Diverticulosis

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

What are diverticulosis and diverticulitis?

Back to top

Diverticula are tiny pouches in your digestive tract that bulge out. When these pouches become inflamed, it is called diverticulitis (di-vur-tik-u-LI-tis). This can occur anywhere, including your stomach, small intestine, even your esophagus. Most often, diverticulitis occurs in the large intestine. You may never know the diverticula exist, because they rarely cause problems. When they become infected, you may experience symptoms such as nausea, fever, abdominal pain and a change in bowel habits. Diverticula are common, especially after age 40, and found in more than half of Americans over age 60. Treatment depends on the severity of the diverticulitis. Diverticulosis and diverticulitis together are called diverticular disease.

What causes diverticulosis?

Back to top

The disease in most common is developed or industrialized countries—particularly the United States, England, and Australia—where low-fiber diets are consumed. It is rarer in Asia and Africa, where most people eat high-fiber diets.

No one knows the exact reason why the sacs or pouches form. The most common cause we do know of is eating a low-fiber diet. 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.

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. These bulges are diverticula. Small pieces of stool can become trapped in these pouches, causing infection or inflammation. 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 diverticulosis?

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 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 diverticulosis treated?

Back to top

Your treatment depends on the severity of your 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

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

Your doctor will suggest that you add more fiber to your diet (if you are bloated or have gas, then avoid the amount of fiber you eat for a few days). Unfortunately, once the pouches (diverticula) have formed, they are here to stay. Some changes in diet and lifestyle can help avoid the “diverticulitis attacks” (inflammation).

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