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 (colon). Diverticula are common, especially after age 40, and seldom cause problems.
These diverticula are thought to form as a result of hard stools passing through a colon that has become weakened over time. When the diverticula cause symptoms such as abdominal pain, a person is said to have diverticular disease, while infection and inflammation of the diverticula is referred to as diverticulitis.
Diverticulosis is “the presence of” and diverticulitis is “inflammation and infection of” one or more diverticula (bulges in your colon wall). Diverticulosis is common, doesn’t cause symptoms or need treatment. Mild diverticulitis is treated with antibiotics. Surgery is needed if problems develop. A high fiber diet, exercise and drinking lots of water can help prevent.
What Is Diverticulosis and Diverticulitis?
Diverticulosis and diverticulitis are two conditions that occur in your large intestine (also called your colon). Together they are known as diverticular disease. Both share the common feature of diverticula. Diverticula are one or more pockets or bulges that form in the wall of your colon.
Diverticula are like expanded areas or bubbles that form when you fill the inner tube of a bike tire with too much air. The increase in pressure from too much air being pumped into the inner tube causes the bubble to form where the rubber is the weakest. Similarly, an increase in pressure inside the colon causes pockets or bulges (diverticula) to form in weakened areas of your colon’s walls.
Diverticula can range from pea-size to much larger. Although they can form anywhere in the inner lining of your colon, they are most commonly found in your lower left-side, in the S-shaped segment of your colon called the sigmoid colon.
Diverticulosis is simply the presence of these tiny bulges or pockets (diverticula) in your colon. They usually don’t cause any symptoms or need to be treated. However, diverticulosis can lead to diverticulitis.
Diverticulitis is inflammation (swelling) and infection in one or more diverticula. You may feel pain, nausea, fever and have other symptoms. This is a much more serious and potentially dangerous condition.
What Are the Signs and Symptoms of Diverticulosis and Diverticulitis?
The majority of people with diverticulosis will never experience any symptoms. This is called asymptomatic diverticulosis.
There may be episodes of pain in the lower abdomen. More specifically, usually in the lower left side of the abdomen. The pain often comes when the individual eats or passes stools. There may be some relief after breaking wind.
Other symptoms include:
- changing bowel habits
- constipation and, less commonly, diarrhea
- small amounts of blood in stools
When diverticulitis becomes inflamed, symptoms include:
- constant and usually severe pain, usually on the left side of the abdomen although occasionally on the right
- more frequent urination
- painful urination
- nausea and vomiting
- bleeding from the rectum
Diverticulitis can be acute or chronic. With the acute form, you may have one or more severe attacks of infection and inflammation. In chronic diverticulitis, inflammation and infection may go down but never clear up completely. Over time, the inflammation can lead to a bowel obstruction, which may cause constipation, thin stools, diarrhea, bloating, and belly pain. If the obstruction continues, abdominal pain and tenderness will increase, and you may feel sick to your stomach or throw up.
If you have any of these symptoms, it’s important to see a health care provider as soon as possible so that your doctor can order tests and make a proper diagnosis.
What Causes Diverticulosis and Diverticulitis?
Scientists aren’t really sure what causes diverticulosis, but they think it’s caused by not eating enough fiber. Not eating enough fiber causes a buildup of waste (constipation) in your colon. Constipation puts extra strain on the walls of the colon. This increased pressure causes the little pockets — the diverticula — to form in weak areas in your colon.
Again, scientists aren’t sure what causes diverticulitis, but they think the infection starts due to the bacteria in stool that gets pushed into the diverticula. Another theory is that the walls of the diverticula itself erode from the increased pressure on the colon walls.
It is unknown why pouches start to protrude outward from the colon. However, a lack of dietary fiber is often thought to be the main cause.
Fiber helps to soften stools, and not consuming enough dietary fiber leads to hard stools. This may cause more pressure or strain on the colon as muscles push the stool down. This pressure is thought to cause the development of diverticula.
Diverticula occur when weak spots in the outside layer of colon muscle give way and the inner layer squeezes through.
Although there is no clear clinical evidence proving a link between dietary fiber and diverticulosis, researchers claim that the circumstantial evidence is convincing. However, the topic is hotly debated.
In parts of the world where dietary fiber intake is large, such as in Africa or South Asia, diverticula disease is fairly uncommon. On the other hand, it is quite common in Western countries where dietary fiber intake is much lower.
However, other reports have debunked the link between increased dietary fiber and diverticulitis prevention, advising that it may actually increase the likelihood of the disease.
Previously, the consumption of nuts, seeds, and corn was thought to be a cause of diverticula development, but a study in 2008 found no link.
How Is Diverticulitis Diagnosed?
If you have symptoms of diverticulitis, it’s important to be seen by your healthcare provider to get the correct diagnosis.
First, your healthcare provider will ask you about your medical history including your current symptoms, the types of foods you normally eat, how often you have bowel movements and other questions about your bowel movements, and will review any medications you are currently taking. Your healthcare provider will check your abdomen for pain and tenderness.
Other tests that may be performed or ordered to help diagnose your condition include:
- Blood test: Your blood is checked for signs of infection, such as a high white blood cell count.
- Stool sample: Your stool sample is checked for the presence of abnormal bacteria or parasites as possible causes of your infection, abdominal pain, blood in stool, diarrhea or your other symptoms.
- Digital rectal exam: In this physical exam, your healthcare provider gently inserts a gloved, lubricated finger into your rectum to feel for any problems in your anus or rectum.
- CT scan: A CT scan can show infected or inflamed diverticula and also reveal the severity of diverticulitis.
- Barium enema (also called a lower gastrointestinal tract radiography): In this test, a liquid containing barium is injected into your anus. The liquid coats the inside of your colon, which helps make any problems in your colon more visible on X-rays.
- Sigmoidoscopy: In this exam, a thin flexible tube with a light on the end is inserted into your rectum and moved into your sigmoid colon. The tube is connected to a video camera. The camera allows a visual inspection of your sigmoid colon (where most diverticula form) and rectum.
- Colonoscopy: In this exam, the full length of your colon can be examined. A thin, flexible, lighted tube with a camera, called a colonoscope, is inserted through your rectum and into your colon. During a colonoscopy, your colon is checked for abnormal growths, sores, ulcers, bleeding or other problems that could cause changes in bowel habits or abdominal pain. Tissue samples can be taken and polyps can be removed.
- Angiography: If you have rapid, heavy rectal bleeding, this procedure helps find where the bleeding is coming from. During this test, the arteries that supply the colon are injected with a harmless dye that allows the source of the bleeding to be seen.
Most people can self-treat their diverticular disease if it is mild, mainly with the help of painkillers and by consuming more dietary fiber.
Painkillers such as aspirin or ibuprofen should be avoided as they increase the risk of internal bleeding, and may also upset the stomach. Acetaminophen is recommended for pain relief from diverticular disease. Acetaminophen is available for purchase over the counter or online.
Eating more dietary fiber, which includes fruits and vegetables, will help resolve the symptoms by softening stool and helping stool patterns become more regular. This may sometimes take a few weeks.
Bulk-forming laxatives may help those who have constipation. It is important to drink plenty of fluids with these medications.
People who experience heavy or constant rectal bleeding should see their doctor.
Mild cases of diverticulitis can generally be treated by the individual. However, a doctor may prescribe antibiotics, as well as acetaminophen for the pain.
It is important to complete the whole course of antibiotics, even if symptoms get better.
Some people may experience drowsiness, nausea, diarrhea, and vomiting while they are taking their antibiotics.
Antibiotics include ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex) and doxycycline (Vibramycin).
For those on the contraceptive pill, it is important to remember that antibiotics can interfere with its effectiveness. This effect on the contraceptive pill continues for about 7 days after stopping the antibiotic, so another form of contraception should overlap with this time.
Hospital treatment may be necessary if any of the following apply:
Normal painkillers do not alleviate the pain, or the pain is severe.
The individual cannot consume enough liquids to keep hydrated.
The person with diverticulitis cannot take oral antibiotics.
They have a poor state of health.
The doctor suspects complications, often if the immune system is weak.
Treatment at home is ineffective after 2 days.
Hospital patients are generally given antibiotics intravenously (IV), as well as fluids if they are dehydrated.
People who have at least two diverticulitis episodes may benefit from surgery. Studies indicate that such patients are significantly more likelyTrusted Source to have further episodes and complications if they do not have surgery.
A colon resection removes part of the affected colon and joins the remaining healthy parts together.
Patients who undergo colon resection will have to introduce solid foods into their system gradually. Apart from this, their normal bowel functions will not usually be affected.
How Do You Prevent Diverticulitis?
Some of the risk factors for diverticulitis are related to lifestyle habits. Fortunately, this means you can do something about them. You may be able to lower your risk of diverticulitis by:
- Eating a diet high in fiber and low in animal fats. A high-fiber diet does not reduce the risk of having diverticula. But it may reduce the chances of developing diverticulitis because a high-fiber diet improves the movement of stool through the bowel.
- Exercising regularly. High intensity or vigorous exercise may have the most benefit.
- Maintaining a healthy body weight
- Quitting smoking or never starting
- Taking medicines that increase the risk of diverticulitis only when absolutely necessary. These medications include aspirin; NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen (Advil, Motrin, and generic versions) and naproxen (Aleve and generic); oral corticosteroids; and opiate analgesics.
There has also been interest in using medicines to prevent inflammation and infection in people who have repeated diverticulitis attacks. This includes using probiotics and the medicines mesalamine (Asacol) or rifaximin (Xiafaxan). Unfortunately, research doesn’t support their routine use at this point. If you want to try probiotics, talk with your doctor about the best strategy.
If you have diverticular disease, talk with your doctor about ways to lower your risk of diverticulitis. Ask about your medicines and find out if they put you at risk. Don’t stop taking medicines without talking to your doctor.