Diverticulitis

It is a condition where the wall of the colon develops outpockets due to weak areas, called diverticula. These occur when the inner intestinal lining has pushed through a weakened area in the colon wall. A single pocket is called a diverticulum. It can occur anywhere in the colon, but 80% occur on the left side mainly in the sigmoid, due to its narrow diameter. The presence of these pockets is called diverticulosis. When they become inflamed or infected, the term is diverticulitis (occurs in 10-25% of diverticulosis patients).

How common are colonic Diverticula?

Depending on dietary habits, most of the Western population will have multiple diverticula (several dozen), by the age of 60. It is less common in lifelong vegetarians due to the high fiber diet.

What causes Diverticular Disease?

Low dietary fiber due to processed foods. Diverticulosis was first noticed in the U.S. in the early 1990’s as processed foods were introduced in the American diet. Fiber is a part of fruits, vegetables, and grains that the body can not digest. Some fiber dissolves in water and takes on a soft, jelly-like texture in the intestines (soluble fiber). Other fiber passes through unchanged (insoluble fiber). Both kinds make stool soft and easy to pass. Thus fiber prevents constipation, so that the muscle wall does not strain to move the stool and increase the pressure. The excess pressure causes the weak spots in the colon to bulge out and become diverticula.

What are the symptoms of Diverticulosis?

Most people with diverticulosis have no symptoms. They may discover that they have the condition after colonoscopy. General symptoms may be mild cramping, bloating, and constipation.

What are the symptoms of Diverticulitis?

The most common symptom is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting chills, cramping and constipation can be present.

What is the treatment for Diverticulosis?

If there are no symptoms, treatment is usually not necessary, but a fiber-rich diet is recommended. High Fiber Diet - Recommended 35 grams of fiber per day:

  1. Grains
  2. Vegetables
  3. Fruits

* Okay to eat seeds and nuts. There is no evidence that small seeds cause diverticula.

What is the treatment for Diverticulitis?

Mild cases require bowel rest and antibiotics. In severe cases, patients need hospitalization, intravenous antibiotics, and possibly surgery to remove the infected segment of colon, due to bleeding or perforation.

What are the complications of Diverticulitis?

  • Bleeding - Rare, but may be severe, caused by small blood vessels in the diverticulum that bursts. Rectal bleeding will occur.
  • Abscess, Perforation, and Peritonitis - If the infection doesn't clear in a few days, an abscess may form with pus causing swelling and destroying tissue. If a hole occurs (perforation) pus may leak out of the colon into the abdominal area. If large it is called peritonitis and requires immediate surgery to clean the abdominal cavity and remove the damaged segment of colon. Without surgery, peritonitis can be fatal.
  • Fistula - An abnormal connection of tissue between two organs, or an organ and skin. When damaged tissue come in contact with each other during infection, they can stick together. During healing a fistula forms. The most common organs involved are the urinary bladder, small intestine, and skin. The most common fistula, especially in males, is the bladder to colon. This type of fistula can result in severe long lasting infection of the urinary tract and usually requires corrective surgery to remove the fistula and the affected portion of the colon.
  • Intestinal Obstruction - The scarring from the infection and healing process may cause partial or total blockage of the large intestine. Complete obstruction requires emergency surgery.