Many people have small pouches in the colons that bulge outward through weak spots, like an inner tube that pokes through weak places in a tire. Each pouch is called a diverticulum. The condition of having bulging diverticula is called diverticulosis. About 10% of Americans over the age of forty have diverticulosis. The condition becomes more common as people age. About half of all people over the age sixty have diverticulosis. When the pouches become inflamed, the condition is called diverticulitis. This happens in ten to twenty-five percent of people with diverticulosis.

Symptoms

Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms do generally appear when the diverticula become inflamed. Diverticulitis generally presents as abdominal pain.  The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause of inflamed diverticula, fever, nausea, vomiting, chills, cramping and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.

Complications

Diverticulitis can lead to bleeding, infections, perforations or blockages. These complications always require treatment to prevent them from progressing and causing serious illness. Bleeding from diverticula is a rare complication. When diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can be severe, but it may stop by itself and not require treatment. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary.

Although the infection causing diverticulitis often clears up after a few days of treatment, abscesses may occur if the infection worsens. An abscess is an infected area with pus that may cause swelling and destroy tissue. Sometimes the infected diverticula may develop small holes, called perforations. These perforations allow pus to leak out of the colon into the abdominal area. If the abscess does not clear with treatment, surgery may be necessary. A large abscess can become a serious problem if the infection leaks out and contaminates areas outside the colon.  Infection that spreads into the abdominal cavity is called peritonitis and requires immediate surgery.

When diverticulitis-related infection spreads outside the colon, the colon’s tissue may stick to nearby tissue, such as the bladder, small intestine and skin. When damaged tissues come into contact with each other during infection and stick together, they can form a fistula. The most common type of of fistula occurs between the bladder and the colon.  It affects men more than women. This type of fistula can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.

Scarring from infection may cause partial or total blockage of the large intestine. When this happens, the colon is unable to move bowel contents normally. When the obstruction totally blocks the intestine, emergency surgery is necessary.

What causes diverticular disease?

Although not proven, the dominant theory is that a low-fiber diet is the main cause of diverticular disease. Diverticular disease is more common in developed or industrialized countries where processed and refined foods are widely available. Is is less common in parts of the world that consume high-fiber vegetable-based diets. Fiber is needed by the body to make stools soft and easy to pass. Fiber helps prevent constipation.

Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. This excess pressure might cause the weak spots in the colon to bulge out and become diverticula.

Diagnosis

To diagnose diverticular disease, the doctor will ask about medical history, perform a medical exam, and may perform one or more diagnostic tests. Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment.

When taking a medical history, the doctor may ask about bowel habits, symptoms, pain, diet and medication. The doctor may test blood for signs of infection. The doctor may also order x-rays or other tests.

Treatment

A high-fiber diet, antibiotics and occasionally mild pain relievers will help relieve symptoms in most cases. Sometimes an attack of diverticulitis is serious enough to require a hospital stay and possibly surgery.

Treatment of diverticulosis generally consists of increasing the amount of fiber in the diet. People differ in the amounts and types of foods they can eat. Decisions about diet should be made based on what works best for each person. Keeping a food diary can be useful to track fiber intake. The doctor may also recommend taking a fiber supplement.

Treatment of diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early. An acute attack with severe pain or severe infection may require a hospital stay, where antibiotics can be given intravenously. In some cases, surgery may be necessary.

Points to Remember

• Diverticulosis occurs when small pouches, called diverticula, bulge outward through weak spots in the colon.
• The pouches form when pressure inside the colon builds, usually because of constipation.
• Most people with diverticulosis never have any discomfort or symptoms.
• The most likely cause of diverticulosis is a low-fiber diet because it increases constipation and pressure inside the colon.
• For most people with diverticulosis, eating a high-fiber diet is the only treatment needed.
• Diverticulitis occurs when the pouches become infected or inflamed and cause pain and tenderness around the left side of the lower abdomen.

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