- What is diverticulosis?
- What is diverticulitis?
- Symptoms of diverticulitis
- Testing for diverticulitis
- Complications associated with diverticulitis
- Treatment for diverticulitis
- Mayo Clinic Q and A: Diverticulosis doesn’t mean diverticulitis
- Diverticular disease and diverticulitis
- Treatment for diverticular disease and diverticulitis
What is diverticulosis?
Diverticulosis is the presence of small pockets, or tics, in the wall of the colon, primarily of the sigmoid colon just above the rectum. The condition is uncommon in cultures and countries where diets feature lots of high fiber foods like grains, fruits and vegetables. In industrialized countries, like the United States and Great Britain, our low fiber diet leads to poor bowel habits. This leads to an increase in pressure in the colonic wall as it works to remove the stool, and thus “tics” form along the colon lining.
By the age of 80, 2/3rds of Americans will have some degree of diverticulosis. However, many won’t even know it unless they have a colonoscopy. For those unlucky 10 to 20 percent of patients who have an “attack” of diverticulitis, the symptoms are easy to recognize: left lower quadrant abdominal pain and tenderness, fever and an elevated white blood cell count on blood testing. A CT scan (specific x-ray of the intra-abdominal organs) may show inflammation around the colon.
Are there some foods like popcorn that lead to a diverticular attack? There is no convincing scientific evidence that foods like popcorn, seeds or nuts become entrapped in the tics and lead to diverticulitis. Most dietitians and gastroenterologists agree though that a lack of fiber combined with increased fat can contribute to an overactive (spasmodic) colon. This increase in activity can lead to pressure build up within the colon, and subsequently results in pressure in any diverticuli.
Drink plenty of water, get a proper amount of fiber in your snacks and diet, and keep processed foods and alcohol in moderation.
Even among those who do develop diverticulitis, most recover uneventfully, typically after seven to 10 days of oral antibiotics. And fewer than one in five experience a recurrence. An analysis of 2,300 patients across 19 studies found very low rates of complications and recurrences among patients with diverticulitis who were treated as outpatients.
Complications are more likely to arise in people who have suppressed immune systems or have other serious diseases, such as kidney failure. They will likely require more aggressive treatment and will be at higher risk for recurrences. This is also true for the minority of patients who have diverticulitis that is complicated by abscess rupture and sepsis.
In some cases, an undetected medical problem may cause a recurrence of diverticulitis. For this reason, the American Gastroenterological Association recommends that colonoscopy be performed after resolution of diverticulitis, unless a colonoscopy was performed recently. The test can help ensure that another diagnosis, such as colon cancer, was not missed.
Studies continue to expand what we know about diverticulitis. The traditional advice to avoid nuts and to increase fiber is being questioned, as is the need for routine antibiotics and surgery. The findings suggest that, for most people, diverticulitis may have a more favorable course than was previously thought.
Do you have a health question? Ask Well
If you have diverticulosis, you know how debilitating diverticulitis flare-ups can be. To prevent these, your doctor may suggest that you eat more fiber, drink plenty of fluids, and exercise regularly.
When lifestyle changes aren’t enough, you have other options to getting you back on the road to health.
Learn more about diverticulum, what the symptoms are, your surgical options and more.
What is diverticulitis?
Diverticulosis is the medical name for the presence of diverticulum, or small pouches formed in the colon wall. The cause for development of these is not well understood. It is possible the development is a side effect of having too low amount of fiber in your diet. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon. There also seems to be a genetic component, so it can run in families.
When the diverticulum are present but not causing problems, we call it Diverticulosis. We find diverticulum when we conduct a test for other reasons, like a colonoscopy or barium enema. Many people with diverticulosis have no symptoms. They will remain symptom free for the rest of their lives.
Diverticulitis happens when the diverticulum become inflamed. Particles of stool or undigested food become stuck in these pouches. This creates both inflammation and infection in the wall of the colon. The infection is due in part to the bacteria that naturally live in the colon. The inflammation causes increased pressure in the diverticulum and discomfort for you.
In severe cases, the pressure can cause the diverticulum to burst. Then stool and bacteria flood your lower abdomen causing a severe wide-spread infection.
