What is diverticulitis?

Diverticulitis develops from a condition called diverticulosis. If you’re older than age 40, it’s common for you to have diverticulosis – small, bulging pouches (diverticula) in your digestive tract. In the United States, more than 50 percent of people older than 60 have diverticula. Although diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestine. Because these pouches seldom cause any problems, you may never know you have them.

Sometimes, however, one or more pouches become inflamed or infected, causing severe abdominal pain, fever, nausea and a marked change in your bowel habits. When diverticula become infected, the condition is called diverticulitis. Mild cases of diverticulitis can be treated with rest, changes in your diet and antibiotics. But serious cases of diverticulitis may eventually require surgery to remove the diseased portion of your colon.

Fortunately, most people with diverticulosis never develop diverticulitis. Best of all, you can help prevent both types of diverticular disease by including more high-fiber foods in your diet.

What are the signs and symptoms of diverticulosis?

Diverticulitis symptoms can feel like appendicitis, except you’ll generally have pain in the lower left side of your abdomen, instead of the lower right side. The pain is usually severe and comes on suddenly, but sometimes you may have mild pain that becomes worse over several days and fluctuates in intensity. You may also have abdominal tenderness, fever, nausea, and constipation or diarrhea.

Less common signs and symptoms of diverticulitis may include:

  • Vomiting
  • Bloating
  • Bleeding from your rectum
  • Frequent urination
  • Difficulty or pain while urinating
  • Tenderness in your abdomen when wearing a belt or bending over

What are the causes of diverticulosis?

Diverticula usually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall. In Western populations, pouches are most common in your sigmoid and descending colon – the lower portions of your large intestine just above your rectum. In Asian populations, pouches in the right colon (cecum and ascending colon) are more common.

Increased pressure in the colon can lead to breakdown of the wall of the diverticula leading to infection. A small tear or perforation can also develop in an infected pouch, which in turn can cause an infection within your abdomen (peritonitis). If the infection is limited to an area around the wall of your colon where the diverticula are inflamed, you may develop a localized collection of pus known as an abscess.

Diverticulosis occurs when small, bulging pouches develop in your digestive tract. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.

What are the risk factors of diverticulosis?

These factors may increase the pressure on the wall of your colon:

  • Aging. You’re more likely to get diverticulitis if you’re over the age of 40, although it’s not known why. It may be due to age-related changes, such as a decrease in strength and elasticity of your bowel wall, that lead to diverticulitis.
  • Too little fiber. Diverticulitis is rare in countries where people eat a high-fiber diet that helps keep stools soft. But it’s common in industrialized nations, such as the United States, where the average diet is high in refined carbohydrates and low in fiber. In fact, diverticular disease emerged after the introduction of steel-rolling mills, which greatly reduced the fiber content of flour and other grains. The disease was first observed in the United States in the early 1900s, around the time processed foods became a mainstay of the American diet.
  • Lack of exercise. Lack of exercise has been associated with a greater risk of formation of diverticula putting a person at risk of diverticulitis. The reasons for this aren’t understood.

Screening and Diagnosis 

Because diverticula by themselves usually don’t cause problems, most people learn they have diverticulosis during routine screening examinations for colorectal cancer or during tests that check for other intestinal problems. Diverticulitis, on the other hand, is usually diagnosed during an acute attack. our doctors is likely to examine your abdomen for tenderness. You may also have a blood test to check your white blood cell count and an imaging test such as a CT scan to help visualize the pouches that are inflamed or infected. A CT scan uses a series of computer-directed X-rays to provide a comprehensive view of your internal organs.

Diverticulitis can be confused with other causes of abdominal pain such as appendicitis, pelvic inflammatory disease or irritable bowel syndrome. Diverticulitis can range from minor inflammation to a massive infection. Because diverticulitis can be serious, see our doctors right away if you suspect you’re having an attack.

What are the complications of diverticulosis?

In rare cases, an infected or inflamed pouch may rupture, spilling intestinal waste into your abdominal cavity and leading to peritonitis – an inflammation of the lining of your abdominal cavity (peritoneum). Peritonitis is a medical emergency and requires immediate care.

