Diverticulosis is a condition marked by the formation of diverticula—small pouch-like herniations along the wall of the gastrointestinal tract. Most commonly, diverticula appear in the left side of the colon; rarely, they also develop as far up as the throat (pharynx). As many as half of all americans over the age of 50 have diverticulosis, although few ever have any noticeable symptoms. Diverticulosis only requires treatment if it causes discomfort (painful diverticular disease) or complications.
In some cases the diverticula become inflamed or infected—a painful condition known as diverticulitis. In severe cases, an inflamed diverticulum may perforate or burst, resulting in abscesses or peritonitis (inflammation of the lining of the abdominal cavity, which may be fatal unless treated immediately). Diverticula may also cause rectal bleeding. Diverticular disorders are not related to colon cancer.
Diverticular disease is most common in people 45 years of age and older and affects 30 percent of adults over age 60.
In diverticulosis, small pouches (diverticula) form in weakened areas in the wall of the colon. In diverticulitis, these pouches become infected and may perforate, which can allow pus to leak outside of the colon.
What Causes Diverticular Disorders?
- Diverticulosis is usually caused by chronically increased pressure and strain on the colon wall.
- A low-fiber diet (common in industrialized Western countries) is correlated with diverticular disease. The disorder is almost unheard of in rural Asian and African societies, where a high-fiber diet is the norm.
- Hereditary factors may play a small role in the development of diverticulosis.
- Increased pressure on the colon from straining during bowel movements or from chronic constipation may lead to the formation of diverticula.
Symptoms of Diverticular Disorders
- Diverticulosis usually causes no symptoms. However, some patients do develop mild complaints, including bloating, gas, nausea, constipation alternating with diarrhea, and tenderness or pain, most often in the lower left abdomen.
- Symptoms are pronounced when a diverticulum becomes inflamed or perforated (diverticulitis). Severe abdominal cramping, usually on the lower left side, is most prominent. Pain may be immediately severe or start off gradually and increase in severity over several days. Other symptoms may include tenderness over the abdomen, fever, nausea, and impaired bowel function. Often, diverticulitis can cause bleeding from the rectum.
Prevention of Diverticular Disorders
- Eat a high-fiber, low-fat diet. Foods high in fiber include fruits, vegetables, and whole-grain breads and cereals.
- Drink plenty of fluids (at least eight full glasses of water a day) to help soften stools.
- Exercise regularly to help maintain regularity of bowel movements.
Diagnosis of Diverticular Disorders
- A barium enema may be performed. The barium creates a sharp image on x-ray of the digestive tract.
- Colonoscopy (use of a thin scope with a lighted end to view the colon) may be performed.
- A CT (computed tomography) scan may be performed to help diagnose acute diverticulitis.
- X-rays may be used to detect spasm of the colon if irritable bowel syndrome is present.
How to Treat Diverticular Disorders
- Following prevention tips for diet (especially incorporating fiber) and exercise is important.
- Your doctor may recommend a bulking laxative containing the fiber psyllium or an artificial fiber like calcium polycarbophil. However, do not take laxatives without consulting your doctor and never use enemas—these may only further aggravate a diverticular disorder.
- For diverticulitis, your doctor may prescribe antibiotics and bed rest, often in the hospital.
- Injections of painkillers may be warranted in severe cases of diverticulitis.
- Antispasmodic drugs may be prescribed to relax the muscles around the digestive tract.
- You may need to have your stomach kept empty (with a tube passed through the mouth into the stomach) and to be fed intravenously to allow inflamed diverticula to heal. You should be able to eat and drink normally when symptoms have subsided (generally in a few days).
- Surgery may be necessary to drain an abscess.
- Blood transfusions may be necessary in patients with profound bleeding from diverticuli.
- In severe or recurrent cases, surgery may be necessary to remove the affected part of the colon. In a few cases, a temporary colostomy may be required, with later operations to reconnect the colon.
When to Call a Doctor
- Call a doctor immediately if you experience severe abdominal pain, with or without fever or abdominal bloating.
- Call a doctor if you notice a change in your bowel habits that lasts longer than two weeks, especially if you also experience rectal bleeding. Call a doctor if minor symptoms of diverticulosis (nausea, bloating, constipation, and others) develop and persist.
- Call a doctor if you start passing blood from the rectum or feel weak or dizzy.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media