring or non-relenting, low grade inflammation symptoms that are now recognized (33727769, 22777341). Such symptoms have been described as ‘smoldering DD’ or ‘SUDD – symptomatic uncomplicated DD’ or the misnomer ‘post-diverticulitis IBS’ More females than males were diagnosed with SUDD in a survey (30023071) and this was a long-term condition (17431721). This is a painful part of some unfortunate patients’ experience of DD affecting quality of life and which does not reach the level of hospital treatment.

There is little information about DD in primary care (22572678). Extensive research at hospital level does not address the problems before patients see the specialists (17681003, 10601059). The number of diverticula can increase with age as can the extent if colon affected. There is no data on this aspect of DD to see if there is a difference between males and females. There are suggestions that more women than men are troubled by long term symptoms. In New Zealand NHS primary care, women had notably more antibiotics prescribed for them than men, particularly those under the age of 60 years, for 5 yrs. before they needed hospital attention for acute or non-acute problems. More antibiotic prescribing for women also continued for the next 5 yrs. of the survey (31314796). Chronic aspects of DD in women also appear in data from hospitals. Females were on average 5 years older than males when seen and had more chronic diverticulitis and strictures, but less bleeding than males (12907908).

This pattern continues in mortality studies. 300 unselected pathology colons found a higher incidence of DD in women and also the onset occurred at an earlier age. Before the age of 50, 21.7% of women and 4.2% of men had DD and diverticula were scattered along the colon in women (5679019). Men were more likely than women to have had surgery and have a surgical complication of diverticulitis as a secondary cause of death and are more likely to die in hospital. Women are more likely than men to die from chronic complications such as sepsis, obstruction or pelvic fistula and are more likely to die at home, in care or in a hospice (33216498, 33216487). Research is not providing reasons for these differences (30046356).

The situation with DD may be like emergency presentation at hospital for colon cancer (30734381). In 2 to 12 months before emergency, twice as many women than men had received a diagnosis of IBS or DD. This increased the risk for women aged 40 – 59 yrs. 20% of women had alarm symptoms before the emergency. These authors cite reports of longer diagnosis intervals, a higher risk of 3 or more consultations before specialist referral of women, different interpretation of symptoms in women compared with men and possible misattribution of symptoms in women to benign causes. New onset of ‘IBS’ in middle aged women was also of concern. Sex differences in health and medicine are increasingly recognized and women are disadvantaged (22699937). This includes DD were women appear to suffer a longer and chronic symptomatic disease which is less acknowledged or treated if and unless it becomes serious.

© Mary Griffiths 2022

REFERENCES

The numbers in the text are PMID references. PubMed is a free resource supporting search and retrieval of biomedical and life science literature with aim of improving health – both globally and personally. It is available at     https://www.pubmed.ncbi.nlm.nih.gov

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Diverticular Disease: Treatments After a Century

Saturday, July 25th, 2020

THE BEGINNING

Diverticula on the colon were a curiosity until increasing reports lead to official recording of deaths in 1923. This newly discovered disease of the elderly was only seen by surgeons trying to alleviate pain or correct the complications due to infection. Some pathologists were also interested in this phenomenon they found during postmortems. They did not know the patient’s problems which had preceded the serious condition, but their observations gave insight into how diverticula were formed.

Thickened wall muscles, concertina-like shortening of the sigmoid colon and narrowing of the lumen were the precursors of the appearance of diverticula. They did not know why this had happened but they did find that the damaged colon could give rise to pain needing surgery just as severe as the result of complications. The diverticula contained hard pellets of faeces (faecoliths) which could have been responsible for the pain and infection. Their observations appropriately led to recommendations for a diet, not necessarily low fibre, but a “softage” diet without pips, seeds or hard roughage. Only 20% of these patients were constipated.

WORLD WARS

With the advent of radiology, diverticula on the sigmoid colon (diverticulosis) were found in increasing numbers of people in the period between the two wars. There was speculation about the cause but no research was done. Advances in anaesthetics, blood transfusions and antibiotics made surgery safer. After WWII elective surgery was available to 10-20% of patients to remove the affected colon part to avoid future serious complications. How these patients were selected has not been reported. Risk/benefit considerations over the years have seen surgery more used as a treatment rather than a prophylactic.