Symptoms of diverticulitis
The symptoms of diverticulitis depend upon the degree of inflammation and infection present. Symptoms can include:
- Abdominal pain, many times in the lower abdomen, more often on the left side, but can be present on the right side as well
- Fever and chills
- Diarrhea or constipation, can have blood or mucous in the stool
- Nausea with decreased appetite, sometimes with vomiting
- Blood from the rectum
- Pain in the pelvis area with urination (this is due to inflammation around your bladder and its proximity to the colon)
You should seek medical attention if you have any of these symptoms. Diverticulitis can progress into a severe, wide-spread infection if left untreated.
Testing for diverticulitis
Your doctor will assess your symptoms and do an examination of your abdomen, as well as the rest of your body. You will need tests to determine if you have diverticulitis.
- Blood tests to look for signs of infection, check your kidney and liver functions
- Urine test to look for infection in the urinary tract
- A CT scan, or an image of your abdominal organs
Complications associated with diverticulitis
Simple diverticulitis accounts for 75 percent of cases. Treatments take place at home using antibiotics and lifestyle changes.
Complicated diverticulitis is more severe and accounts for 25 percent of cases. In most cases, you will need hospitalization and surgery. Complications associated with diverticulitis can include the following:
- Abscess — This is a localized collection of infection next to the inflamed colon. This is usually caused by a “microperforation,” or a very small hole in the diverticulum. The hole allows bacteria to escape from the colon into the abdomen. The body is able to contain the infection to a small area by “walling off” the pus.
- Recurrence — After you have one episode of diverticulitis, you are at higher risk of having another. Each flare up can become more severe. About 1/3 of patients that have one episode of diverticulitis will have future episode(s).
- Fistula — This is a hole created between two areas not normally connected. For example, a hole forms between the colon and the bladder.
- Obstruction — A blockage of the colon is due to inflammation of the colon. The colon wall thickens and stool is not able to pass through.
- Peritonitis — If your colon develops a hole, the contents of your intestines spill into your abdomen. This wide-spread infection of the abdominal cavity has the diagnosis of peritonitis.
- Sepsis — An overwhelming body-wide infection that can lead to failure of many organs.
- Diverticular bleeding — When a small artery located within the diverticulum breaks through the colon lining and bleeds into the colon. This can happen with diverticulosis and diverticulitis. Diverticular bleeding usually causes painless bleeding from the rectum. In about 50 percent of cases, the person will see maroon or bright red blood with bowel movements. Bleeding with bowel movements is not normal and you should immediately seek medical attention. Most cases of diverticular bleeding resolve on their own. Some people will need further testing or treatment to stop bleeding. Testing may include a colonoscopy, angiography (blocking off the bleeding artery) or surgery.
Treatment for diverticulitis
Treatment of diverticulitis depends upon how severe your symptoms and disease are. People with diverticulosis who do not have symptoms do not need treatment.
- Increase fiber to add bulk to the stool — Fiber can help to bulk up your stool. A high-fiber diet might prevent new diverticula, diverticulitis or diverticular bleeding. Fiber has not proven to prevent these conditions or get rid of current diverticuli. Fruits and vegetables are a good source of fiber. You calculate fiber content of packaged foods by reading the nutrition label.
- Take fiber supplements — You can take fiber supplements like Metamucil, Citrucel or Benefiber to bulk up your stool.
- Seeds and nuts — In the past we advised diverticulitis patients to avoid whole pieces of fiber, like seeds, corn and nuts. There was concern that these foods could cause an episode of diverticulitis. This belief is completely unproven. So we no longer recommend avoiding these high fiber foods.
Mayo Clinic Q and A: Diverticulosis doesn’t mean diverticulitis
DEAR MAYO CLINIC: After my last colonoscopy, I was told I have diverticulosis. Will this lead to diverticulitis? I currently have no symptoms but wonder if I should do anything to prevent it from progressing.
ANSWER: Although the two conditions are related, and diverticulosis is a risk factor for diverticulitis, many people who have diverticulosis never go on to have diverticulitis. In those who do eventually develop diverticulitis, it is not clear what causes the condition, so it’s difficult to know how to prevent it. A healthy diet and regular exercise may help.
Diverticulosis is a condition that affects the gastrointestinal tract. Small sacs, called diverticula, bulge out of the wall of your colon. The condition is very common as people age. Estimates are that about half of the U.S. population over 50 has diverticulosis. Most people have it by the time they reach 80. With those statistics in mind, a finding of diverticulosis during a colonoscopy isn’t unusual. Generally, it’s not a cause for concern.
