Colonic Diverticulosis

What is Diverticulosis?

Diverticulosis is a medical word that describes the presence of small out-pouchings (diverticula) or sacs that can develop in the wall of the gastrointestinal tract with or without the presence of associated problems. While diverticula can be present anywhere in the intestines, they are most common on the left side of the large intestine, the area known as the descending and sigmoid colon.

How common is diverticulosis?

Diverticulosis is a common condition, especially in older people. The condition is uncommon in people under the age of 30 years, and becomes more common with age, affecting 5 people in 100 people over the age of 40, increasing to 60 people in 100 people over the age of 80. Diverticulosis may be somewhat more common in men than in women. Also its mostly seen in western countries.

What causes diverticulosis?

Definite cause is not known but a few theories have been suggested. There appears to be a genetic predisposition; that is, if your parent or sibling has diverticulosis, you may be more likely to develop it. Some believe that abnormal intermittent high pressure in the colon due to muscle spasm or straining may cause diverticula to form at weak spots in the colonic wall. Low-fiber diets were thought to play a role in the development of diverticulosis but this theory is not proven.

What are the symptoms?

Most with diverticulosis have no specific symptoms, and will never know that they have the condition unless it is discovered during an endoscopic or Barium X-ray examination. Some people who have diverticulosis may experience chronic pain, discomfort in the left lower abdomen, bloating, and change in bowel habits.

How is diverticulosis diagnosed?

Colonoscopy:

This test uses, flexible tube with a light and camera to view the inside of the colon. Diverticula can be seen very clearly in this examination. Click here to learn more about colonoscopy.

Barium enema:

This x-ray test involves putting liquid material into the colon through a tube placed in the rectum. The x-ray image shows the outline of the colon, and can identify if diverticula.

CT scan:

This radiological test takes multiple cross-sectional pictures of the body. It is not generally performed to make a diagnosis of diverticulosis, but this type of exam, when done for other reasons, may identify diverticula.

What is Diverticulitis?

Diverticulitis is inflammation of one or a few diverticula in the same area of the colon (usually the sigmoid or descending colon). Diverticulitis occurs in less than 5% of people who have diverticulosis. People with diverticulitis characteristically present with the fairly sudden onset of pain in the abdomen, usually on the lower left side. Other common symptoms include fever, diarrhea and/or constipation, decreased appetite, nausea (feeling vomitish) and fatigue.

Can diverticulosis be prevented?

It is not known whether diverticulosis can be prevented. People who eat a diet high in fiber are less likely to develop diverticulosis than those who eat little fiber. Therefore, regularly taking a high-fiber diet is generally recommended but may not prevent diverticulosis if you have a strong genetic component. Those who are obese or overweight are more likely to have diverticulosis. Therefor loosing weight is generally recommended. Smoking may also increase the possibility of developing diverticulosis. Therefore, abstaining from smoking may decrease the possibility of developing diverticulosis.

Can diverticulitis be prevented?

Preventive measures already described above for the prevention of diverticulosis is also suitable for the prevention of diverticulitis. Additionally, the following is recommended. Minimizing the use of non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin, may decrease the chances of developing diverticulitis. Opiates (Morphine / codaine / tramadol) & corticosteroids (Prednisolone) also appear to predispose to diverticulitis. Some believe reducing non digestive particles in the diet such as popcorn, nuts, and fruits with small seeds helps. However, it is not proven. Increasing the finer content in the diet, reducing the amount of red meat in the diet may also decrease the possibility of diverticulitis. Studies show that people who maintain a healthy weight and/or exercise regularly are less likely to develop diverticulitis and diverticular bleeding. Not smoking is also likely to help prevent diverticulitis, especially perforated diverticulitis.

How is diverticulitis Treated?

Diverticulitis is typically treated with antibiotics and a liquid or low-residue diet until symptoms improve (similar to a low-fiber diet). However, some studies suggest that patients with mild diverticulitis who do not have an abscess or perforation (see above), and are otherwise healthy can be managed without antibiotics. People with severe diverticulitis (high fever, signs of severe infection) or with complications (abscess, perforation) require antibiotics and are usually treated in the hospital.

What are the complications?

People with diverticulitis can commonly develop following complications including:

Abscess

An abscess (a collection of pus outside of the intestinal/colon wall) can form. This causes abdominal pain, fever. tenderness. May need antibiotics, or a procedure to drain the pus. If the infection spreads, it causes peritonitis (inflammation of the lining of your abdomen), needing an emergency operation.

Stricture

The scars that form when the inflammation is healed cause a narrowing (stricture) in your bowel. Any movement of solid matter through the narrowing can be painful. 
This can also cause bowel obstruction, abdominal pain, distension and vomiting. This needs surgery/endoscopy

Fistula

Inflamed diverticulae can stick to other organs in your abdomen (bladder or vagina), creating an abnormal connection (fistula) between them. There may be faeces or wind passing through vagina or with urine. This needs surgical repair.

Perforation

A hole developed in the colon that allows bowel contents to leak into the abdomen. This is the most serious complication of diverticulitis. This causes severe pain and fever. Emergency surgery is the treatment.

Bleeding

Sometimes the inflamed diverticulae will erode a nearby blood vessel, causing passage of large amount of red or maroon blood through your back passage. Tends to occur without warning and there is no associated abdominal pain. May need endoscopy, CT Angio, Isotope scans or surgery.

Surgery for diverticulitis

Surgery will typically remove the diseased part of your colon. Sometimes they may also need to remove the upper part of your rectum. Your surgeon will usually join the ends of your bowel back together inside your abdomen (Colectomy / Anterior resection). Very rarely, the surgeon may not be able to join your bowel (Hartmann’s procedure). A temporary colostomy (drainage of stool from the intestine into a bag on the outside of the abdomen) may be required during surgery for complicated diverticulitis.