Diverticulosis of the Colon

What is Diverticulosis of the Colon?

Diverticula are sac-like protrusions (pouches or bulges) of the mucous membrane of the colon. They can range in size from that of a pea to much larger dimensions and are formed by increased pressure on the wall of the intestine from gas or stool, such as in cases of constipation. They are most commonly found in the lower part of the colon (sigmoid colon).

Complications affect about 20% of people with diverticula. One of these complications is rectal bleeding, also known as enterorrhagia. Bleeding from diverticula occurs when there is chronic (long-term) injury to small blood vessels near the diverticula.

Another complication is diverticulitis. Diverticulitis occurs when there is inflammation (swelling) and infection in one or more diverticula. This usually happens when they become blocked with waste, allowing bacteria to cause an infection.

Diverticulosis is very common in Western populations and occurs in 10% of individuals over 40 years old and in 50% of those over 60. The rate of diverticulosis increases with age, affecting nearly everyone over 80 years old.

What are the Symptoms of Diverticulosis?

Typically, diverticulosis does not cause bothersome symptoms. Some people may feel tenderness over the area where the diverticula are located or experience cramps in the abdomen.

How is Diverticulosis Diagnosed?

Because most people with diverticulosis have no symptoms, it is usually discovered incidentally when the patient undergoes tests for another reason.

How is Diverticulosis Treated?

People with diverticulosis without symptoms or complications do not need treatment, but it is important to adopt a diet rich in fiber. Laxatives should not be used to treat diverticulosis, and the patient should also avoid enemas or use them rarely.

How Can Diverticulosis be Prevented?

Good bowel hygiene is most important for preventing diverticulitis or reducing complications. This means:

• Having regular bowel movements to avoid constipation and straining.
• Eating adequate amounts of the right type of fiber.
• Drinking plenty of water.
• Exercising regularly.

The American Dietetic Association recommends 20 to 35 grams of fiber per day. Every person, whether they have diverticula or not, should try to consume this amount of fiber daily. Fiber is the part of plant foods that cannot be digested.

Foods rich in fiber include:

• Whole grain breads, cereals, and crackers
• Berries and other fruits
• Vegetables like broccoli, cabbage, spinach, carrots, asparagus, and beans
• Brown rice
• Whole grain products
• Baked dried peas and beans, among other foods.

A diet high in fiber helps prevent constipation and provides a range of other health benefits, including lower blood pressure, reduced cholesterol levels, improved blood sugar levels, and a decreased risk of developing certain intestinal disorders.

Other ways to prevent diverticulitis include drinking eight glasses of water a day, monitoring changes in bowel movements (from constipation to diarrhea), and allowing necessary time for rest and sleep.

What are the Symptoms of Diverticulitis?

Symptoms of diverticulitis include painful cramps or tenderness in the lower abdomen, and chills or fever.

How is Diverticulitis Diagnosed?

If you experience symptoms of diverticulitis, it is important to see your doctor for a proper diagnosis. Some symptoms of irritable bowel syndrome and peptic ulcers may be similar to those of diverticular disease.

Your doctor will ask about your medical history (such as bowel habits, symptoms, diet, and medications) and will conduct a physical examination. The doctor may recommend one or more tests to diagnose your condition. These tests may include X-rays, CT scans, ultrasounds, sigmoidoscopy, colonoscopy, and blood tests to look for signs of infection or to assess bleeding.

For people with severe, acute rectal bleeding, the doctor may recommend an invasive test called angiography to determine the source of the bleeding. During this test, doctors inject a harmless dye into the patient’s arteries that will allow the doctor to see the source of the bleeding.

What are the Complications of Diverticulitis?

Severe complications can arise as a result of diverticulitis. Most arise due to perforation (hole) of the intestinal wall. If this occurs, intestinal contents may leak from the intestines into the abdominal cavity, leading to the following problems:

• Peritonitis (a painful infection of the abdominal cavity)
• Abscesses
• Obstruction (blockages of the intestine)

How is Diverticulitis Treated?

Diverticulitis sometimes resolves without medical care, but in many cases, the patient will need antibiotics. Sometimes the infection is so severe that the patient must be hospitalized for intravenous antibiotics and other supportive care. In rare cases, the surgeon may need to remove the affected area of the intestine.

During the active phase of the infection, many specialists recommend a low-fiber diet and plenty of fluids. About a month after the infection, fiber should be reintroduced into the diet.

Emergency treatment, including surgery, may be required when antibiotics do not work, and in cases of large abscesses, perforation, peritonitis, or ongoing severe rectal bleeding. If an abscess is present, the doctor may need to drain the fluid by inserting a needle into the infected area. Sometimes surgery is necessary to clean out the abscess and remove part of the colon.

If the disease spreads to the abdominal cavity (peritonitis), surgery is necessary to clean the cavity and remove the damaged portion of the colon. The infection can lead to scarring of the colon, and the scar tissue can cause partial or complete obstruction. A complete obstruction requires surgery, while a partial obstruction does not necessarily require it.

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