This information was developed by the Publications Committee of the American Society for Gastrointestinal Endoscopy (ASGE). For more information about ASGE, visit www.asge.org.

Understanding Diverticulosis

What is diverticulosis? abdominal cramps or due symptoms and, therefore, do not need Diverticulosis is a condition in which to difficulty in stool passage through treatment. When diverticulosis is ac- there are small pouches or pockets the affected region of the colon. companied by abdominal pain, in the wall or lining of any portion of or constipation, your doctor may rec- How is the diagnosis of the digestive tract. These pockets oc- ommend a high-fiber diet to help make diverticulosis made? cur when the inner layer of the diges- stools softer and easier to pass. While tive tract pushes through weak spots in Because most people do not have it is recommended that we consume 20 the outer layer. A single pouch is called symptoms, diverticulosis is often found to 35 grams of fiber daily, most people a . The pouches associated incidentally during evaluation for an- only get about half that amount. The with diverticulosis are most often locat- other condition or during a screening easiest way to increase fiber intake is to ed in the lower part of the large intes- exam for polyps. Gastroenterologists eat more fruits, vegetables and grains. tine (the colon). Some people may have can directly visualize the diverticula Apples, pears, broccoli, carrots, squash, only several small pouches on the left (more than one pouch, or diverticu- baked beans, kidney beans, and lima side of the colon, while others may have lum) in the colon during a procedure beans are a few examples of high-fiber involvement in most of the colon. that uses a small camera attached to a foods. As an alternative, your doctor lighted, flexible tube inserted through may recommend a supplemental fiber Who gets diverticulosis? the . One of these procedures product such as psyllium, methylcellu- is a sigmoidoscopy, which uses a short lose, or poly-carbophil. These products Diverticulosis is a common condition in tube to examine only the rectum and come in various forms including pills, the United States that affects half of all lower part of the colon. A powders and wafers. Supplemental fi- people over 60 years of age and nearly uses a longer tube to examine the entire ber products help to bulk up and soften everyone by the age of 80. As a person colon. Diverticulosis can also be seen the stool, which makes bowel move- gets older, the pouches in the digestive using other imaging tests, for example ments easier to pass. Your doctor may tract become more prominent. Diver- by computed tomography (CT) scan or also prescribe medications to help relax ticulosis is unusual in people under 40 barium x-ray. spasms in the colon that cause abdomi- years of age. In addition, it is uncom- nal cramping or discomfort. mon in certain parts of the world, such What is the treatment for as Asia and Africa. diverticulosis? Are there complications from diverticulosis? What causes diverticulosis? Once diverticula form, they do not dis- appear by themselves. Fortunately, most Diverticulosis may lead to several Because diverticulosis is uncommon patients with diverticulosis do not have complications including , in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables, most doctors believe this condition is due in part to a diet low in fiber. A low-fiber diet leads to consti- pation, which increases pressure within DIVERTICULUM the digestive tract with straining during Diverticulosis is a bowel movements. The combination of common condition pressure and straining over many years in the United States likely leads to diverticulosis. that affects half of all people over 60 years of age and nearly What are the symptoms of di- everyone by the age of verticulosis? 80. Most people who Most people who have diverticulosis are have diverticulosis are unaware that they unaware that they have the condition have the condition because it usually does not cause symp- because it usually does toms. It is possible that some people not cause symptoms. with diverticulosis experience bloating,

1 infection, bleeding or intestinal block- lum and is called diverticular bleeding. mine the cause of bleeding and to treat age. Fortunately, diverticulosis does This is the most common cause of ma- the bleeding. Occasionally, surgery or not lead to cancer. occurs jor colonic bleeding in patients over 40 other procedures may be necessary to when the pouches become infected or years old and is usually noticed as pas- stop bleeding that cannot be stopped inflamed. This condition usually pro- sage of red or maroon blood through by other methods. Intestinal blockage duces localized abdominal pain, ten- the rectum. Most diverticular bleeding may occur in the colon from repeated derness to touch and fever. A person stops on its own; however, if it does attacks of diverticulitis. In this case, sur- with diverticulitis may also experience not, a colonoscopy may be required for gery may be necessary to remove the , vomiting, shaking, chills or evaluation. If bleeding is severe or per- involved area of the colon. constipation. Your doctor may order a sists, a hospital stay is usually required CT scan to confirm a diagnosis of di- to administer intravenous fluids or pos- verticulitis. Minor cases of infection sibly blood transfusions. In addition, a are usually treated with oral antibiot- colonoscopy may be required to deter- The easiest way to increase fiber ics and do not require admission to the intake is to eat more fruits, veg- hospital. If left untreated, diverticulitis etables and grains. Diverticulosis may lead to a collection of pus (called is uncommon in regions of the world where diets are high in an ) outside the colon wall or a fiber and rich in grains, fruits and generalized infection in the lining of the vegetables. Most doctors believe abdominal cavity, a condition referred this condition is due in part to a to as . Usually a CT scan is diet low in fiber. required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the ab- scess. Repeated attacks of diverticulitis may require surgery to remove the af- fected portion of the colon. Bleeding in the colon may occur from a diverticu-

TRANSVERSE COLON

ASCENDING COLON asge.org screen4coloncancer.org

DESCENDING COLON

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RECTUM

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APPENDIX

Bleeding in the colon may occur from a diverticulum. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. If left untreated, diverticulitis may lead to an abscess outside the colon wall or an infection in the lining of the abdominal cavity. 2 Notes or questions:

This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you consult your doc- tor about your specific condition.

Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and diges- tive health by promoting excellence in gastrointestinal endoscopy. ASGE, with more than 11,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, and is the foremost resource for en- doscopic education. This information is the opinion of and provided by the American Society for Gastrointestinal Endoscopy.

Copyright © 2010. American Society for Gastrointestinal Endoscopy. All rights reserved. This information may not be reproduced without express written permission by ASGE. For permission requests, please contact the ASGE Communications Department at 630-673-0600.

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