July 8, 2015
Diverticulosis is a condition that mostly causes no symptoms and no problems. In people over 40, the colon very commonly but gradually develops diverticula--small out-pocketings of the lining of the colon--and by age 65, nearly 2/3 of all people have some of these diverticula. The pressure inside the colon from food and gas, and from the colon's natural strong squeezing contractions, gradually pushes out these small pockets of its own lining through weak spots in the muscle layers of the colon. These small sacs are called diverticula, and having diverticula is the condition called diverticulosis.
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 diet that’s low in fiber 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 for problems from diverticulosis have 2 major factors. 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. Second, age increases one’s risk of developing the condition.
Signs & SymptomsDiverticulosis itself does not cause symptoms. 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:
- Abdominal tenderness, usually on the lower left side
- Sense of incomplete bowel movement
- Gas or bloating
- Loss of appetite
- Rectal bleeding
Diverticulosis doesn't lead to cancer or polyps, but symptoms from the colon shouldn't be taken for granted or assumed to be from diverticulosis without discussing it with your clinician. If fever and abdominal pain occur, ALWAYS contact your clinician promptly.
Screenings & Diagnostic Tests
Diagnostic testing all depends on the situation. People don't need routine tests to find out if they have diverticulosis, but should have routine tests to detect polyps and cancers once they get to age 50, preferably colonoscopy. If symptoms of the colon occur, some are investigated by colonoscopy, some by CAT scan or other imaging, and many times diverticulitis is so “typical” that treatment doesn’t require any tests run, as long as it gets better as we expect. Blood work and sometimes stool tests may be needed. If a person has diverticulosis but is feeling well, they don't need tests that are special, but they should have the routine preventive tests for colon cancer prevention.
Diverticulosis and Diverticulitis can be treated in three different manners:
1. If diverticulosis if found on a scope exam or Xray but we don't think it is causing any problems, the best treatment is not to worry about it, but to maintain a healthy fiber intake in diet. Adding comfortable portions of bran in cereals and muffins, having more fruits like apples and citrus, having more vegetables like carrots, broccoli, and beans can help prevent complications and keep bowel function better. Some people can't get enough of a fiber comfortably diet, so they take one or another supplemental form of fiber product. 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 better bowel function just like food fiber does.
2. In acute diverticulitis, usually short periods of restricted diets (clear liquid for a few days till pain is gone, use of ibuprofen or similar if otherwise allowed for pain, and then gradually resuming fiber intake) will be given until the inflammation is gone. Usually 1 to 2 week periods of antibiotics are useful to clear up the infection part of the problem. Most commonly we use ciprofloxacin generic (Cipro) and metronidazole (Flagyl). Most people can be at home and be treated; a few need to be hospitalized. During recovery, resuming a higher fiber intake gradually is helpful. Patients who have repeated episodes of diverticulitis need guidance about what to do if symptoms return. See basic guidance below.
3. In bleeding diverticulosis, fortunately rare, patients almost always needs hospitalization to treat the condition safely. Most of the time the bleeding simply stops, we do tests to show that there isn't any other serious cause of bleeding like a cancer of the colon, and so surgery isn't needed.
Most diverticulitis treatments work well, but once diverticula form they will be there for your entire lifetime. This means that you could acquire diverticulitis again at any time. Lifestyle modifications can help you prevent diverticulitis in the future. Drinking plenty of water is imperative for making sure you don’t get constipated, as is putting more fiber into one’s diet.
A note about seeds and nuts: an old myth is that seeds and nuts, popcorn etc in diet brings on diverticulitis. In reality as part of a balanaced diet, these foods actually reduce therisk of diverticulitis. Rarely, “gorging” on these foods when a person isn’t used to them may seem to trigger some abdominal pain or seems associated with getting diverticulitis, but people rarely need to restrict these foods.