Guide to Diverticulosis and Diverticulitis

Diverticular Disease Can Cause Bleeding In The Gastrointestinal Tract

Diverticula
Diverticula are little outcroppings in the colon that can become inflamed and bleed under certain circumstances. Image © A.D.A.M.

Diverticulosis is a common condition of the large intestine (colon) that occurs as people age. In diverticulosis, the wall of the large intestine develops weak spots which bulge outward to form little pockets, which are called diverticula. When these diverticulum become inflamed or infected, it is called diverticulitis. Diverticulosis and diverticulitis are together known as diverticular disease.

Who Gets Diverticulosis?

Diverticulosis tends to occur in people over the age of 40, with as many as 50% of people over the age of 60 showing signs of the disease.

Diverticular disease is more common in the United States, England, and Australia, which could mean that the low-fiber diets common in these countries may be a contributing factor. Diverticular disease is less common in areas where a high-fiber diet is the norm, such as in Asia and Africa.

What Are the Symptoms

Diverticulosis might not cause any symptoms, but in some cases there may be bleeding.

Diverticulitis is caused by infection or inflammation in the diverticula, and is often accompanied by abdominal pain. The abdominal pain is variable, and typically begins suddenly, but it could also develop over the course of several days. Symptoms of diverticulitis can include:

Causes Of Diverticular Disease

The cause is not entirely understood, but Western diets, which tend to be low in fiber, and a sedentary lifestyle are thought to contribute to diverticular disease.

A low-fiber diet could lead to constipation. Constipation in and of itself might not cause diverticular disease, but the straining to pass hard stools could cause the walls of the colon to bulge outward and lead to diverticula. It's not currently known why a sedentary lifestyle may also linked to diverticular disease.

Diverticulitis might be caused by stool getting stuck in the diverticula.

Diagnosing Diverticular Disease

In the absence of any symptoms, diverticulosis usually goes undiagnosed. It's not uncommon for diverticulitis to be diagnosed when a physician is actually looking for the cause of some other symptoms, or during a routine screening colonoscopy.

Tests that can help diagnose diverticular disease include:

Colonoscopy. Diverticulitis might be found during a colonoscopy that was performed to check out symptoms, such as bleeding or abdominal pain. A colonoscopy is a routine screening test in people over the age of 50, which might lead to a diagnosis of asymptomatic diverticular disease.

Computerized Tomography (CT) Scan. A CT scan is a series of x-rays that can provide a detailed view of the abdomen and other body areas. They are typically non-invasive, painless, and harmless. In some cases, intravenous and/or oral contrast dyes are used to enhance the visibility of certain structures (such as the large intestine).

Contrast medium is either given in a drink, or injected into a vein. The dye helps the physician to find the organs inside the abdomen and to look for anything unusual, such as diverticula.

Treating Diverticular Disease

Initial treatment for diverticulosis includes increasing the amount of fiber in the diet.

Most people in the United States don't get enough fiber in their diet. Fibrous foods help keep stool soft and easy to pass, which can help prevent constipation and subsequent straining to have a bowel movement. Fiber can also be added to the diet through fiber supplements. If you have been diagnosed with diverticular disease, talk to your doctor about which type of fiber supplement is right for you.

In the past, it was recommended that people with diverticular disease avoid foods that might get "stuck" in the diverticula, such as popcorn, nuts, and seeds such as sunflower, pumpkin, caraway, and sesame. There isn't any evidence to back up this recommendation, but check with your doctor about dietary restrictions.

Diverticulitis requires more intensive evaluation and treatment, usually involving a CT or other imaging scan, consultation with a gastroenterologist and a general surgeon, antibiotics, bowel rest, and –- not infrequently -– surgery on either an elective or an urgent basis.

Complications of Diverticular Disease

Bleeding. When diverticula bleed, the blood could be found either in the toilet bowl or in the stool. The blood is thought to be caused by a broken blood vessel and might not need any treatment. This is not a common complication, but it can result in a significant amount of blood.

In some cases, the bleeding might need to be investigated and stopped during a colonoscopy or through surgery. Even if you have been diagnosed with diverticular disease, it is important to get any bleeding from the rectum checked out by a doctor.

Abscess. Diverticulitis is an infection of the diverticula, and such an infection could lead to an abscess.

An abscess is a pocket of pus that's found in inflamed tissue. An abscess inside the body, such as in the large intestine, is not always easy to find, but if it is small it could be treated with a course of antibiotics. More severe abscesses might need to be drained, which is accomplished by using a local anesthetic to numb the area and then inserting a needle through the skin and into the abscess.

Perforation. A perforation is a hole that develops in the infected diverticula. If the hole is large enough, it could cause pus to build up inside the abdominal cavity and ultimately lead to peritonitis. Peritonitis is a serious condition that could be fatal if it isn't treated immediately through surgery.

Fistula. A fistula is an abnormal tunnel connecting two body cavities or a body cavity to the skin. A fistula may form when an abscess fills with pus, doesn't heal, and breaks through to another organ. With diverticulitis, fistulas might occur between the large intestine and small intestine, the large intestine and the skin, or, most commonly, the large intestine and the bladder.

Bowel Obstruction. Infected diverticula may cause scar tissue to form in the large intestine. Too much scar tissue could cause the intestine to become partially or completely blocked, preventing stool from passing through. Bowel obstructions often require surgery.

Sources:

American Society of Colon and Rectal Surgeons . "Diverticular Disease." FASCRS.com Jan 2008. 13 Aug 2013.

Cedars-Sinai Medical Center. "Diverticular Disease." Cedars-Sinai.edu 2011. 13 Aug 2013.

FamilyDoctor.org. "Diverticular Disease." American Academy of Family Physicians Nov 2010. 13 Aug 2013.

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