Understanding Diverticular Disease

What is Diverticular Disease?

Diverticular disease is made up of three different conditions that are related to diverticula, which are small pockets or bulges that form in the colon.

Diverticulosis means there are diverticula in the colon but they may or may not be causing any problems. This condition is very common, with up to 50% of people over the age of 60 having diverticulosis, which often results from straining during bowel movements.

Diverticulitis occurs when these pockets become inflamed or infected, usually when the pockets become blocked by fecal waste, allowing bacteria to build up in the pockets. Symptoms can start suddenly and can include pain in the left lower abdomen, chills or fever, nausea or vomiting, and bowel movements that alternate between diarrhea and constipation.

Diverticular bleeding occurs when small blood vessels located inside the diverticula become injured from chronic irritation. Bleeding is usually painless and only noticed as bright red blood with bowel movements.

How is Diverticular Disease Diagnosed?

Diverticulosis is usually diagnosed during testing of the colon that is done for another reason, like a routine colonoscopy used to screen for colon cancer.

If you develop diverticulitis symptoms, your doctor will take your medical history and perform a physical exam. They will also order diagnostic tests, such as a CT scan, x-ray of the abdomen, or blood tests.

A rectal exam and blood tests may be done to diagnosis diverticular bleeding. A colonoscopy may also be ordered.

How is Diverticular Disease Treated?

Diverticulosis: If you have diverticulosis without any symptoms you do not need treatment. It is usually recommended that you increase your fiber intake, drink plenty of fluids, and exercise regularly. The best way to get more fiber in your diet is to eat more fruits, vegetables, and whole grains (brown rice, oatmeal, barley, etc.). As an alternative, your doctor may recommend that you take a fiber supplement, such as psyllium or methylcellulose. But beyond this, nothing has been shown to help prevent diverticulosis related problems from occurring.

Diverticulitis: If you develop mild diverticulitis, there is a good chance you can be treated at home with a clear liquid diet and oral antibiotics. But if you have moderate to severe symptoms you will require treatment in a hospital. Likely, you will not be allowed to eat or drink anything until your symptoms improve and antibiotics will be given intravenously. If an abscess forms in the colon, it may need to be drained by either placing a drainage tube through your abdomen into the abscess or by having surgery to open the abscess. A rare but serious complication can occur called peritonitis, which is a generalized infection of the abdomen. This requires emergency surgery to remove the affected part of the colon and to clean out the infection from the abdomen.

Diverticular Bleeding: Most of the time, diverticular bleeding will stop on its own. If it doesn't, treatment options include a colonoscopy, angiography (procedure to block the bleeding artery), or surgery.

What is the Prognosis of Diverticular Disease?

Diverticulosis: Most people with diverticulosis never have a problem. However, about 20% of people will develop a complication from their diverticulosis, either bleeding or diverticulitis.

Diverticulitis: The vast majority of people with diverticulitis will respond well to treatment with antibiotics, while approximately 15% will require surgery to treat the infection. After the first episode is cured, about one-third of people will be symptom free, one-third of people will have episodes of cramps without any signs of infection, and one-third of people will develop additional episodes of diverticulitis. Only 10% of people are symptom free after having a second episode.

Where Can You Get More Information About Diverticular Disease?

National Library of Medicine: https://medlineplus.gov/healthtopics_d.html

American Society of Colon and Rectal Surgeons: https://www.fascrs.org/patients

National Institute of Diabetes and Digestive and Kidney Diseases: https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis