Diverticulosis is the condition of having pouches form inside the lining of your colon. Diverticulitis is when those pouches become inflamed.
Diverticulitis and diverticulosis are related gastrointestinal conditions affecting the colon.
Diverticulosis involves the formation of small pouches, called diverticula, in the colon wall, while diverticulitis occurs when these pouches become inflamed or infected.
Diverticulosis and diverticulitis are common conditions that become more common as you get older. Usually, diverticulosis does not cause any problems, but diverticulitis can cause more issues.
Learn more about diverticulitis and diverticulosis, including their definitions, causes, symptoms, diagnosis, treatment, and potential risks and complications.
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What are diverticulosis and diverticulitis?
Diverticulosis
Diverticulosis is a condition where small pouches, called diverticula, form in the wall of the colon. These pouches are usually benign and often do not cause symptoms. Diverticulosis is common, especially in older adults.
Diverticulitis
Diverticulitis occurs when one or more of the diverticula become inflamed or infected. This condition can lead to more severe symptoms and may result in serious complications if not treated.
Remember
Diverticula are the small pouches that form in the wall of the colon.
Causes of diverticulosis and diverticulitis
Diverticulosis
Weak spots in the colon wall: Diverticulosis occurs when high pressure inside the colon pushes against weak spots in the colon wall, causing pouches to form.
Risk factors include:
- Aging
- Low-fiber diet
- Lack of physical activity
- Obesity
- Smoking
- Family history of the condition
Diverticulitis
- Infection or inflammation: Diverticulitis arises when fecal matter or undigested food particles become trapped in the diverticula, leading to bacteria growth and infection.
- Risk factors: In addition to the risk factors for diverticulosis, other contributing factors include nonsteroidal anti-inflammatory drug (NSAID) use and a history of diverticulitis.
Symptoms of diverticulosis and diverticulitis
Diverticulosis
- Often asymptomatic: Most people with diverticulosis do not experience symptoms.
- Mild symptoms: Some may have mild symptoms such as bloating, constipation, or mild abdominal discomfort.
Diverticulitis
- Abdominal pain: Sudden, severe pain, typically in the lower left side of the abdomen.
- Fever and chills: Symptoms of infection and inflammation.
- Nausea and vomiting: Caused by gastrointestinal upset.
- Changes in bowel habits: Constipation or diarrhea.
- Bloating and gas: Associated with the inflamed diverticula.
- Tenderness in the abdomen: Pain on pressing the affected area.
Diagnosis of diverticulosis and diverticulitis
Medical history and physical examination
- Symptom assessment: Detailed inquiry about the presence, duration, and severity of symptoms such as abdominal pain, fever, and changes in bowel habits.
- Physical examination: Palpation of the abdomen to assess tenderness and detect any masses or discomfort.
Diagnostic tests
- Blood tests: To check for signs of infection or inflammation, such as elevated white blood cell count.
- Stool tests: To rule out other causes of gastrointestinal symptoms.
- Imaging studies:
- CT scan: Commonly used to diagnose diverticulitis, providing detailed images of the colon and identifying inflamed or infected diverticula.
- Ultrasound: Can visualize the colon and help detect complications.
- Colonoscopy: Used to diagnose diverticulosis by directly visualizing the colon. It is generally avoided during acute diverticulitis due to the risk of perforation.
- Barium enema X-ray: Involves injecting a contrast dye into the colon to enhance X-ray imaging, allowing for the visualization of diverticula.
Learn more about what happens during a colonoscopy>>
Treatment of diverticulosis and diverticulitis
Diverticulosis
Diverticulosis can typically be treated without any medical or surgical intervention. Lifestyle changes can often be effecting in treating diverticulosis.
- High-fiber diet: Increasing fiber intake through foods like fruits, vegetables, whole grains, and legumes to promote regular bowel movements and reduce the risk of diverticula formation.
- Hydration: Drinking plenty of fluids to help fiber move through the digestive system.
- Exercise: Regular physical activity to support healthy bowel function.
- Avoiding straining: Preventing straining during bowel movements to reduce pressure on the colon.