“How fortunate I am having the opportunity of having this operation while I am fit and healthy”

     “I have seen many doctors and they all refuse me an operation so I am left suffering constant pain and discomfort every day”

In the UK deaths from diverticular disease (DD) increased up to 1939 then the rate was static until the 1950s. There was loss of interest in DD. This pause in mortality was later taken as evidence that the wartime diet in the UK, presumed to have more fibre, would prevent the diseases of the western world including DD. It was in fact due to the recording of deaths of civilians only. In the 1950s DD was beginning to be noticed again. The NHS was in its infancy. People resorted to herbal and traditional medicines. Laxatives were big business, people with or without DD were trying to conform to the daily toileting ideal of that era.

“—it was in 1948 when I first had stomach problems, and our dear old doctor, that we had then, explained to me why I was getting pain and wind, and on occasions blood, these were his words. Once when you were a little girl you ate too much, and your stomach couldn’t take all the food at once, so a part of it stretched a bit like a balloon and now you have a sort of pouch there which sometimes gets a bit packed out with food and causes all your problems, nothing can be done about this, so you must just be careful what you eat.”

     “I was told that I was part of a whole generation brought up during the war with a weekly purging of Syrup of Figs on a Saturday night therefore making a lazy bowel” 

WESTERN DISEASES

(more…)

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Diverticular Disease: Progression, Smoking and Nicotine

Sunday, April 14th, 2019

 

Diverticular disease (DD) can progress from changes in the gut nerves and muscles to formation of diverticula (diverticulosis), to symptoms of colon dysfunction, to infections and inflammation (diverticulitis), to chronic symptoms, and to serious abdominal complications. The number of sufferers along this pathway diminishes greatly at every stage, only a minority ever need surgical treatment. On the other hand, progression and ageing go hand in hand.

The causes and risk factors of progression after diverticulosis are as varied as the people with DD.  Nobody knows what brings on diverticulitis which can be a gateway to problems. Historically, a diet low in fibre was thought to be responsible for all of the disease spectrum and could be easily remedied. This is no longer accepted. In the second half of the 20th century nobody considered an effect of smoking on the gut. Most Western adults smoked despite the risks of lung cancer and heart disease. Cigarettes had calmed the soldiers of the war, they were glamorous and macho, and nicotine was strongly addictive.

Cigarette use was aligned much closer to the appearance of DD in the world than diets which were variable and often assumed. Articles on this website in 2012 and 2013 have details of this epidemiology and also explain the pharmacology of nicotine where chronic use can cause the damage to the colon characteristic of DD.

(more…)

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Diverticular disease AND/OR irritable bowel syndrome

Friday, June 29th, 2018

Information about diverticular disease (DD) is available in fact sheets on many internet sites, but these should be assessed. Is it up to date, does it help day-to-day problems, is it a charity or a business? Discussions on forums show a variety of experiences of DD and no general approach on what can be done to help. DD is sometimes mentioned by charities which support younger people with, for example, Crohn’s and ulcerative colitis (IBD) or Irritable Bowel Syndrome (IBS). In the last few years some people with DD have been told that they also have IBS. This can be very confusing because DD and IBS are different complaints sometimes with conflicting treatments and certainly different potential outcomes. Some researchers propose that any symptoms without diverticulitis must be IBS. This ignores or denies the colon damage which resulted in diverticula forming. Sources of information about IBS do not cover an IBS/DD diagnosis, never mind any differences which should be considered. (more…)

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The Microbiome in Diverticular Disease

Thursday, November 10th, 2016

New techniques which identify individual species have lead to an explosion of research into the role of bacteria in the colon. The terms ‘microbiota’ (the bacteria) and ‘microbiome’ (the collection of bacteria) are widely used. Some researchers consider the microbiome as equivalent to a body organ. It is certainly a significant, integral and specific part of the digestive system in man and animals. In protein-eating humans the microbiome is in the caecum, the first bag-like part of the large intestine which receives the residues of digestion and has enzymes which degrade amino acids from proteins. In herbivores the microbiome is in an earlier part of the digestive system to deal with large quantities of plant material to extract maximum nutrients for its host with enzymes to synthesise amino acids (1). The microbiome in humans can have both beneficial and unhelpful effects. Its position in the human body and the role of an associated appendix had not been considered apart from the letter on this website (2). The appendix is no longer considered a vestigial organ (3), contains extremely variable bacteria (4) and may be involved in microbiome changes (5).

Differences in the bacteria present in the microbiome have been found in conditions  such as obesity, autoimmune diseases, autism and bowel disease including diverticular disease (DD). The microbiome and its surrounding immune system are linked (6).

  • Is the microbiome content a cause or an effect of a disease?
  • Is the presence of a specific organism significant?
  • Could the microbiome be changed to treat a disease?

