Overview
Introduction:
Diverticular disease occurs when pouches (diverticula) in the intestine, usually the large intestine or colon, become inflamed. Most diverticula occur in the sigmoid colon, the curved part of the large intestine closest to the rectum, and they tend to become more numerous as we age.
Diverticulosis is the presence of many diverticula along the intestinal wall. It occurs more commonly in countries such as the U.S. where the diet is generally low in fiber. More than 50% of adults over age 70 have diverticula, and 80% have no symptoms.
Diverticulitis occurs when one or more diverticula become inflamed. The inflammation may be local (just in the area of the diverticulum), or may spread to the abdominal lining (peritoneum), called peritonitis. Small (microscopic) or large perforations (holes in the intestinal wall) occur in 15 - 20% of people who have diverticula.
The most common types of diverticular disease are:
- Diverticulosis. People with diverticulosis have pouches in the large intestine. Most people with diverticulosis don't have any symptoms and may not even know they have it.
- Diverticulitis. This occurs when the pouches become infected and inflamed. Symptoms of diverticulitis can include severe abdominal pain, fever, nausea, constipation or diarrhea. Less common symptoms include vomiting and frequent and painful urination. Pain is most often located on the lower left side of the abdomen. Complications of diverticulitis can include intestinal blockages and openings in the bowel wall.
- Diverticular bleeding. Diverticular bleeding occurs when a blood vessel next to the pouches bursts. You may find blood in a bowel movement or in the toilet. If you notice blood coming from your rectum, you should call your doctor immediately.
Signs and Symptoms
Often diverticula cause no symptoms, although you may experience irregularities in bowel habits. If symptoms do appear, they may include the following:
- Abdominal pain, especially pain low on the left side of the abdomen after a meal
- Either painless rectal bleeding or passing of blood in stool
- Fever
- Nausea
- Vomiting
- Irregular bowel movements, including constipation or diarrhea
- Gas
- Bloating
What Causes It?
The cause of diverticular disease is unknown, but several factors may contribute to changes in the wall of the colon. These include aging, the movement of waste through the colon, changes in intestinal pressure, a low-fiber diet, and physical abnormalities.
Who's Most At Risk?
These factors increase the risk for developing diverticular disease:
- Low-fiber diet
- Advanced age (more than half of people over age 70 have the condition)
- Obesity
- Male gender, for diverticulitis
The following may contribute as well:
- High fat intake
- Lack of regular physical activity
How can my doctor tell if I have diverticular disease?
Your doctor may check your abdomen for tenderness and ask you about your bowel habits, diet and medications. Your doctor may also want to do some tests to screen for diverticular disease:
- Barium Enema.For this test, you are given an enema (injection of fluid into the rectum) with a liquid that makes your colon show up on an X-ray.
- Flexible sigmoidoscopy. In this test, your doctor puts a thin, flexible, hollow tube with a light on the end into your rectum. The tube is connected to a tiny video camera, which allows your doctor to see the rectum and the last part of your colon.
- Colonoscopy.Before you have this test, you are given a medicine to make you relaxed and sleepy. A thin, flexible tube connected to a video camera is put into your rectum, which allows your doctor to see your whole colon. A colonoscopy may be uncomfortable, but it is usually not painful.
- CT Scan. This test is a type of X-ray that allows your doctor to see the pouches in your digestive tract that are inflamed or infected.
How is diverticular disease treated?
For diverticulosis, your doctor may suggest that you eat more fiber, drink plenty of fluids and exercise regularly to help prevent the pouches from becoming infected or inflamed.
For mild cases of diverticulitis, your doctor may prescribe antibiotics. He or she may also suggest that you eat more fiber, drink plenty of fluids and exercise regularly to help prevent future problems.
For severe cases of diverticulitis or diverticular bleeding, your may need surgery to remove the pouches and the diseased parts of your colon.
Treatment Options
To help prevent diverticular disease:
- Eat a high-fiber (25 - 35 g of fiber per day), low-fat diet that contains lots of vegetables. Such a diet is also beneficial for overall health, and may reduce the risk of heart disease and cancer.
- Avoid red meat.
- Avoid foods that may block the opening of a diverticulum and lead to inflammation, such as seeds.
- Exercise regularly.
Surgical and Other Procedures
If you have repeated episodes of diverticulitis, respond poorly to medical therapy, or have other complications, your health care provider may recommend removing part of the colon. If you have severe complications, or if your condition worsens within 1 - 2 days of attack, you may need surgery right away.
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