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Thursday, February 21, 2008

Diverticulosis and Diverticulitis

Diverticular disease consists of diverticulosis and diverticulitis. Diverticulosis is the formation of numerous tiny pockets, or diverticula, in the lining of the bowel. Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste or liquid. Diverticula can form while straining during a bowel movement, such as with constipation. They are most common in the lower portion of the large intestine (called the sigmoid colon).

Complications can occur in about 20% of people with diverticulosis. One of these complications is rectal bleeding, called diverticular bleeding, and the other is diverticulitis.

Diverticular bleeding occurs with chronic injury to the small blood vessels that are adjacent to the diverticula. Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with waste, allowing bacteria to build up causing infection.

Diverticulosis is very common and occurs in 10% of people over age 40 and in 50% of people over age 60. The occurrence of diverticulosis increases with age and affects almost everyone over age 80.

Usually diverticulosis does not cause any troublesome symptoms. Some people may feel tenderness over the affected area or abdominal cramps.

Because most people with diverticulosis do not have any symptoms, it is usually found through tests ordered for an unrelated reason.

People who have diverticulosis without symptoms or complications do not need treatment, yet it is important to adopt a high-fiber diet.

Laxatives should not be used to treat diverticulosis, and enemas should also be avoided or used infrequently.

Good bowel hygiene is most important to prevent diverticular disease or reduce the complications from it. This means having regular bowel movements and avoiding constipation and straining. Eating appropriate amounts of the right types of fiber are important to maintain good bowel hygiene. Drinking plenty of water and exercising regularly are also important.

The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day. Fiber is the indigestible part of plant foods. High-fiber foods include whole grain breads, cereals and crackers; berries; fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash and beans; brown rice; bran products; and cooked dried peas and beans, among other foods.

A high-fiber diet helps prevent constipation and provides a number of other health benefits, including lowering blood pressure, reducing blood cholesterol, improving blood sugar and reducing your risk of developing certain intestinal disorders.

Drinking eight 8-ounce glasses of water a day, monitoring changes in bowel movements (from constipation to diarrhea) and getting enough rest and sleep, are other ways to prevent diverticular disease.



  • Painful cramps or tenderness in the lower abdomen
  • Chills or fever

If you are experiencing the symptoms of diverticulitis, it is important to see your doctor for the correct diagnosis. Some symptoms of irritable bowel syndrome and stomach ulcers may be similar to those of diverticular disease.

Your doctor will ask you questions about your medical history (such as your bowel habits, symptoms, pain, diet and current medications) and perform a physical exam, including a digital rectal exam.

One or more diagnostic tests may be ordered to help diagnose your condition. Tests may include X-rays, CT scanning, ultrasound testing, a sigmoidoscopy, colonoscopy, barium enema, and blood tests to look for signs of infection or the extent of bleeding.

In people with rapid, heavy rectal bleeding, the doctor may perform a procedure called angiography to locate the source of the bleed. During this test, doctors insert the patient’s arteries with a harmless dye that will allow the doctor to view the source of the bleeding using a special.

Diverticulitis sometimes resolves without medical treatment, but it frequently requires antibiotics. Sometimes the infection is so severe that it is necessary to be admitted to a hospital for intravenous antibiotics and other supportive care. Rarely, a surgeon may need to remove the affected part of the bowel.

During the active stage of the infection, many experts recommended eating a low fiber diet and drinking plenty of water. A month or so after the infection resolves, fiber should be back on the menu.

Emergency treatment including surgery may be needed when the antibiotics do not work, and in cases of a large abscess, perforation, peritonitis or continued rectal bleeding.

Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity causing the following problems:

  • Peritonitis (a painful infection of the abdominal cavity)
  • Abcesses ("walled off" infections in the abdomen)
  • Obstruction (blockages of the intestine)

If an abscess is present, the doctor will need to drain the fluid by inserting a needle into the infected area. Sometimes surgery is needed to clean the abscess and remove part of the colon. If the infection spreads into the abdominal cavity (peritonitis), surgery is needed to clean the cavity and remove the damaged part of the colon. Without proper treatment, peritonitis can be fatal.

Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A partial blockage does not require emergency surgery; however, complete blockage does require emergency surgery.

Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. The most common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.

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