Diverticular disease is a condition affecting the large intestine or colon. Also called diverticulitis, diverticular disease occurs when small pouches or sacs (diverticula) on the interior lining of the colon become infected. These diverticula are most likely to form weak spots on the sides of the colon.
Some people have diverticula in their colon and never experience any adverse side effects. However, for others, the pouches can become inflamed, which can cause complications ranging from mild discomfort and bloating to more severe pain, infections, and bleeding.
Your physician or a gastrointestinal specialist should investigate any unusual or sustained discomfort in the abdomen or blood in the stool. MAKE AN APPOINTMENT
What is Diverticular Disease?
As mentioned above, diverticular disease is diagnosed when the diverticula of the colon start causing problems. It is more common in older people, and we believe that low-fiber diets are a common cause.
The less quickly or regularly solid waste moves through the colon, the more it is forced to store. Over years and decades, over-taxed colon walls become weak, leading to the formation of the pouches and sacs. When the sacs get infected or inflamed, patients experience uncomfortable symptoms.
Signs & Symptoms of Diverticular Disease
The most common sign or symptoms of diverticular disease are abdominal discomfort and bloating. However, if the infection persists, inflammation is severe, or more than one pouch is affected, patients experience more intense symptoms.
- Lower-abdominal pain, typically more on the left side
While we all experience these symptoms occasionally due to stomach flu or food poisoning, any long-term experience of abdominal pain or chronic recurrences of these symptoms should be addressed by a specialist.
What Causes Diverticulitis?
There are no clear causes of diverticulitis, but certain themes recur across the patients who suffer from the disease. Indications are that a low-fiber diet over the years creates increased colon pressure and results in pockets or diverticula.
Patients with a family history of diverticular disease are more prone to developing it.
Patients who are 60 years and older are more likely to suffer from it. According to literature, more than 50% of the population have diverticular sacs or pouches in their colon. However, only a portion of these patients experiences the infections or inflammation that leads them to our office.
Certain lifestyle choices increase your risk of developing diverticular disease. These include:
- Diets low in fiber
- Diets high in red meat
- Lack of exercise
- Regular or long-term use of non-steroidal anti-inflammatory medications (NSAIDs) like ibuprofen as well as steroids
Other factors or situations that elevate the risk of diverticulitis include:
- Overgrowths of bacteria trapped in the diverticula
- Changes in the microbiome of the gut (such as antibiotic use that kills the good bacteria and allows harmful bacterial populations to get out of control)
- Issues in the colon’s connective tissue that causes pouches/sacs to form
- Compromised or weakened immune system
What is the difference between Diverticulosis and Diverticulitis?
Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.
Who is at Risk for Developing Diverticular Disease?
Patients more susceptible to developing diverticulitis include:
- Those with poor diet and exercise habits
- Patients who are chronically overweight or obese
- Those who have a family history of diverticulitis
- Patients 60-years-old or more
- Adults who have a history of frequent NSAID, steroid, or antibiotic use
- Those with poorly functioning immune systems
Diagnosing Diverticular Disease
Once we’ve reviewed your symptoms, personal/family medical history, and lifestyle habits, we’ll also ask about your bowel habits and perform a physical exam.
If we suspect you have diverticulitis, we’ll recommend further testing that includes:
- Blood tests
- Stool tests (to rule out other G.I. issues, such as IBS, that have similar symptoms and side effects
- Imaging tests allow us to see the pouches, sac, or inflammation resulting from diverticular disease. These tests may include one or a combination of tests such as ultrasound, CT scans, or colonoscopy imaging.
Treating Diverticular Disease
Diverticulosis and diverticular disease are usually treated by diet and occasionally, medications to help control pain, cramps and changes in bowel habits. Increasing the amount of dietary fiber from grains, legumes, and vegetables, and sometimes restricting certain foods reduces the pressures in the colon, and complications are less likely to arise.
If testing and imaging reveal you have diverticulitis, we’ll take a multi-step approach to manage and treat this and future flare-ups. Treatment for diverticulitis may mean:
- Antibiotics to treat bacterial infections, combined with a probiotic regimen to repopulate your gut biome
- Draining severe abscesses or abscesses that don’t clear up on their own with antibiotics and lifestyle changes
- Switching to a high-fiber, healthy diet that minimizes bowel upset and inflammation
- Weight management
- Getting mild to moderate physical exercise every day
- Quitting smoking
In very severe cases or long-term diverticulitis that leads to fistulas, perforations, or other complications, we recommend surgical treatment.
Diverticulitis requires more intense management. Mild cases may be managed without hospitalization, but this is a decision made by your physician. Treatment usually consists of oral antibiotics, dietary restrictions and possibly stool softeners. Severe cases require hospitalization with intravenous antibiotics and strict dietary restraints. Most acute attacks can be relieved this way.
Surgery is usually only recommended for recurrent episodes, complications or severe attacks when there’s little or no response to medication.
In surgery, usually part of the colon, commonly the left or sigmoid colon, is removed and the colon is hooked up, or anastomosed, again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks.
For more information about Diverticular Disease, you can visit the National Institute of Health page on diverticulitis.
In the meantime, our team at CRS – Colorectal Specialists is dedicated to disease prevention, detection, diagnosis, and treatment. Please call us with questions or schedule an appointment online to put your mind at ease.