Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (bowel). Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits. Mild diverticulitis can be treated with rest, changes in your diet and antibiotics, but severe or recurring diverticulitis may require surgery.
What are diverticula?
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 very common, especially after age 40, and seldom cause problems.
What is the difference between diverticulosis and diverticulitis?
Diverticulosis is simply the presence of these tiny bulges or pockets (diverticula) in your colon. They usually do not 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.
Who is most likely to get diverticulosis and diverticulitis?
Almost anyone can develop diverticular disease, but your are at increased risk of diverticular disease (diverticulosis or diverticulitis) if you:
• Are over 40 years of age.
• Are male.
• Are overweight.
• Eat a low-fibre diet. You do not eat a lot of fruits, vegetables, beans and legumes, breads and grains or nuts.
• Eat a diet high in fat and red meat.
• Do not exercise regularly.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs); steroids; or opioids.
• Smoke
What causes diverticulosis and diverticulitis?
Authorities are not really sure what causes diverticulosis, but many think it is caused by not eating enough fibre. Not eating enough fibre 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.
We are not 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.
What are the symptoms of diverticulitis?
The symptoms of diverticulitis might vary in severity. They include the following:
• Pain, tenderness or sensitivity in the left lower side of your abdomen. Pain can start out mild and increase over several days or come on suddenly. (Pain is the most common symptom.)
• Fever.
• Nausea and/or vomiting.
• Chills.
• Cramps in the lower abdomen.
• Constipation or diarrhoea (less common).
• Rectal bleeding.
You should seek medical attention anytime you have constant, unexplained abdominal pain, particularly if you also have a fever and constipation or diarrhoea.
Diagnosis
Diverticulitis is usually diagnosed during an acute attack. As abdominal pain can indicate a number of problems, your doctor should rule out other causes for your symptoms. Following a history and physical examination your doctor might arrange for a number of tests. In women a pelvic examination is warranted to rule out pelvic disease.
How is diverticulosis treated?
If you have diverticulosis, you likely do not have symptoms and do not need treatment. However, since diverticulosis could lead to diverticulitis, you should eat a diet high in fibre as a preventive measure. This means eating more fruits, vegetables, grains, nuts, seeds, beans, legumes and less red meat.
How is diverticulitis treated?
If your diverticulitis is mild, your healthcare provider will prescribe an oral antibiotic. Rest, taking over-the-counter medications for pain, and following a low-fibre diet or a liquid diet, may be recommended until your symptoms improve. Once your symptoms improve, you can slowly return to soft foods, then a more normal diet which should be one that includes many high-fibre foods. You and your healthcare provider will discuss the specifics of your treatment plan.
If your diverticulitis is severe, you have rectal bleeding, or are having a repeat bout of diverticulitis, you may be admitted to the hospital to receive intravenous (IV) antibiotics, IV fluids or possibly be considered for surgery.
Surgery for diverticulitis is considered if you have abscesses. (An abscess is a contained or “walled-off” infection in the abdomen).Perforation/peritonitis, a tear (perforation) in your colon allows pus or stool to leak into your abdominal cavity, resulting in peritonitis. This is a life-threatening infection and requires emergency surgery to clean the cavity and remove the damaged part of the colon, blockages, strictures or fistulas. Diverticular bleeding occurs when a small blood vessel near the diverticula bursts. Mild bleeding usually stops on its own, but about 20% of cases require treatment. Surgery may be needed if other attempts to stop the bleeding fail. Surgery is also indicated if there is severe diverticulitis that has not responded to other treatment methods, or if the patient is having multiple attacks despite following a high-fibre diet.
Complications
About 25% of people with acute diverticulitis develop complications which may vary in severity. These complications often require urgent treatment in hospital.
Prevention
Having regular bowel movements, and avoiding constipation and straining, are important to prevent diverticular disease and reduce its complications. To help prevent diverticulitis the following are recommended:
• Exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes on most days.
• Eat more fibre. A high-fibre diet decreases the risk of diverticulitis. Fibre-rich foods, such as fresh fruits and vegetables and whole grains, soften waste material and help it pass more quickly through your colon. Eating seeds and nuts is not associated with developing diverticulitis.
• Drink plenty of fluids. Fibre works by absorbing water and increasing the soft, bulky waste in your colon. But if you do not drink enough liquid to replace what is absorbed, fibre can be constipating.
• Avoid smoking. Smoking is associated with an increased risk of diverticulitis.
Conclusion
Diverticular disease is very common condition. If you have been told you have diverticulosis, this is usually not cause for concern. This condition is very common and increases with age. It is present in about 50% of people over age 60 and in almost everyone over age 80. Up to 30% of people with diverticulosis do develop diverticulitis. Diverticulitis can be a serious, and even a potentially life-threatening, complication. You might develop rectal bleeding, abscesses and fistulas, obstruction and perforation, leading to peritonitis. Fortunately, once diagnosed, diverticulosis can be treated. Most people who have diverticulitis will recover with about a seven to 10-day course of antibiotics and rest. The best self-treatment is to eat a high-fibre diet. Also, drink more fluids (half your body weight in ounces each day) and exercise regularly.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field is ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
