Many individuals have a number of protruding pouches but feel no ill effects. However, when one of them becomes infected, it can be very painful.
In this article, we will look at the causes, symptoms, risk factors, and treatments of diverticulitis and related conditions. We will also discuss the diverticulitis diet.
Contents of this article:
Here are some key points about diverticulitis. More detail and supporting information is in the main article.
- Diverticulitis is an infected pouch in the colon.
- Symptoms of diverticulitis include pain, constipation, and blood in the stool.
- One of the main causes of diverticular disease is thought to be a lack of dietary fiber.
- Most people are able to self-treat the condition.
- Surgery for diverticulitis may be necessary if the condition is recurring.
How common is diverticulitis?
Around 50 percent of people are thought to have diverticulosis by the age of 50.
An estimated10-25 percent of people with diverticulosis will go on to develop diverticulitis, although this figure is debated, and some believe it may be as low as 1 percent.
By the age of 80, an estimated 65 percent of people have diverticulosis.
The majority of people with diverticulosis will never experience any symptoms; this is called asymptomatic diverticulosis.
A study found that the incidence of diverticulitis among young obese adults is growing. A National Institutes of Health (NIH) report revealed that the cost of digestive diseases is now more than $141 billion a year in the United States.
Symptoms of diverticulitis and diverticular disease
The symptoms of diverticular disease and diverticulitis differ, so here, we will handle them separately:
Diverticulosis or diverticular disease symptoms
There may be episodes of pain in the lower abdomen. More specifically, usually in the lower left side of the abdomen. The pain often comes when the individual eats or passes stools. There may be some relief after breaking wind.
Other symptoms include:
- bowel habits change
- diarrhea (sometimes - less common than constipation)
- small amounts of blood in stools
- Constant and usually severe pain.
- Pain starts at the lower left side of the abdomen (rarely, it may be on the right side of the abdomen; this occurs more frequently in Asian people).
- Elevated temperature (fever).
- More frequent urination.
- Painful urination.
- Nausea and vomiting.
- Bleeding from the rectum.
Causes of diverticula
Lack of dietary fiber is thought to be the main cause of diverticula (pouches protruding outward from the colon). Fiber helps our stools remain soft.
If you do not consume enough dietary fiber and the stool is hard, there may be more pressure or strain on the colon as muscles push the stool down - this pressure may cause diverticula to develop.
Diverticula occur when weak spots in the outside layer of colon muscle give way, and the inner layer squeezes through.
Although there is no clear clinical evidence to prove a link between dietary fiber and diverticulosis, experts say the circumstantial evidence is convincing, although the debate continues.
Studies have shown that in parts of the world where dietary fiber intake is large, such as in Africa or South Asia, diverticula disease is fairly uncommon. On the other hand, it is quite common in western countries where dietary fiber intake is much lower.
Previously, consumption of nuts, seeds, and corn was thought to be a cause of diverticula development, but a study in 2008 found no link.
Risk factors for diverticulitis
Experts do not fully understand why diverticulitis - the infection of at least one diverticulum - occurs. We do know that the bacteria in the stool rapidly multiply and spread, causing an infection. It is thought that a diverticulum might become blocked, possibly by a piece of stool, which then leads to infection.
Risk factors include:
- Age - older adults have a higher risk than younger individuals.
- Weight - being obese increases diverticulitis risk.
- Lack of exercise.
- Diet high in animal fats and low in fiber.
- Some medications - including steroids, opiates, and non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen.
Some studies have indicated that genetics may be a factor.
Diagnosis of diverticular disease
A number of techniques may be used to aid diagnosis.
Diagnosing diverticular and diverticular-related diseases can be challenging, and there are a number of tests that might be carried out to ensure correct diagnosis.
There are several illnesses and conditions with similar symptoms, such as IBS (irritable bowel syndrome), so diagnosis of diverticular disease is not easy.
A doctor can rule out other conditions by having some blood tests done. They may also use the following techniques:
Colonoscopy - the doctor has a look inside the colon using a colonoscope - a thin tube with a camera at the end. The colonoscope enters through the rectum. Hours or a day before the procedure begins, people are given a laxative to clear their bowels.
A local anesthetic is given before the procedure starts. This test is not usually done during an acute episode of diverticulitis, but done around 6 weeks after resolution to ensure there are no signs of cancer.
Barium enema X-ray - a tube is inserted into the rectum, and a barium liquid is squirted into the tube and up the rectum. Barium is a liquid that shows up in X-rays. When organs that do not normally show up on X-ray are coated with barium, they become visible. The procedure is not painful.
If an individual has a history of diverticular disease, the doctor will be able to diagnose diverticulitis by carrying out a physical examination and asking some questions about symptoms and their medical history.
