Diverticulosis

Diverticulosis is diagnosed and treated by the GI Division of Premier Medical Group.

What are diverticulosis and diverticulitis?

Back to top

Diverticulosis is the formation of tiny pouches in your digestive tract that bulge out. These pouches are called diverticula. They are common, especially after age 40, and found in more than half of Americans over age 60. You may never know the diverticula exist, because they rarely cause problems. However, when these pouches become infected or inflamed, it is called diverticulitis (di-vur-tik-u-LI-tis).

Diverticulitis can occur anywhere, including your stomach, small intestine, even your esophagus. Most often, it occurs in the large intestine. Diverticulitis may cause nausea, fever, abdominal pain and a change in bowel habits. Treatment depends on the severity of the condition. Diverticulosis and diverticulitis together are called diverticular disease.

What causes diverticulosis?

Back to top

No one knows exactly what causes diverticulosis, but researchers believe that the diverticula form when high pressure inside the colon pushes against weak spots in the colon wall. Constipation or hard stool can cause straining which in turn causes the increased pressure in the colon, which may cause the colon lining to bulge out through weak spots in the colon wall.

The most common cause of diverticulosis is eating a low-fiber diet. The disease is most common in developed or industrialized countries—particularly the United States, England, and Australia—where low-fiber diets are consumed. Most Americans eat processed food, so they don’t get enough fiber in their diet. Examples of processed food are white rice, white bread, most breakfast cereals, and things like pretzels and crackers. Diverticulosis is rarer in Asia and Africa, where most people eat high-fiber diets.

What causes diverticulitis?

Back to top

Again, we don’t exactly know why some people get the disease and some people don’t, but the proximal cause of diverticulitis may be small pieces of stool that become trapped in these pouches. The same pressure that created the pouches in the first place may push these contaminants into the pouch. This results in inflammation and/or infection. An attack of diverticulitis can develop suddenly and without warning. Diverticula are most common in the lower portion of the large intestine, called the sigmoid colon.

What are the symptoms of diverticulitis?

Back to top

The most common symptom of diverticulitis is abdominal pain; however, most people with diverticulosis do not have any discomfort or symptoms. Other symptoms can be pain similar to cramps, or discomfort in the lower abdomen, bloating, and constipation. The pain can be mild and worsen over a few days, but it can also be severe and come on suddenly. Some people experience nausea, fever, chills, loss of appetite, and a change in bowel habits. The symptoms of diverticulitis can be similar to those of IBS, or stomach ulcers. It’s very important to visit your doctor for a complete check-up and diagnosis.

How is diverticulosis diagnosed?

Back to top

In order to diagnose diverticular disease, your doctor will first take your medical history and perform a physical exam. In most cases, diverticulosis is discovered only when tests such as a barium enema, X-ray, or a colonoscopy are performed, often when looking for something completely different. Because the symptoms don’t show up until there is a flare-up, people can have diverticulosis for a long time without knowing it. Most often, it is found during a routine colonoscopy.

The physical exam usually involves a digital rectal exam with a lubricated, gloved finger. This will detect tenderness, blockage, or blood. The health care provider may also check the stool for blood. Other tests, which can detect diverticulosis, are computerized tomography (CT) scan, or barium enema.

How is diverticulitis treated?

Back to top

The treatment for diverticulitis depends on the severity of the symptoms. Usually you can treat this problem at home, but if it is severe, you may need to be hospitalized to get it under control. The doctor may treat you with antibiotics, and he or she may recommend the following to help your pain:

  • Pain medication
  • Bed rest
  • A warm pad, such as a heating pad on your belly
  • Fluids for a day or two and then the gradual introduction of denser liquids and then foods

If you are bloated or have gas, then avoid the amount of fiber you eat for a few days. However, when you are past the acute stage, your doctor will recommend that you add more fiber to your diet and refrain from certain foods, such as:

  • Coffee, tea, or alcohol only in moderation (they can make constipation worse)
  • Beans, peas, coarse grains, coconut
  • Dried fruits, skins on vegetables and fruits

What is the treatment for diverticulosis?

Back to top

Unfortunately, there is no treatment for diverticulosis. Once the pouches (diverticula) have formed, they are here to stay. However, there are things you can do to avoid diverticulitis attacks. In addition to dietary changes, your doctor will likely suggest that you:

  • Avoid constipation by drinking lots of fluids
  • Use a fiber supplement such as Metamucil, Citrucel, or Benefiber
  • Exercise regularly
  • Try to have your bowel movement the same time every day

Surgery may be indicated if the symptoms of diverticulitis are frequent, or if there is no response to antibiotics and resting the colon. If surgery is advised, the surgeon will remove the affected portion of the colon and join the remaining ends together. This is called a colon resection. This type of surgery is also used if there is a fistula or partial intestinal obstruction.

Another type of surgery is performed if there are other complications such as complete intestinal obstruction, severe bleeding, peritonitis, perforation, or large abscess. This type of surgery is two parts, first to clean the infected area and perform a temporary colostomy. An opening or stoma is created in the abdomen and the end of the colon is connected to the opening to allow normal eating while healing occurs. Stool is collected in a pouch attached to the stoma.

In the second surgery several months later, the surgeon rejoins the ends of the colon and closes the stoma.

FAQs

Back to top

Q: What are the complications of diverticulitis?
A: Diverticulitis can lead to infections, perforations, bleeding and even blockages of the colon.

Q: Can diverticulosis be prevented?
A: Eating a high-fiber diet, getting plenty of fluid, and exercising regularly may help prevent diverticulosis.

Q: When is surgery indicated?
A: When symptoms of diverticulitis are frequent, or the patient does not respond to antibiotics and rest. Immediate surgery may be necessary when the patient has other complications, such as perforation, a large abscess, peritonitis, complete intestinal obstruction, or severe bleeding.

Q: When should I contact a medical professional?
A: You should call your health care provider if you have blood in your stool, fever over 100.4, vomiting, chills, nausea, or sudden belly or back pain that gets very severe.