Discussing common conditions: diverticulosis & diverticulitis

April 20, 2024

Chances are, you know someone who has had diverticulosis. It was likely a grandparent or older adult, and they may have received a diagnosis after a routine colonoscopy. Most people with diverticulosis never have problems from it or experience symptoms, according to the American Society of Colon and Rectal Surgeons (ASCRS). 

So what is diverticulosis, and if it doesn’t cause many problems, why should you know about it? 

What is Diverticulosis & How Common is it?

Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are found most often in the lower part of the large intestine, which is the colon. Diverticula are common, especially after age 40, but again, they don't always cause problems.

ASCRS says that the exact cause of diverticulosis is not known, but it is very common. The most widely accepted theory is that low amounts of fiber in your diet can cause stool to become relatively dry, forcing the colon to create high pressures to move the stool along. These high pressures cause the weakest point of the colon wall to bulge out. 

When the colon wall bulges out, this is called diverticular disease. While diverticular disease is not typically a big deal, sometimes, one or more of the pouches become inflamed or infected. This condition is known as diverticulitis.

We estimate that 10 to 20% of people with diverticulosis will develop diverticulitis. Diverticulitis is chronic inflammation that can cause:

• Severe abdominal pain
• Fever
• Nausea
• Changes in your bowel habits

Mild diverticulitis is easily treatable with:

• Rest
• Changes in diet
• Antibiotics

Severe or recurrent diverticulitis is more difficult to treat and may require surgery. That's why it is crucial to get diverticulitis diagnosed sooner rather than later.

Diagnosing Diverticulitis

To get diverticulitis diagnosed in our patients, we take a history and do a full physical exam, often with the aid of diagnostic tests. If needed, the most common tests to help diagnose diverticulitis and its complications are blood tests and a CT scan of the abdomen and pelvis.  A CT scan can show what part of the colon is involved and if there are any signs of complications.

Signs, Symptoms & Risk Factors of Diverticulitis

For those with diverticulitis, pain (particularly in the lower left side of the abdomen) may be constant and persistent for several days. Other diverticulitis symptoms include nausea and vomiting; fever; abdominal tenderness; constipation; or less commonly, diarrhea.

If you have constant, unexplained abdominal pain, especially if you also have fever and constipation or diarrhea, it's very important that you seek medical attention as soon as possible. 

Several factors may increase your risk of developing chronic diverticulitis too, such as:

• Low fiber diet -- Diets that are low in fiber, fruits, and vegetables and are high in red meat are risk factors for developing diverticulitis. Adding fiber to your diet may help protect your colon. 
• Nonsteroidal anti-inflammatory drugs (NSAIDs) -- Use of NSAIDs for conditions such as arthritis has been associated with complications of diverticulosis. 
• Immune status -- Patients whose immune systems are suppressed from medications such as steroids or anti-rejection medications for a transplanted organ are at risk for more severe complications such as colonic perforation.
• Alcohol -- Excessive consumption of alcohol may raise the risk of diverticulitis by 2 to 3 times as compared to those who do not drink.
• Age and gender --It is unclear the extent to which age and gender are a risk factor for complications from diverticulosis. Women tend to have complications from diverticulosis later in life than men.

Diverticulitis Complications

About 25 percent of people with diverticulitis develop complications, which may include:

• An abscess, which occurs when pus collects in the pouch
• A blockage in your colon or small intestine caused by scarring
• An abnormal passageway (fistula) between sections of bowel or the bowel and bladder
• Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care.

To Help Prevent Diverticulitis:

Regular colonoscopies, starting at age 50 (or possibly earlier if you are at higher risk), help diagnose diverticulitis and guide you toward changes that can lessen your chances of developing symptoms or complications. Lifestyle changes that may help before developing problems or after include:

1. Regular exercise -- Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes most days.
2. Eat more fiber -- A high-fiber diet decreases the risk of diverticulitis. Focus on high fiber foods like fresh fruits, vegetables, and whole grains. Eating seeds and nuts isn't associated with developing diverticulitis, although this is a common misconception.
3. Drink plenty of fluids -- Fiber works by absorbing water and increasing the soft, bulky waste in your colon. But if you don't drink enough liquid to replace what's absorbed, fiber can be constipating.

Alabama Colon & Rectal Institute is centered around treating diseases of the colon, rectum, and anus

Alabama Colon & Rectal Institute (also known as the “Butt Hutt” around town!) has been in practice since 1990 as a free-standing, private practice located in downtown Birmingham, Alabama.  We are known for our efficiency and patient care, in a more relaxed office-based setting.  Our doctors are known regionally for their expertise and are active in teaching surgical residents and other physicians. Check out our website for more information, or give us a call to make an appointment at (205) 458-5000, or email us at [email protected].