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What Is Diverticulosis?

Diverticulosis is a condition marked by the formation of diverticula—small pouch-like herniations along the wall of the gastrointestinal tract. Most commonly, diverticula appear in the left side of the colon; rarely, they also develop as far up as the throat (pharynx). As many as half of all Americans over the age of 50 have diverticulosis, although few ever have any noticeable symptoms. Diverticulosis only requires treatment if it causes discomfort (painful diverticular disease) or complications.

In some cases the diverticula become inflamed or infected—a painful condition known as diverticulitis. In severe cases, an inflamed diverticulum may perforate or burst, resulting in abscesses or peritonitis (inflammation of the lining of the abdominal cavity, which may be fatal unless treated immediately).

Diverticula may also cause rectal bleeding. Diverticulitis and diverticulosis are not related to colon cancer.

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Causes

Diverticula are thought to be caused by increased pressure within the lumen of the colon. Increased intra-colonic pressure secondary to constipation may lead to weaknesses in the colon walls, giving way to diverticula. Other causes may include a colonic spasm that increases pressure, which may be due to dehydration or low-fiber diets;[2] although this may also be due to constipation. Fiber causes stools to retain more water and become easier to pass (either soluble or insoluble fiber will do this). A diet without sufficient fiber makes the stools small, requiring the bowel to squeeze harder to remove the smaller stool.

Conditions

If you experience severe abdominal pain, with or without fever or abdominal bloating.

If you notice a change in your bowel habits that lasts longer than two weeks, especially if you also experience rectal bleeding.

If minor symptoms of diverticulosis (nausea, bloating, constipation, and others) develop and persist.

If you start passing blood from the rectum or feel weak or dizzy.

How do these conditions occur?

Although the exact cause of diverticulosis is unknown, it becomes more prevalent with age and there appears to be a familial incidence. One theory is that diverticula occur when pressure, such as that caused by constipation, builds up inside the colon and makes the intestinal wall balloon out in spots where the wall is weak.

The bowel tends to become irritable and spastic when there is inadequate bulk passing through. With segmental areas of spasms, the pressure in the intervening areas can be very high, pushing out small pouches of the bowel at the weakest spots. These weak spots are the sites between the muscle bundles that run longitudinally up and down the colon.

The presence of irritating particles and bacteria within the diverticula may produce inflammation in and around the site, causing the condition mentioned above as diverticulitis.

The wide geographic variability of diverticular disease and its striking correlation with an urban diet has long suggested a dietary factor as its cause. History shows an increased diverticular disease incidence in Britain in the decades following the introduction of steel rolling mills in 1880, which greatly reduce the fibre content of milled grains. Around the same time, refined sugar was introduced, with a lesser use of crude grains. Additional support for the link between diet and diverticular disease stems from the observation that clinical diverticular disease began to emerge in the decades following these dietary modifications.

Although quite common in developed countries, with the highest incidences seen in the United States, Europe, and Australia, studies show that diverticular disease is rare in rural Africa and Asia. However, data in these studies arose during a period when lifespan in Africa was significantly less than that in Western populations, potentially affecting data results for this disease, which increases with age.

Diagnosis

Since diverticulosis is often asymptomatic (without symptoms), it tends to be discovered during examinations for other conditions such as colorectal cancer. Diverticulitis is usually diagnosed during an acute attack.

Tests to confirm the diagnosis of diverticular disease include:

Medical history – including dietary habits.

Physical examination – including rectal examination.

Colonoscopy – a slender flexible tube is inserted into the anus so that the doctor can look at the entire length of the large intestine.

Barium enema – a special contrasting dye is flushed into the bowel via the anus and x-rays are taken.

CT scan – to detect abscesses outside the bowel lining.

Blood tests – to check for signs of infection.

Stool tests – to check for the presence of blood in the faeces or the presence of infections, which may mimic the symptoms of diverticulosis and diverticulitis.

Treatment

Following prevention tips for diet (especially incorporating fiber) and exercise is important to prevent diverticulosis.

Your doctor may recommend a bulking laxative containing the fiber psyllium or an artificial fiber like calcium polycarbophil. However, do not take laxatives without consulting your doctor and never use enemas—these may only further aggravate a diverticular disorder.

For diverticulitis, your doctor may prescribe antibiotics and bed rest, often in the hospital.

Injections of painkillers may be warranted in severe cases of diverticulitis.

Antispasmodic drugs may be prescribed to relax the muscles around the digestive tract.

You may need to have your stomach kept empty (with a tube passed through the mouth into the stomach) and to be fed intravenously to allow inflamed diverticula to heal. You should be able to eat and drink normally when symptoms of diverticulitis have subsided (generally in a few days).

Surgery may be necessary to drain an abscess.

Blood transfusions may be necessary in patients with profound bleeding from diverticuli.

In severe or recurrent cases of diverticulitis, surgery may be necessary to remove the affected part of the colon. In a few cases, a temporary colostomy may be required, with later operations to reconnect the colon.

Complications

Some of the complications of diverticular disease include:

Abscess – untreated, diverticulitis may lead to an abscess (a ball of pus).

Perforation – a weakened pocket of bowel wall may rupture. The contents of the bowel can then seep into the abdominal cavity. Symptoms include pain, high fever and chills. A perforated bowel is a medical emergency.

Peritonitis – perforation can lead to peritonitis (infection of the membranes that line the abdominal cavity and abdominal organs). This complication is potentially life threatening.

Haemorrhage – diverticula can be the source of haemorrhage. When bleeding occurs, it is important to exclude other causes. A person with diverticulosis can also get cancer.

Risk factors

A diet that is low in fiber content or high in fat

High intake of meat and red meat

Increasing age

Constipating conditions

Connective tissue disorders that may cause weakness in the colon wall (such as marfan syndrome).

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