These are the questions research is trying to answer. Bacteria will only survive and flourish if the conditions and nutrients are right for the species. There is great variation both between and within people, with age and even with geographical location. So far only diet appears to make a difference (1, 7). Does the microbiome match dietary residues and the disease affect diet? (more…)

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Diverticular Disease: Genetics and Collagen

Thursday, July 9th, 2015

Compared with other diseases, advancements in science and technology left diverticular disease (DD) behind decades ago. Worldwide occurrence, poor quality of life, level of mortality and healthcare costs should have generated far more research effort. Preoccupation with dietary fibre levels, constipation and ageing has and still is stunting research. Fibre levels have benefits for constipation and symptoms but research into cause, prevention and other treatments has been overtaken by the necessary investigations into the surgical rescue of DD effects. Recently valid trials and surveys have disputed traditional thinking about a dietary cause and revealed a genetic factor. (more…)

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Diverticular Disease And Colon Cancer

Thursday, April 3rd, 2014

Does having diverticular disease (DD) increase the risk of colon cancer (CC)?  One expert would say “yes” and another would answer “no”. Much depends on the design of studies, choice of patients, what data is fed into the computer for statistical analysis, interpretation of the results and what opinions and conclusions are made.

Research can be based on the occurrence of the two separate diseases, how many people with DD have CC and how many people with CC have DD (1). Comparison can be made with the levels of CC and DD which would be expected in the general population. Information can be expanded by including different types of cancerous lesions and their position in the colon. The diagnosis of DD is not so stable. Diverticulitis but not diverticulosis was indicated to be in a long-term causal relationship with increased risk of left-sided CC (2). However, these conditions at diagnosis can change. Diverticulitis can revert to diverticulosis with few further problems, or, diverticulosis can later progress to diverticulitis or even further to serious complications. This is a basic problem in DD research. (more…)

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Diverticulitis: a wind of change

Sunday, December 2nd, 2012

There have been many changes over the years in the approach to diverticular disease (DD), even in the names used. Diverticular disease is the overall name. The presence of the grape-like diverticula on the outside of the colon results in a diagnosis of diverticulosis. Diverticulitis occurs when there is infection and inflammation of the diverticula but is often used when there are any symptoms caused by the disease.

Diverticulosis can have episodes of diverticulitis or complicated diverticulitis when problems such as bleeding, abscess, fistula or blockage need surgical treatment. This is a simplistic explanation of what might happen in DD in decreasing numbers, so that only a small fraction of people with DD ever need surgery. Any progression in the disease can stop and revert to symptomless diverticulosis at any time, some people with diverticulosis do not even know that they have it.

There has been confusion over many years about the symptoms with DD. (more…)

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Colon Wall Muscles in Diverticular Disease

Sunday, September 2nd, 2012

MUSCLE LAYERS

Between the mucus producing lining and the outer layer of the colon wall, there are two major muscle systems. The inner circular muscles surround the colon, contraction can close the colon or they can act in waves to propel contents along. Between the appendix at the beginning and the rectum at the end of the colon, longitudinal muscles are gathered into three bands known as taenia. This arrangement allows contractions to shorten the colon and propel faeces without compressing them. Coordination between the two types of muscle can produce a variety of movements. An earthworm moving along soil is a good example to observe a similar system.

MOVEMENTS ALONG THE COLON

In the caecum, repeated circular muscle contractions mix the liquid contents (chyme). These change into backwards and forwards segmenting and propulsive movements to dry and move the mushy contents along the ascending and transverse lengths of the colon. Longitudinal muscles become more involved as faeces become more solid in the second, left side, of the colon. Occasional powerful contractions sweep faeces into the descending and sigmoid areas. Faeces are stored with the sigmoid area acting as a vertical warehouse with supporting arcs of circular muscle. Strong contractions of longitudinal muscles produce a concertina effect to push out colon contents on defaecation. The first half of the colon is controlled automatically by the vagus nerve from the brain. The left side has some local nerve reflexes and a person can have some influence such as when to defaecate.

CHANGES WITH DIVERTICULAR DISEASE

Changes in the colon musculature in diverticular disease (DD) were described even before the early 20th century when DD was rare, (1) and in many reports since. Muscle abnormality and dysfunction persisted in the colon after resection of the areas with diverticula (2). Long sections of the left colon can change in appearance without any diverticula which may only occur years later. The muscular abnormalities are the primary pathogenic mechanisms of DD (3). DD is only diagnosed when diverticula are observed, changes in muscles have had little attention especially in areas without diverticula. (more…)

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