Diverticulosis and Diverticulitis

Diverticulosis and Diverticulitis 7July

Dr. Robert Ripley, MD, FACSBy: Robert Ripley, MD,FACS

These are 2 conditions that occur in the large intestine. They have in common diverticula, which is a weak spot between the muscle fibers of the colon wall causing a bulge or pocket. Although this can occur in the small intestines as well, it is much more common in the left side of the colon, called the sigmoid colon. It’s believed that the cause is increased pressure that over eventually causes a weak spot. Typically, people have more than 1 of these diverticula, and they can be shallow or deep with a small or wide opening or mouth.

The difference between diverticulosis and diverticulitis is that diverticulosis is simply the presence of diverticula, occurring in 50% of people over the age of 60. Diverticulitis is an infection of 1 or more of the diverticula. It will cause pain, usually on the lower left side of the abdomen. that is constant and associated with nausea and a low-grade fever.

Although diverticulosis can occur in men and women of all shapes and sizes, it occurs more often in overweight males who eat a low fiber diet, meaning they don’t eat enough vegetables or fruits. Additionally, its associated with people who smoke, have a high fat diet and take nonsteroidal medications like aspirin, ibuprofen, Aleve, steroids and narcotics

Diverticulosis usually causes no symptoms, but it can cause some tenderness on the left side of the abdomen associated with occasional cramps, bloating and constipation. The symptoms of diverticulitis are a constant pain, again usually in the left lower abdomen with loss of appetite, occasional vomiting, chills, cramps and constipation.

Diverticulitis can be suspected during a history and physical exam and confirmed with a CT scan of the abdomen and pelvis. Additional studies can include a white blood cell count, digital rectal exam and other x-rays such as barium enema.

When you are found to have diverticulosis, you do not need to take any medication, but it is recommended to alter your diet to a high fiber diet. Foods that have a high percentage of fiber are fruits, vegetables, grains, seeds, beans, nuts and legumes. Red meat is not excluded from this diet, but it is recommended to decrease the amount that you eat.

On the other hand, diverticulitis requires treatment, in mild cases, with oral antibiotics and a liquid diet. More severe cases need to be admitted to the hospital and treated with intravenous antibiotics and bowel rest, meaning no eating for several days. Most cases of diverticulitis resolve with this management. However, complications can occur such as abscesses, perforation, or strictures. These complications require surgery to return your colon to normal function.

There is 1 additional complication that can occur from diverticulosis that does not involve infection. It is bleeding. The walls of the colon have multiple small blood vessels to help bring nutrients to the colon wall. If 1 of these is located near a diverticulum then the thinning of the wall beside it, along with increased pressure, can cause a blood vessel to burst and bleed into the lumen of the colon. Most cases are self-limiting and will stop on their own. However, sometimes bleeding is severe enough that it requires transfusion and surgery.

To prevent or lessen the chance of diverticulosis and diverticulitis, remember to eat more fiber. Fiber will act like a sponge and hold water in the stool making it softer and easier to move. Drink plenty of water to prevent dehydration and exercise daily for 30 minutes. Exercise helps food pass through the colon in a regular and constant fashion. The National Institute of diabetes and digestive disease recommends eating 28 g of fiber per day. Fiber is the part of plants and vegetables that is not digestible and will hold onto water to make your movements softer and easier to pass. Other benefits of a high fiber diet are lowering of your blood pressure, decreasing blood cholesterol, improving control of blood sugar and decreasing the risk of developing colon cancer

In the past it was recommended to avoid eating nuts, seeds and popcorn if you had diverticular disease. However newer studies indicate that these foods are not associated with flareups. So, it is fine to enjoy popcorn at the movie, just try not to put any butter on it.

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