Diverticulosis is the condition of having small pouches protruding from the wall of the colon. According to the IFFGD, these pouches are extremely common among Americans, for example, where about 1 out of 10 people over age 40 have diverticula, half of those older than 60 and 2 out of 3 over age 80 have them in their colon.
is the condition that occurs when the small pouches become inflamed or infected. Diverticulosis can lead to diverticulitis in about 1 out of 6 cases.
Dr. Havranek’s viewpoint – I see patient with diverticular disease a lot, so this is a very common problem to have. The majority of the time they never develop diverticulitis and don’t cause much issues at all. If you do develop diverticulitis and have never had a colonoscopy, make sure you talk to your doctor about getting one. Cancers and masses in the colon can be masked by the inflammation caused by diverticulitis on radiology study, so I always recommend a colonoscopy about 4-6 weeks after an episode of diverticulitis if you have never had a colonoscopy.
When to see a Doctor
Since diverticulosis alone typically does not cause symptoms, patients will often see a physician when diverticulitis symptoms occur. Patients should call their doctor in San Antonio, TX if they experience abdominal pain in a concentrated area coupled with fever, nausea, bloody stool or abdominal distention. This is not an inclusive list, but it represents the more common symptoms that I see diverticulitis for in my San Antonio clinic.
If you present with symptoms of diverticulitis and have never had diverticulitis before, typically you will get blood work and a CT scan to confirm the diagnosis. If you have had diverticulitis in the past and present with your “typical” symptoms, we may skip the CT scan and just proceed to antibiotics. Then, as mentioned above, if you have never had a colonoscopy (or its been more than 10 years since your last one) you would get a colonoscopy about 4-6 weeks after the diverticulitis resolves. One of the risks of diverticulitis is that it can develop an abscess in your abdomen, so if symptoms are prolonged you may need a CT to rule this out as well.
There is no way to prevent diverticulosis or diverticulitis. Awareness of the signs and symptoms and close communication with your physician are key.
Diverticulosis and Diverticulitis Causes
There is not a definitive cause known for diverticulosis. Until recently, many doctors felt that the cause was due in part to a low-fiber diet. This reasoning is based on the theory that a low-fiber diet can cause constipation, which increases pressure within the digestive tract with straining during bowel movements. More recent studies indicate the correlation between a low-fiber diet and constipation is not as strong as once thought. Also, recent studies show that there appears to be a genetic predisposition to diverticulosis. If you have a family history of diverticulosis, you should share that information with your doctor. As far as we know there is no way to prevent from getting diverticula. And once you have diverticula they are not going away.
Diverticulitis occurs when the small pouches protruding from the colon wall get infected, resulting in inflammation and pain. The precise reason why the diverticula get infected is unknown. We do know it is NOT caused by them getting blocked with seeds, nuts or other foods like we once thought.
Diverticulosis and Diverticulitis Symptoms
Diverticulosis is typically asymptomatic and most people don’t even know they have them. However, there are symptoms that can occur with diverticulosis that include:
- Abdominal pain or cramps
Symptoms of diverticulitis are similar to the symptoms of diverticulosis but can also include the following:
- Fever and chills
- Loss of appetite
- Worsening pain lasting hours or days
- Blood in your stool
Any diverticulitis pain will typically be felt in the lower left side of the abdomen as this is the most common location for diverticulosis, however, depending on the location of the diverticula in the colon (they can be anywhere along the entire colon) the pain can happen anywhere in the abdomen.
There are no specific diet restrictions for diverticulosis. We used to think avoiding nuts, grains, seeds and popcorn would lessen the incidence of diverticulitis, but we have since learned this is not true. If you have diverticulosis, you CAN eat these things. I generally recommend a high fiber high fluid diet to keep the stool soft and avoid constipation mainly because it helps with the symptoms diverticulosis can sometimes cause. As far as diverticulitis goes, it’s a bit different. After an attack of diverticulitis, you will be on antibiotics and a bland liquid diet until symptoms start to resolve. Then as you start feeling better you can slowly advance your diet but don’t go too fast or add back too much fiber too soon, this will cause more pain. Eating the wrong thing too soon won’t make the diverticulitis (the infection) worse, it will just cause symptoms. Your body will let you know if you’re advancing too fast.