Other complications of diverticulitis may include bleeding, a blockage in your colon or small intestine, an abscess or a fistula. A fistula is an abnormal passageway that occurs between different parts of your intestine, between your intestine and your bladder or vagina, or between your intestine and abdominal wall.

Although there’s no evidence that diverticular disease increases your risk of colon or rectal cancer, it can make cancer more difficult to diagnose. Because of this, our doctors often recommends a colonoscopy after you’ve recovered from a bout of diverticulitis along with more frequent cancer-screening tests. A colonoscopy is a test that allows our doctors to examine your entire colon and rectum for abnormalities using a long, flexible tube with a tiny video camera at the tip (colonoscope).

What are the treaments of diverticulosis?

In general, treatment depends on the severity of your signs and symptoms and whether this is your first attack of diverticulitis. If your symptoms are mild, a liquid or low-fiber diet and antibiotics may be all you need. But if you’re at risk of complications or have recurrent attacks of diverticulitis, you may need more advanced care.

Home care
If your condition calls for home treatment, expect to remain quiet for a few days. You’ll also temporarily need to avoid all whole grains, fruits and vegetables so that your colon can rest and heal. Once your symptoms improve – often in two to four days – you can gradually start increasing the amount of high-fiber foods in your diet.

In addition, our doctors will likely prescribe antibiotics to help kill the bacteria causing your infection. Even if you start feeling better, be sure to finish your entire course of medication. Stopping too soon could cause your infection to come back or could contribute to creating strains of bacteria that are resistant to antibiotics.

If you have moderate or severe pain, our doctors may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others). Our doctors may also prescribe a more potent pain medication, although these medications tend to be constipating and may aggravate the problem.

If you have a more severe attack that includes or puts you at risk of bowel obstruction or peritonitis, you may require hospitalization and intravenous antibiotics.

If you have a fistula or recurring diverticulitis, our doctors may recommend surgery to remove the diseased part of your colon. There are two types of surgery:

  • Primary bowel resection. This is the standard surgery for people with diverticulitis. Your surgeon removes the diseased part of your intestine and then reconnects the healthy segments of your colon (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open (traditional) surgery or laparoscopic surgery. In open surgery, your surgeon makes one long incision in your abdomen, while laparoscopic surgery is performed through three or four tiny incisions. You’ll heal faster and recover more quickly with laparoscopic surgery. Laparoscopic surgery may not be an option if you are very overweight or have extensive inflammation.
  • Bowel resection with colostomy. This surgery may be necessary if you have so much inflammation in your colon that it’s not possible to rejoin your colon and rectum. During a colostomy, your surgeon makes an opening (stoma) in your abdominal wall. The unaffected part of your colon is then connected to the stoma, and waste passes through the opening into a bag. A colostomy may be temporary or permanent. Several months later – once the inflammation has healed – your surgeon may be able to perform a second operation to reconnect your colon and rectum.

Preventive care for diverticulosis

Here are things you can do to help prevent or slow the progression of diverticular disease:

  • Eat more fiber. High-fiber foods, such as fresh fruits and vegetables and whole grains, soften waste material and help it pass more quickly through your colon. This reduces pressure inside your digestive tract. Aim for 25 to 30 grams of fiber each day. An apple or 1/2 cup of spinach contains 2 to 3 grams of fiber, and 1/2 cup of baked beans contains about 6 grams. Try to substitute fruits, vegetables and grain products for foods high in fat. Be sure to add fiber gradually to avoid bloating, abdominal discomfort and gas. If it’s difficult for you to consume 25 to 30 grams of fiber every day, consider using a fiber supplement, such as psyllium (Metamucil, Nature’s Way) or methylcellulose (Citrucel). Although commonly recommended, there’s little evidence that avoiding eating seeds or nuts prevents recurrent attacks of diverticulitis.
  • Drink plenty of fluids. Fiber works by absorbing water and increasing the soft, bulky waste in your colon. But if you don’t drink enough liquid to replace what’s absorbed, fiber can be constipating.
  • Respond to bowel urges. When you need to use the bathroom, don’t delay. Delaying bowel movements leads to harder stools that require more force to pass and increased pressure within your colon.
  • Exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes on most days.

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