IBS and Diverticulosis: What to Do When You Have Both

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Has your doctor diagnosed you with having diverticulosis alongside your irritable bowel syndrome (IBS)? Do you wonder if there is a relationship between the two? And do you find it challenging to figure out what to eat so as not to make the symptoms worse of either of the two health problems? Let's take a look at any possible overlap and then discuss what you can do to take care of yourself when you have both.

What Is Diverticulosis?

Diverticulosis is a health condition in which tiny pockets (sacs) are present in the lining of the large intestine. These sacs are known as diverticula, and they push outward on the wall of the colon. They are most likely to be found in the sigmoid colon, which is the lowest part of the large intestine.

Diverticulosis is one of the three conditions classified as diverticular disease—the other two being diverticulitis, in which the pockets or sacs known as diverticula become infected or inflamed, and diverticular bleeding, in which the diverticula start to bleed.

It is estimated that approximately 20 percent of people in the U.S. have diverticular disease. Prevalence rates increase with age as it is estimated that it affects approximately 70 percent of Americans over the age of 80. It is also estimated that 25 percet of individuals with diverticular disease will experience diverticulitis as some point in their life.

Symptoms of Diverticulosis

For many people, diverticulosis causes no symptoms. In others, the presence of these sacs may contribute to constipation, diarrhea, abdominal pain and bloating. All symptoms of IBS as well! (We'll address that later.)

The symptoms of diverticulitis can be more severe. Pain can range from mild to severe, and come on quickly or gradually worsen.

Pain may wax and wane. Other symptoms of diverticulitis include:

  • Abdominal pain and cramping
  • Abrupt change in bowel habit, i.e. constipation or diarrhea
  • Chills
  • Fever
  • Lower abdomen tenderness, particularly on the left side
  • Vomiting

A dangerous risk with untreated diverticulitis is that of bowel perforation—a potentially life-threatening condition that will require surgery.

Diverticular bleeding is typically evidenced by a sudden large amount of bright red to dark maroon blood in the stool. Bleeding usually stops on its own, but if you experience any bleeding in your stool or from your rectum, you must see a physician to accurately evaluate what caused the bleeding.

Overlap Between IBS and Diverticulosis

In case you were wondering if you were imagining things that your two health problems may be connected, you might be pleased to know that the thought has occurred to researchers as well. Let's take a look at a couple of key studies and their results:

One study followed a large group of subjects who were diagnosed as having diverticulitis, with no previous history of a functional gastrointestinal disorder (FGDs) such as IBS or a psychiatric illness, at a Veterans Administration hospital, over a period of approximately six years.

They found that these individuals were at an almost five percent greater risk for developing IBS, and at approximately twice the risk for developing a different FGD or a mood disorder. These results have led this group of researchers to propose the notion of "postdiverticulitis IBS" (PDV-IBS), a label that would be applied to individuals who experience chronic IBS digestive symptoms following an episode of diverticulitis. Please keep in mind that this is just one study—much more work would have to be conducted before any official classification is made of a new sub-type of IBS!

A different study used a questionnaire approach to determine if there is a relationship between having diverticular disease and IBS. The results indicated that having IBS raised a person's risk for diverticulosis, but did not necessarily raise one's risk for experiencing diverticulitis. This increased risk for diverticulosis was even more prominent for individuals with IBS who were older than 65. Interestingly, regardless of age, the increased risk for diverticulosis was more likely to be seen in individuals who were diagnosed with diarrhea-predominant IBS (IBS-D) or alternating type IBS (IBS-A).

Another large study was conducted in Japan. The researchers highlight that there is a primary difference as to where diverticular disease presents itself when comparing individuals from the West (Europe and the United States) versus those from Asia. Apparently, in the West, diverticular disease is more likely to show up in the distal colon—the descending colon on the left side and the sigmoid colon. In contrast, in Asia, diverticular disease is more likely to show up on the right side of the colon. Why is this important? According to the researchers state these differences are important as left-sided diverticulitis tends to be more severe, while right-sided diverticular disease leaves one at an increased risk for bleeding.

In this Japanese study, results indicated that participants who showed signs of diverticular disease on either the left side, or on both sides, of the colon, were more likely to have IBS while participants who had right-side diverticular disease did not show this higher risk.

What to Do If You Have Both

It can seem very challenging to figure out what to do if you have both health problems. Luckily, some of the same treatment recommendations for IBS apply to diverticular disease:

There are some lifestyle recommendations for reducing problems from diverticular disease. Although these factors are not necessarily associated with IBS, making these changes will help to improve your overall and digestive health:

  1. If you are a smoker, take steps to stop.
  2. Be sure to exercise regularly.
  3. Maintain a healthy weight.
  4. Keep alcohol use to a minimum.
  5. Keep your use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) to a minimum.

Sources:

Cohen E, et al. Increased Risk for Irritable Bowel Syndrome After Acute Diverticulitis.  Clinical Gastroenterology and Hepatology. ​2013; 11:1614-1619.

Diverticular Disease  National Digestive Diseases Information Clearinghouse (NDDIC).

Jung H, et al. Diarrhea-Predominant Irritable Bowel Syndrome Is Associated With Diverticular Disease: A Population-Based StudyAmerican Journal of Gastroenterology. 2009; 105:652–661.

Templeton A & Strate L. Updates in Diverticular DiseaseCurrent Gastroenterology Reports. 2013; 15:339.

Yamada E, et al. Association Between the Location of Diverticular Disease and the Irritable Bowel Syndrome: A Multicenter Study in JapanAmerican Journal of Gastroenterology. 2014; 109:1900–1905.

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