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Diverticular Disease (Diverticulitis)

Last Updated October 2023 | This article was created by editorial staff and reviewed by Peter Rippey, MD, CAQSM

What is diverticular disease?

Diverticular disease is a group of conditions that affect your large intestine (colon). It involves small pouches or sacs, called diverticula. These pouches can form in your intestine wall. They can push through the wall of your colon. The most common conditions of diverticular disease are:

  • Diverticulosis. This is the base condition where the pouches form. It becomes more common as you age. Most people with diverticulosis don’t know they have it.
  • Diverticulitis. This occurs when the pouches become inflamed or infected. It can cause pain and other symptoms. Serious cases could require staying in the hospital.
  • Diverticular bleeding. Diverticular bleeding occurs when a blood vessel in a pouch bursts. It’s not as common as diverticulitis

Symptoms of diverticular disease

Diverticulosis normally doesn’t have symptoms. It could cause mild cramps, bloating, constipation, and diarrhea. Many other conditions cause these symptoms, too.

The most common symptom of diverticulitis is severe abdominal pain. It is usually felt in the lower left side of your abdomen. It often comes on suddenly. It can also start out mild and increase over several days. Other symptoms could include fever, nausea, constipation, or diarrhea.

You may have diverticular bleeding if you see a large amount of blood in your stool or in the toilet. Call your doctor right away if any of these things happen. Also call your doctor right away if you notice blood coming from your rectum.

What causes diverticular disease?

Doctors haven’t determined exactly what causes diverticular disease. They think it may be caused by not eating enough fiber. When you don’t eat enough fiber, your stools may not be soft. You can get constipated. Constipation and hard stools increase the pressure in the bowel walls. This pressure may cause the diverticular pouches to form.

Other factors that could contribute to diverticular disease include:

  • Genetics
  • Lack of exercise
  • Obesity
  • Smoking
  • Decrease in healthy gut bacteria
  • Increase in disease-causing bacteria in your colon
  • Certain medicines, including steroids and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

Diverticular disease becomes more common as you age. Your risk starts increasing after age 40. Most people have it by the time they’re 80 years old.

How is diverticular disease diagnosed?

If you’re having symptoms, your doctor may check your abdomen for tenderness. They may ask about your bowel habits, diet, and any medicines you take. Your doctor may want to do tests to look for diverticular disease. These tests can include:

  • CT scan. This type of X-ray allows your doctor to see if you have pouches in your colon. It can show if any are inflamed or infected. This is the most common test for diagnosing diverticular disease.
  • Barium enema(also called a lower GI series). This test injects liquid barium into your rectum and colon. Then X-rays are taken. The barium makes your colon more visible on the X-rays.
  • Flexible sigmoidoscopy. In this test, your doctor puts a thin, flexible tube with a light on the end into your rectum. The tube is connected to a tiny video camera. This allows your doctor to look at your rectum and the last part of your colon.
  • In this procedure, the video camera and light go through your rectum and your whole colon. This allows your doctor to see the inside of your entire large intestine. Before the test, you are given medicine to make you relaxed and sleepy. A colonoscopy may be uncomfortable, but it’s usually not painful.

Sometimes, diverticular disease is found when you are being tested for something else. This could include a routine screening to check for colorectal cancer or when tests are performed to diagnose other digestive problems.

Can diverticular disease be prevented or avoided?

The best way to prevent diverticular disease is with a healthy lifestyle and a high-fiber diet. You can increase the amount of fiber in your diet by eating more fruits, vegetables, and whole-grain foods. Also, be sure to drink plenty of fluids and exercise regularly.

Diverticular disease treatment

Diverticulosis treatment focuses on preventing the pouches from getting inflamed or infected. Your doctor may recommend:

  • A high-fiber diet
  • Fiber supplements
  • Medicines
  • Probiotics

For mild cases of diverticulitis, your doctor may recommend rest and a liquid diet until symptoms ease. They may also prescribe medicine to treat the infection.

For severe cases of diverticulitis or diverticular bleeding, you may need to stay in the hospital. There you can get intravenous medicine and the rest you need. Some people need surgery to remove the pouches and diseased parts of their colon.

Living with diverticular disease

If you have diverticulosis, you may sometimes get flare-ups of diverticulitis. To prevent these, your doctor may suggest you eat more fiber, drink plenty of fluids, and exercise regularly. This should help prevent the pouches from becoming infected or inflamed.

In the past, doctors thought people with diverticulosis should avoid certain foods. These included nuts, seeds, and popcorn. Research now suggests these foods aren’t harmful and won’t cause diverticulitis flare-ups. Everyone is different, though. If you think certain foods are making your symptoms worse, stop eating them and talk to your doctor.

If you start feeling symptoms of diverticulitis, call your doctor right away. Untreated diverticulitis can lead to dangerous complications. These include intestinal blockages and openings in the bowel wall. Diverticular disease can also lead to an abscess that could require surgery.

Questions to ask your doctor

  • What lifestyle changes can I make to prevent diverticular disease from getting worse?
  • Is diverticular disease a sign of colon cancer or another health condition?
  • Does having diverticular disease put me at an increased risk of colorectal cancer?
  • If I have a mild case of diverticulitis, do I have to take antibiotics?
  • Are there medicines that treat diverticular disease?
  • Will I need surgery to treat diverticular disease? Are there other options?
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