Diverticulitis (Diverticulosis, Diverticular Disease)
Facts you should know about diverticulosis and diverticulitis
- Most people with diverticulosis (diverticular disease) have few or no symptoms, and the symptoms that occur with diverticulosis probably are not caused by the diverticula, even though this has been referred to as "diverticular disease." The symptoms of diverticulitis include:
- When diverticulosis is associated with inflammation and infection it is called "diverticulitis."
- Diverticulitis as well as diverticular disease can be diagnosed with barium X-rays, sigmoidoscopy, colonoscopy, or CT scan.
- Treatment of diverticulitis and diverticular disease can include high fiber diet, and anti-spasmodic drugs.
- Foods to eat in your diet that are thought to prevent diverticulitis flares include fruits and vegetables, legumes, and whole grains.
- It has been suggested that people with diverticulitis should avoid eating seeds, nuts, and corn; however, there is little evidence to support this recommendation.
- When diverticulosis is associated with inflammation and infection the condition is called diverticulitis.
- Complications of diverticulosis and diverticulitis include rectal bleeding, abdominal infections, and colon obstruction.
What is diverticulosis? What does it look like (pictures)?
The colon (large intestine or large bowel) is a long tube-like structure approximately 6 feet in length that stores and then eliminates waste material left over after digestion of food in the small intestine takes place. It is thought that pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to in the plural as diverticula. Diverticula can occur throughout the colon but are most common near the end of the left colon, referred to as the sigmoid colon, in Western countries. In Asia, the diverticula occur mostly on the right side of the colon. The condition of having these diverticula in the colon is called diverticulosis.
Diverticula are common in the Western world but are rare in areas such as Asia and Africa. Diverticula increase with age. They are uncommon before the age of 40, but are seen in more than 74% of people over the age of 80 years in the U.S. A person with diverticulosis usually has few or no symptoms. The most common symptoms associated with diverticulosis are abdominal pain, constipation, and diarrhea. In most people with diverticular disease, the symptoms may be due to the concomitant presence of irritable bowel syndrome (IBS) or abnormalities in the function of the muscles of the sigmoid colon; simple diverticula should cause no symptoms. Occasionally, bleeding originates from a diverticulum, and it is referred to as diverticular bleeding.
What is diverticulitis?
When a diverticulum ruptures and inflammation and infection sets in around the diverticulum, the condition is called diverticulitis. Often, a person with diverticulitis has symptoms and signs that include:
- Abdominal pain
- Abdominal tenderness
- An obstruction in the colon (colonic obstruction)
- An elevated white blood cell count in the blood, and fever.
What causes diverticula and how do diverticula form?
The muscular wall of the colon grows thicker with age, although the cause of this thickening is unclear. It may reflect the increasing pressures required by the colon to eliminate feces. For example, a diet low in fiber can lead to small, hard stools which are difficult to pass and which require increased pressure to pass. The lack of fiber and small stools also may allow segments of the colon to close off from the rest of the colon when the colonic muscle in the segment contracts. The pressure in these closed-off segments may become high since the increased pressure cannot dissipate to the rest of the colon. Over time, high pressures in the colon push the inner intestinal lining outward (herniation) through weak areas in the muscular walls. These pouches or sacs that develop are called diverticula.
Lack of fiber in the diet has been thought to be the most likely cause of diverticula, and there is a good correlation among societies around the world between the amount of fiber in the diet and the prevalence of diverticula. Nevertheless, studies have not found similar correlations between fiber and diverticula within individual societies. Many people with diverticular disease have excessive thickening of the muscular wall of the colon where the diverticula form. The muscle also contracts more strongly. These abnormalities of the muscle may be contributing factors in the formation of diverticula. Microscopic examination of the edges of the diverticula show signs of inflammation, and it has been suggested that inflammation may be important for the formation of the diverticula and not just the result of them.
What are diverticulitis symptoms?
Most patients with diverticulosis have few or no symptoms. The diverticulosis in these individuals is found incidentally during tests for other intestinal problems. It has been thought as many as 20% of individuals with diverticulosis will develop symptoms related to the diverticulosis, primarily diverticulitis; however, the most recent study suggests that the incidence is closer to 5%.
The most common signs and symptoms of diverticulitis include:
- Abdominal pain (left lower abdomen)
- Abdominal tenderness (left lower abdomen)
- Fever
- Elevated white blood cell count in the blood
- Constipation or, sometimes, diarrhea.
Is there a diverticulitis diet? What food should be avoided to prevent diverticulitis? What foods prevent flares?
Once formed, diverticula do not go away; they are permanent. No treatment has been shown to treat or prevent diverticular disease or diverticulitis. Nevertheless, recommendations have been made in regard to which foods to eat, and which foods to avoid.
Foods to eat that may prevent flares
Since one theory holds that it is reduced fiber in the diet that causes diverticulitis, diets high in fiber are the most recommended treatment for diverticula. Fiber clearly increases stool bulk and prevents constipation, and, if it really reduces pressures in the colon, theoretically it may help prevent further diverticula formation or worsening of the diverticular condition. Foods high in fiber include:
- Fruits and vegetables
- Legumes/beans, (for example, lima, kidney, cannellini, and red kidney beans; chickpeas, split peas, and tofu)
- Whole grains (for example, brown rice, cracked wheat, oatmeal, quinoa, rolled oats, rye bread, wild rice; and whole wheat bread, cereal, crackers, pasta, and tortillas)
Foods to avoid with diverticulitis
Some doctors recommend avoiding nuts, corn, and seeds, which are thought by some to plug diverticular openings and cause diverticulitis, but there is little evidence to support this recommendation. Nevertheless, foods frequently recommended to be avoided include:
- Popcorn
- Poppy seeds
- Sesame seeds
What about probiotics and diverticulitis or diverticular disease?
Because inflammation has been found at the edges of diverticula, it has been speculated that colonic bacteria may be playing a role in the rupture of diverticula by promoting inflammation. This has led some people to further speculate that changing the bacteria in the colon might reduce inflammation and rupture and to suggest treatment with probiotics and/or prebiotics; however, there is not enough evidence of a benefit of probiotics yet to recommend treatment with probiotics of patients with diverticular disease.
