Diverticulosis/diverticulitis

Diverticula are small, outwardly protruding pouches that can develop in the gastrointestinal tract (usually in the colon). The presence of diverticula is called diverticulosis. If the diverticula are inflamed, infected or ruptured, the condition is called diverticulitis.


Causes/associated factors
No one knows for sure why diverticula develop. Some experts think there may be a genetic link, but most believe diverticula form when there's not enough fiber in your diet.
Because dietary fiber isn't digested, it creates larger volume or bulkier stools. It also pulls water into the intestines, which makes bowel movements easier. When the colon doesn't have to work as hard at propelling stool forward within the colon, passage time through the colon can be shortened.

Without enough fiber in your diet, you may become constipated. In turn, the pressure exerted with passage of stool within the colon and during defecation may cause diverticula to develop.

The highly refined, low-residue diet typical in the United States and other developed countries may make diverticula more common. Diverticula are rare in countries such as Asia or Africa, where high-fiber diets are common. Also, the risk of developing diverticula increases with age.

Diverticula of the colon can range from a few millimeters to several centimeters in diameter. It's possible to have just one or several dozen. True diverticula include all layers of the intestinal wall.


Signs/symptoms
Most people with diverticulosis don't have any symptoms. The condition is often found by coincidence during a colon exam or imaging study done for other reasons. When symptoms appear, they're usually intermittent and may include:

mild cramping or tenderness in the left side of the abdomen (The discomfort may be relieved by passing gas or having a bowel movement.)
excessive gas
bloating
diarrhea
constipation
occasionally, a small amount of bright red blood in the stool (If you have this symptom, be sure to talk with your doctor.)
If you develop diverticulitis, symptoms may include:

pain or tenderness, usually in the lower left side of the abdomen
appetite loss
nausea
vomiting
diarrhea
constipation
fever (sometimes not for older adults, however)
occasionally, urinary symptoms such as burning during urination or increased urgency or frequency
abdominal distention (an abdomen that appears to be stretched out)

Diagnosis
Your doctor will do a physical exam and ask questions about your medical history. Diagnostic tests may be recommended, such as:
barium test (an X-ray of the bowel after you receive a solution of barium sulfate)
flexible sigmoidoscopy (examination of the rectum and lower part of the colon)
colonoscopy (another procedure that helps doctors see the inside of the colon)
computed tomography (CT scan, a computer-generated, cross-sectional picture of internal body parts)
ultrasound (using sound waves to create an image of internal body parts)
X-rays
lab tests, such as a complete blood count

Treatment
Diverticulosis
If you have diverticulosis, eat a high-fiber diet. Try bran and whole- grain breads and cereals. Aim for six servings of fruits and vegetables a day. Make sure to drink plenty of fluids. Talk with your doctor about any foods you may need to limit.

Until recently, excluding foods such as nuts, popcorn, raisins or raspberries was often recommended because it was thought that seeds and pits could lodge in the diverticula and cause an infection. However, there's no scientific evidence to support this theory.

If you have acute diarrhea, your doctor may recommend cutting back on dietary fiber. When the diarrhea clears up, slowly add fiber back into your diet so that your body has time to adjust. Eventually, your doctor may recommend over-the-counter fiber supplements (Metamucil or Citrucel, for example).

Diverticulitis
If you have diverticulitis, treatment depends on the severity of your symptoms. For mild cases, your doctor may recommend bedrest, a low-fiber or liquid diet, and oral antibiotics.

If you have a severe infection or you don't improve after outpatient treatment, you may need to be hospitalized. Through an IV, you'll receive antibiotics and pain medication. You may also need nasogastric suction (emptying gas and liquids through a tube in your nose that extends to your stomach).

Surgery may be needed it you have severe or recurrent episodes of diverticulitis or severe diverticular bleeding. The surgery may range from draining an abscess to removing part of your colon.

After recovering from diverticulitis, ask your doctor about resuming a high-fiber diet.


Complications
In some cases, the diverticula may bleed. If you develop diverticulitis, additional complications may include:

abscess (a collection of pus)
perforation (a hole or tear)
peritonitis (inflammation of the membrane lining the abdominal cavity)
bowel obstruction
fistula (an abnormal passage from one cavity to another)
heavy bleeding

Pregnancy-specific information
The symptoms of diverticular disease can mimic other conditions associated with pregnancy, such as ectopic pregnancy (when the fertilized egg implants itself outside the uterus). Diverticulosis or diverticulitis is rare among women of childbearing age, so report any new, persistent or severe symptoms to your doctor promptly.

Senior-specific information
Again, the risk of developing diverticula increases with age. In fact, diverticular disease is most common for adults age 60 and older.

Prevention
Simple steps can help reduce the risk of developing diverticula:
Eat a high-fiber diet.
Drink plenty of fluids.
Avoid straining during bowel movements.
Exercise regularly.