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Diverticulosis and Diverticulitis Diverticulosis and Diverticulitis National Digestive Diseases Information Clearinghouse What are diverticulosis and diverticulitis? Many people have small pouches in the lin­ ing of the colon, or large intestine, that bulge Colon (large intestine) U.S. Department of Health and outward through weak spots. Each pouch is Human Services called a diverticulum. Multiple pouches are called diverticula. The condition of having NATIONAL diverticula is called diverticulosis. About INSTITUTES OF HEALTH 10 percent of Americans older than 40 have diverticulosis.1 The condition becomes more common as people age. About half of all people older than 60 have diverticulosis.2 Diverticula are most common in the lower portion of the large intestine, called the sigmoid colon. When the pouches become Diverticula inflamed, the condition is called diverticulitis. Ten to 25 percent of people with diverticulosis get diverticulitis.3 Diverticulosis and divertic­ Many people have small pouches in their colon that ulitis together are called diverticular disease. bulge outward through weak spots. Each pouch is called a diverticulum. Multiple pouches are called diverticula. The condition of having diverticula is What are the symptoms called diverticulosis. of diverticulosis and diverticulitis? not always mean a person has diverticulosis. Diverticulosis People with chronic symptoms should visit Most people with diverticulosis do not have their doctor or health care provider. any discomfort or symptoms. However, Diverticulitis some people may experience crampy pain or discomfort in the lower abdomen, bloating, The most common symptom of diverticulitis and constipation. Other conditions such as is abdominal pain. The most common sign irritable bowel syndrome and stomach ulcers on examination is tenderness in the lower cause similar problems, so the symptoms do left side of the abdomen. Usually, the pain is severe and comes on suddenly, but it can also be mild and become worse over several days. 1Bogardus ST. What do we know about diverticular disease? A brief overview. Journal of Clinical The intensity of the pain can fluctuate. A per­ Gastroenterology. 2006;40:S108–S111. son may experience cramping, nausea, vomit­ 2Ibid. ing, fever, chills, or a change in bowel habits. 3Ibid. What are the complications Infected diverticula may develop perfora­ tions. Sometimes the perforations leak pus of diverticulitis? out of the colon and form a large abscess Diverticulitis can lead to bleeding; infections; in the abdominal cavity, a condition called small tears, called perforations; or blockages peritonitis. A person with peritonitis may be in the colon. These complications always extremely ill with nausea, vomiting, fever, and require treatment to prevent them from pro­ severe abdominal tenderness. The condi­ gressing and causing serious illness. tion requires immediate surgery to clean the abdominal cavity and remove the damaged Bleeding part of the colon. Without prompt treatment, Rectal bleeding from diverticula is a rare peritonitis can be fatal. complication. Doctors believe the bleeding is caused by a small blood vessel in a diver­ Fistula ticulum that weakens and then bursts. When A fistula is an abnormal connection of tissue diverticula bleed, blood may appear in the between two organs or between an organ and toilet or in the stool. Bleeding can be severe, the skin. When damaged tissues come into but it may stop by itself and not require treat­ contact with each other during infection, they ment. A person who has bleeding from the sometimes stick together. If they heal that rectum—even a small amount—should see way, a fistula may form. When diverticulitis- a doctor right away. Often, colonoscopy is related infection spreads outside the colon, used to identify the site of bleeding and stop the colon’s tissue may stick to nearby tissues. the bleeding. Sometimes the doctor injects The organs usually involved are the bladder, dye into an artery—a procedure called small intestine, and skin. angiography—to identify and treat diver­ The most common type of fi stula occurs ticular bleeding. If the bleeding does not between the bladder and the colon. This stop, surgery may be necessary to remove the type of fistula affects men more often than involved portion of the colon. women. It can result in a severe, long-lasting Abscess, Perforation, and infection of the urinary tract. The problem can be corrected with surgery to remove the Peritonitis fistula and the affected part of the colon. Diverticulitis may lead to infection, which often clears up after a few days of treatment Intestinal Obstruction with antibiotics. If the infection gets worse, Scarring caused by infection may lead to par­ an abscess may form in the wall of the colon. tial or total blockage of the intestine, called An abscess is a localized collection of pus intestinal obstruction. When the intestine is that may cause swelling and destroy tissue. blocked, the colon is unable to move bowel If the abscess is small and remains in the wall contents normally. If the