Diverticulosis by itself typically doesn’t trigger any symptoms. Rarely, diverticula may bleed, causing blood in the stool. As in your case, diverticulosis is often found during a routine colonoscopy or on an imaging exam, such as a CT scan, that’s done for another reason. You can have diverticulosis for years without any complications or problems. If one or more of the diverticula become inflamed, however, that condition is diverticulitis.
While diverticulosis usually doesn’t lead to any discomfort, diverticulitis can be quite painful. Common symptoms include significant abdominal pain, as well as fever, constipation or diarrhea, nausea, and fatigue. A mild case of diverticulitis may go away on its own without any treatment. When treatment is necessary, antibiotics and a liquid or low-fiber diet may be all that is necessary to resolve symptoms.
However, in more severe cases, diverticulitis can lead to a tear in the colon that allows bowel contents to leak into the abdomen. In that situation, hospitalization usually is required for effective treatment. In some cases, emergency surgery may be necessary to repair a hole in the colon.
In contrast to diverticulosis, diverticulitis is uncommon. Only about 5 percent of people who have diverticulosis ever go on to develop diverticulitis. In general, diverticulitis is poorly understood. Unfortunately, little is known about what leads a person with diverticulosis to develop diverticulitis.
Although limited knowledge about what causes diverticulitis makes it difficult to offer solid prevention strategies, there are a few guidelines that may help. People who are overweight tend to develop diverticulitis more often that people who are at a healthy weight. So, exercising regularly and maintaining a healthy weight may provide some protective benefit against diverticulitis. Some research suggests diet also may play a role, with people who eat a low-fiber diet possibly at increased risk for diverticulitis. Eating a well-balanced diet that includes plenty of fiber may prevent diverticulitis.
If you have questions or concerns about diverticulosis, talk to your health care provider. He or she may be able to offer suggestions based on your individual medical situation. If you experience symptoms that could be related to diverticulitis — especially sudden pain in your abdomen — seek medical care right away. — Dr. David Etzioni, Colon and Rectal Surgery, Mayo Clinic, Scottsdale, Arizona
Diverticular disease and diverticulitis
Treatment for diverticular disease and diverticulitis
Treatments for diverticular disease
Eating a high-fibre diet may help ease the symptoms of diverticular disease and stop you developing diverticulitis.
Generally, adults should aim to eat 30g of fibre a day.
Good sources of fibre include fresh and dried fruits and vegetables, beans and pulses, nuts, cereals and starchy foods.
Fibre supplements, usually in the form of sachets of powder that you mix with water, are also available from pharmacists and health food shops.
Find out how to get more fibre in your diet
Gradually increasing your fibre intake over a few weeks and drinking plenty of fluids can help prevent side effects associated with a high-fibre diet, such as bloating and wind.
Paracetamol can be used to relieve pain.
Some painkillers, including aspirin and ibuprofen, should not be taken regularly as they can cause stomach upsets. Ask a pharmacist about this.
Speak to a GP if paracetamol alone is not working.
You may be prescribed a bulk-forming laxative to help ease any constipation or diarrhoea.
Treatments for diverticulitis
If you have diverticulitis, a GP may recommend that you stick to a fluid-only diet for a few days until your symptoms improve.
While you’re recovering you should eat a very low-fibre diet to rest your digestive system.
Once the symptoms have gone, you can return to a higher-fibre diet, aiming to eat about 30g of fibre a day.
Diverticulitis can usually be treated at home with antibiotics prescribed by a GP.
You can take paracetamol to help relieve any pain. Talk to a GP if paracetamol alone is not working.
Do not take aspirin or ibuprofen, as they can cause stomach upsets.
But more serious cases of diverticulitis may need hospital treatment.
In hospital, you’ll probably get injections of antibiotics, and be kept hydrated and nourished using a tube directly connected to your vein (intravenous drip).
You may also be prescribed a stronger painkiller if paracetamol is not helping.
In rare cases, surgery may be needed to treat serious complications of diverticulitis.
Surgery usually involves removing the affected section of your large intestine.
This is known as a colectomy. This is the treatment for rare complications such as fistulas, peritonitis or a blockage in your intestines.
After a colectomy, you may have a temporary or permanent colostomy, where one end of your bowel is diverted through an opening in your tummy.
The most common complication of diverticulitis is developing abscesses.
These are usually treated with a technique known as percutaneous drainage, which is done by a radiologist.
If surgery is being considered, your doctor should discuss the benefits and the risks very carefully with you.