A blood test is useful because if it reveals a high number of white blood cells, it probably means there is an infection. However, many people without a high number of white blood cells may still have diverticulitis.
People who have no history of diverticular disease will need additional tests. Other conditions can have similar symptoms, such as a hernia or gallstones.
A computer tomography (CT) scan may be used and is often the most helpful. A barium enema X-ray may also be useful. If symptoms are severe, the CT scan may tell whether the infection has spread to another part of the body, or whether there is an abscess.
Treatment of diverticulitis and diverticular disease
Often, if the case is not too severe, the individual can treat themselves.
Diverticular disease treatment
Most people are able to self-treat their diverticular disease if it is mild and not causing complications, mainly with the help of painkillers and by consuming more dietary fiber.
Painkillers such as aspirin or ibuprofen should be avoided as they increase the risk of internal bleeding, and may also upset the stomach. Acetaminophen is recommended for pain relief from diverticular disease.
Eating more dietary fiber, which includes fruits and vegetables, will help resolve the symptoms by softening stool and helping stool patterns become more regular - this may sometimes take a few weeks.
Bulk-forming laxatives may help those who have constipation. It is important to drink plenty of fluids with these medications.
People who experience heavy or constant rectal bleeding should see their doctor.
Antibiotics may be used to treat some cases of diverticulitis.
Mild cases of diverticulitis can generally be treated by the individual. However, a doctor may prescribe antibiotics, plus acetaminophen for the pain.
It is important to complete the whole course of antibiotics, even if symptoms get better.
Some people may experience drowsiness, nausea, diarrhea, and/or vomiting while they are taking their antibiotics.
Antibiotics include ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex) and doxycycline (Vibramycin).
It is important to remember that antibiotics can interfere with the contraceptive pill's effectiveness. This effect on the contraceptive pill continues for about 7 days after stopping the antibiotic, so another form of contraception should overlap with this time.
Hospital treatment may be necessary if:
- Normal painkillers do not alleviate the pain, or the pain is severe.
- The individual cannot consume enough liquids to keep hydrated.
- They cannot take oral antibiotics.
- They have a poor state of health.
- The doctor suspects complications (often if the immune system is weak).
- Treatment at home is ineffective after 2 days.
Hospital patients are generally given antibiotics intravenously, as well as fluids if they are dehydrated.
Surgery for diverticulitis - colon resection
People who have at least two diverticulitis episodes may benefit from surgery. Studies indicate that such patients are significantly more likely to have subsequent episodes, as well as complications if they do not have surgery. Colon resection removes part of the affected colon and joins the remaining healthy parts together.
Patients who undergo colon resection will have to introduce solid foods into their system gradually. Apart from this, their normal bowel functions will not usually be affected. A small study suggests that chewing gum after colon surgery may accelerate the return of normal bowel function and shorten patients' hospital stays.
Sometimes, a doctor will recommend that someone with diverticulitis goes on a special diet, to give the digestive system an opportunity to rest.
Initially, just clear liquids are allowed for a few days; these include:
- ice chips
- fruit juice without pulp
- ice pops
- tea and coffee without cream
As symptoms ease, the diet starts to include low-fiber foods, including:
- Canned or cooked fruits and vegetables (without skin or seeds).
- Low-fiber cereals.
- Eggs, poultry, and fish.
- Milk, yogurt, and cheese.
- Refined white bread.
- Pasta, white rice, and noodles.
Complications of diverticulitis
Peritonitis - infection may spread into the lining of the abdomen if one of the infected diverticula bursts. Peritonitis is serious and can sometimes be fatal. It requires immediate antibiotic treatment. Some cases of peritonitis require surgery.
Abscess - this is a puss-filled cavity that requires antibiotics. Sometimes, surgery is required to get the puss out.
Fistula - these are abnormal tunnels (tubes) that connect two parts of the body, such as the intestine to the abdominal wall or the bladder. A fistula can be formed after infected tissues touch each other and stick together; when the infection is over, a fistula forms. Often, surgery is needed to get rid of a fistula.
Intestinal obstruction - the colon may become partly or totally blocked if infection has caused scarring. If the colon is blocked completely, emergency medical intervention is needed. Total blockage will lead to peritonitis. If the colon is partially blocked, they will need treatment - however, it is not as urgent as total blockage.
Depending on the degree of scarring and the extent of blockage, a colon resection may be needed. Sometimes, a colostomy may be required - a hole is made on the side of the abdomen, and the colon is redirected through the hole and connected to a colostomy bag (external). As soon as the colon has healed, the colon is rejoined. In rare cases, the doctors may have to create an ileo-anal pouch (internal pouch).
Prevention of diverticulitis
If you eat a well-balanced diet with plenty of fruit and vegetables, your chances of developing diverticulitis are considerably lower.