intestine is com­ of the colon, it may clear up after treatment pletely blocked, emergency surgery is neces­ with antibiotics. If the abscess does not clear sary. Partial blockage is not an emergency, up with antibiotics, the doctor may need to so the surgery to correct it can be planned. drain it using a catheter—a small tube— placed into the abscess through the skin. After giving the patient numbing medicine, the doctor inserts the needle through the skin until reaching the abscess and then drains the fluid through the catheter. This process may be guided by sonography or x ray. 2 Diverticulosis and Diverticulitis What causes diverticular How is diverticular disease disease? diagnosed? Although not proven, the dominant theory To diagnose diverticular disease, the doctor is that a low-fiber diet causes diverticular asks about medical history, does a physical disease. The disease was first noticed in the exam, and may perform one or more diag­ United States in the early 1900s, around nostic tests. Because most people do not the time processed foods were introduced have symptoms, diverticulosis is often found into the American diet. Consumption of through tests ordered for another ailment. processed foods greatly reduced Americans’ For example, diverticulosis is often found fiber intake. during a colonoscopy done to screen for cancer or polyps or to evaluate complaints of Diverticular disease is common in developed pain or rectal bleeding. or industrialized countries—particularly the United States, England, and Austra­ When taking a medical history, the doc­ lia—where low-fiber diets are consumed. tor may ask about bowel habits, pain, other The disease is rare in Asia and Africa, where symptoms, diet, and medications. The most people eat high-fi ber diets. physical exam usually involves a digital rectal exam. To perform this test, the doctor inserts Fiber is the part of fruits, vegetables, and a gloved, lubricated finger into the rectum to grains that the body cannot digest. Some detect tenderness, blockage, or blood. The fiber, called soluble fiber, dissolves easily in doctor may check stool for signs of bleeding water. It takes on a soft, jelly-like texture in and test blood for signs of infection. If diver­ the intestines. Insoluble fiber passes almost ticulitis is suspected, the doctor may order unchanged through the intestines. Both one of the following radiologic tests: kinds of fiber help prevent constipation by making stools soft and easy to pass. • Abdominal ultrasound. Sound waves are sent toward the colon through Constipation—or hard stool—may cause a handheld device that a technician people to strain when passing stool during glides over the abdomen. The sound a bowel movement. Straining may cause waves bounce off the colon and other increased pressure in the colon, which may organs, and their echoes make electrical cause the colon lining to bulge out through impulses that create a picture—called weak spots in the colon wall. These bulges a sonogram—on a video monitor. If are diverticula. the diverticula are inflamed, the sound Lack of exercise also may be associated waves will also bounce off of them, with a greater risk of forming diverticula, showing their location. although the reasons for this are not well • Computerized tomography (CT) scan. understood. The CT scan is a noninvasive x ray that Doctors are not certain what causes divertic­ produces cross-section images of the ula to become inflamed. The infl ammation body. The doctor may inject dye into may begin when bacteria or stool are caught a vein and the person may be given a in the diverticula. An attack of diverticulitis similar mixture to swallow. The person can develop suddenly and without warning. lies on a table that slides into a donut- shaped machine. The dye helps to show complications of diverticulitis such as perforations and abscesses. 3 Diverticulosis and Diverticulitis How is diverticular disease data support this treatment measure. Eat­ ing a high-fiber diet is the only require­ treated? ment highly emphasized across the medical A high-fiber diet and pain medications help literature. Eliminating specific foods is not relieve symptoms in most cases of diverticu­ necessary. The seeds in tomatoes, zucchini, losis. Uncomplicated diverticulitis with mild cucumbers, strawberries, and raspberries, as symptoms usually requires the person to rest, well as poppy seeds, are generally considered take oral antibiotics, and be on a liquid diet harmless. People differ in the amounts and for a period of time. Sometimes an attack types of foods they can eat. Decisions about of diverticulitis is serious enough to require diet should be made based on what works a hospital stay, intravenous (IV) antibiotics, best for each person. Keeping a food diary and possibly surgery. may help identify what foods may cause Diverticulosis symptoms. Increasing the amount of fiber in the diet If cramps, bloating, and constipation are may reduce symptoms of diverticulosis and problems, the doctor may prescribe a short prevent complications such as diverticulitis.
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