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July 8, 2015

Diverticulosis & Diverticulitis

Diverticulosis is a condition in which small pouches (diverticula) develop in the lining of the gastrointestinal tract, chiefly in the lower bowel (colon or large intestine). Diverticulosis is extremely common – affecting half of all Americans over the age of 60. Pressure inside the colon from food and gas, and from the colon's contractions, gradually pushes the small pockets through weak spots in the muscle layers of the colon. Most people with diverticulosis are unaware they have the condition as it often does not produce any symptoms or complications.

Causes

No one knows exactly what causes diverticula, but eating a diet that’s low in fiber is thought to contribute to the formation of the sacs. Eating fiber helps your stool stay soft, which makes it easier to pass. A low-fiber diet can cause problems such as constipation. This requires more pressure to pass your stool. Increased pressure inside the colon is believed to lead to the development of diverticula. Diverticulitis occurs when a diverticulum ruptures and the release of bacteria triggers inflammation and infection.

Risk Factors

Inadequate fiber in diet - Not eating enough fiber will increase your risk of getting diverticulitis. Taking fiber supplements or eating more fresh fruit, vegetables and whole grain products can help; nuts and seeds in a balanced high fiber diet are helpful.

Age – It increases one’s risk of developing the condition

Signs & Symptoms

Diverticulosis or having the diverticula itself does not cause symptoms. But inflammation of diverticula will. The most common symptoms of diverticulitis include pain on the lower left side of the abdomen and can occur suddenly or gradually. Other signs and symptoms include:

  • Nausea
  • Sense of incomplete bowel movement
  • Vomiting
  • Constipation
  • Fever
  • Gas or bloating
  • Diarrhea
  • Loss of appetite
  • Rectal bleeding

Diverticulosis doesn't lead to cancer or polyps, but symptoms related to colon health should not be taken lightly without discussing it with your clinician. If fever and abdominal pain occur, contact your clinician promptly.

Screenings & Diagnostic Tests

Diagnostic testing all depends on the situation. People do not need routine tests to find out if they have diverticulosis. If any of the symptoms of the colon occur and diverticulitis is suspected, then blood work, stool tests and other tests such as a CAT scan or colonoscopy may be needed.

Treatment

Diverticulosis and Diverticulitis can be treated in three different manners:

1. If diverticulosis is found on a scope exam or X-ray but your physician doesn’t think it is causing any problems, then the best treatment is to maintain a healthy fiber intake in your diet. Adding portions of bran, fruits, and vegetables can help prevent complications and maintain healthy bowel function. Supplemental form of fiber product can also be taken. Two common types are psyllium (a grain product, in brands like Metamucil, Konsyl, Trader Joes and many generics) and methylcellulose (a plant substance in such brands as Citrocel). Mixed into water or juice and used daily, these promote improved bowel function just as food fiber does.

2. In acute diverticulitis, short periods of restricted diets consisting of clear liquids may be ordered until the inflammation has subsided. Ibuprofen may be taken for pain management in most individuals; opiate medication for pain is problematic for a variety of reasons. A fiber diet is then resumed gradually and transitioned to higher fiber intake for future prevention.

Usually 1 to 2 week periods of antibiotics are effective in treating infection of the diverticula. Most commonly prescribed are ciprofloxacin (Cipro) and metronidazole (Flagyl). Most people can be treated at home but few may need to be hospitalized. During recovery, resuming a higher fiber intake is recommended. Patients who have repeated episodes of diverticulitis need guidance about what to do if symptoms return.

3. In rare cases of bleeding diverticulosis, patients almost always need to be hospitalized in order to safely treat the condition. Most of the time the bleeding simply stops. Often patient’s with bleeding diverticulosis are recommended to undergo testing to ensure there are no serious causes of bleeding and therefore do not require surgery.

Treatment Outlook

Most diverticulitis treatments are effective, but once diverticula form they will be there for your entire lifetime--meaning you can acquire diverticulitis again at any time. Lifestyle modifications can help prevent diverticulitis in the future. Drinking plenty of water is imperative for making sure you don’t get constipated, as is putting more fiber in one’s diet.

A note about seeds and nuts: an old myth is that seeds, nuts, popcorn, etc. bring on diverticulitis. In reality, as part of a balanced diet, these foods actually reduce the risk of diverticulitis. “Gorging” on these foods when a person isn’t used to them may trigger some abdominal pain or be associated with symptoms of diverticulitis, but rarely does one need to restrict the consumption of such foods.

>>Search for a doctor that can help you manage this condition.

Additional Information

Diverticulitis 101

Badgut.org (Canadian source) http://www.badgut.org/information-centre/a-z-digestive-topics/diverticular-disease/

Uptodate patient education beyond the basics https://www.uptodate.com/contents/diverticular-disease-beyond-the-basics

American College of Gastroenterology http://patients.gi.org/topics/diverticulosis-and-diverticulitis/