Diverticulitis
Treatment for diverticulitis depends on the severity of the problem. Mild cases can often be treated with a combination of medicine and lifestyle adjustments. Severe cases of diverticulitis may require surgery.
Mild cases:
- Dietary changes: Starting with a clear liquid diet and gradually reintroducing low-fiber foods as symptoms improve. Increasing fiber intake once symptoms resolve.
- Antibiotics: Prescribed to treat the infection and reduce inflammation.
- Pain management: Over-the-counter pain relievers such as acetaminophen.
Severe cases:
- Hospitalization: May be required for severe symptoms, including IV antibiotics, intravenous fluids, and pain management.
- Bowel rest: Patients may need to avoid eating solid foods for a few days to allow the colon to heal.
- Abscess drainage: If an abscess forms, it may need to be drained by inserting a needle through the skin to remove the infected fluid.
- Surgery: Required for complications such as perforation, abscess, fistula, or recurrent episodes of diverticulitis. Surgical options include:
- Bowel resection: Removing the affected segment of the colon and reconnecting the healthy ends.
- Colostomy: In severe cases, a temporary or permanent colostomy may be necessary, where the end of the colon is brought to the surface of the abdomen to pass stool into a colostomy bag.
Potential risks and complications
Complications of diverticulosis
- Diverticulitis: Inflammation or infection of the diverticula, leading to more severe symptoms and complications.
- Bleeding: Diverticula can occasionally bleed, causing noticeable blood in the stool.
Complications of diverticulitis
- Abscess: A pocket of pus that can form around the inflamed diverticula.
- Perforation: A hole in the wall of the colon, leading to peritonitis (infection of the abdominal cavity).
- Fistula: An abnormal connection between the colon and another organ, such as the bladder or vagina.
- Bowel obstruction: Blockage of the colon due to inflammation and scarring from recurrent diverticulitis.
Surgical risks
- Infection: Risk of infection at the surgical site.
- Bleeding: Risk of bleeding during and after surgery.
- Anastomotic leak: Leakage at the site where bowel ends are reconnected.
Diverticulitis and diverticulosis are common gastrointestinal conditions that can cause significant discomfort and complications if not properly managed. Understanding the causes, symptoms, diagnostic methods, and treatment options is essential for effective care. If you or a loved one are experiencing symptoms of diverticulitis or diverticulosis, consulting with a health care provider will help develop a comprehensive treatment plan tailored to your specific needs and circumstances.
Frequently asked questions about diverticulosis and diverticulitis
Diverticulosis and diverticulitis are not exactly the same thing. Diverticulosis is the presence of small diverticula or pouches in the wall of the colon. Diverticulitis is when one or several of these diverticula burst and cause infection or inflammation. While diverticulosis is common, occurring in more than half of American senior citizens, diverticulitis only occurs in about 20% of patients with diverticulosis. The majority of diverticulitis occurs in the last segment of the colon above the rectum called the sigmoid colon.
Diverticulosis, or the presence of diverticula, is common in the United States because of our Western diet, which is generally high in fat and low in fiber. In general, diverticulosis and diverticulitis result from high pressures in the colon related to the typical Western diet. These diverticula are weak spots in the colon that can burst and cause diverticulitis. Even if a person has diverticulosis, there is good evidence that a diet high in fiber decreases the risk of developing diverticulitis.
In general, seeds and nuts do not cause diverticulitis. In fact, a healthy diet that is high in fiber can be preventative for developing diverticulitis. Patients often are told to avoid anything with seeds or nuts, including strawberries. There is no evidence to support avoidance of these foods.
Symptoms from diverticulitis include lower or left-sided abdominal pain and fever. Lower abdominal tenderness is common. Some patients will develop more chronic symptoms including pain when they need to have a bowel movement.
Antibiotics are not always required, especially with very mild cases. Often patients will improve with dietary modifications.
For the most part, with elective surgery for diverticulitis, a colostomy is not necessary. There are exceptions to this rule, usually when patients have had extremely severe attacks or have developed extremely complex fistulas. Usually, when an ostomy is necessary in these situations, it is temporary.
If emergency surgery is required in cases of complete perforation and peritonitis, a colostomy is frequently necessary. This is usually a temporary colostomy and it can be reversed several months after the patient has recovered.
