Diverticular Disease

What is diverticular disease?

In the colon, some people have small pouches that bulge outward through weak spots where the blood vessels enter the colon. A single pouch is called a diverticulum.

  • Two or more pouches are called diverticula.
  • Having diverticula is a condition called diverticulosis.
  • Having a perforation of the diverticula that causes infection and inflammation is a condition called diverticulitis.
  • The conditions of diverticulosis or diverticulitis are referred to as diverticular disease.

Diverticulitis occurs in 10 to 25 percent of people with diverticulosis. Approximately half of Americans ages 60 to 80, and almost everyone over age 80, have diverticulosis at some time. The disease is common in developed or industrialized countries – particularly the United States, England, and Australia – where low-fiber diets are common. It is rare in countries in Asia and Africa, where people eat high-fiber diets.

 What causes diverticular disease?

It is believed that a low-fiber diet is the main cause of diverticular disease. Fiber is the part of fruits, vegetables, and grains that the body cannot digest.

  • Soluble fiber dissolves easily in water and takes on a soft, jelly-like texture in the intestines.
  • Insoluble fiber passes almost unchanged through the intestines.

Both kinds of fiber help make stools soft and easy to pass, which helps to prevent constipation.
Constipation is the main cause of increased pressure in the colon, making the muscles within the colon strain to move stool that is too hard. The excess pressure caused by the straining makes the weak spots in the colon bulge out, forming diverticula. Physicians do not know what causes the infection that causes diverticulitis, but believe it may begin when stool or bacteria are caught in the diverticula.

What are the symptoms of diverticular disease?

The following are the most common symptoms of diverticular disease. However, each individual may experience symptoms differently. Symptoms may include:

  • Diverticulosis. It may not cause any discomfort or symptoms, but could include mild cramps, bloating, and constipation. These symptoms may also be caused by irritable bowel syndrome (IBS), stomach ulcers, or other problems and do not always indicate diverticulosis.
  • Diverticulitis. The most common symptom is abdominal pain and the most common sign is tenderness around the left side of the lower abdomen. Fever, nausea, vomiting, chills, cramping, and constipation may also occur.

The symptoms of diverticular disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is diverticular disease diagnosed?

In addition a complete medical history and physical examination, your physician may perform a digital rectal examination (DRE) to feel for tenderness, blockage, or blood. A computed tomography (CT) scan is now a common way to diagnose diverticulitis. Diverticula without diverticulitis are also commonly seen during colonoscopy done for other reasons, such as screening for colon cancer.

Treatment for diverticular disease

Specific treatment for diverticular disease will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include increasing dietary fiber intake by eating foods such as the following: whole grain breads, cereals, and other products fruit, such as berries, apples, and peaches vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, and squash beans.

In the past, avoiding foods with small seeds, such as tomatoes or strawberries, was suggested because it was believed that particles could lodge in the diverticula and cause inflammation. Consult your physician regarding which foods you should avoid.

Treatment for diverticulitis may also include:

  • medications (to control pain)
  • medications (for infection and inflammation)
  • medications (to control muscle spasms)
  • resting the colon, with liquid diet and bed rest
  • surgery to remove the inflamed portion of the colon

Hospitalization may be required for acute attacks with severe pain or infection. Surgery for diverticular disease.  Surgery is the only way to remove the area of diverticulitis that is causing problems.

Rarely, the infection from diverticulitis may spread quickly throughout the abdomen, requiring emergency surgery to stop the spread of pus and stool. When this happens, the area of infection is usually removed, but often the bowel cannot be connected. This requires a colostomy, where the colon is brought out to the abdominal skin and stool is collected in a bag. These patients can usually be “hooked up” again and use the bathroom normally, but only after the inflammation goes down after several weeks.

For patients whose diverticulitis responds to medicines, surgery may be indicated after the inflammation has resolved, to help prevent another attack. This may be true for patients with a severe attack, multiple attacks or patients who are young. After each attack, the risk of another attack grows higher.