Diverticulosis and Diverticulitis

1. Diverticulosis

Diverticulosis is the formation of small pouches, or sacs, called diverticula in the walls of the colon. These pouches typically form in weakened areas of the digestive tract and are more common in the lower part of the large intestine (sigmoid colon). Diverticulosis by itself often causes no symptoms and is commonly found during routine colonoscopy or imaging studies for unrelated conditions.

• Prevalence: It becomes more common with age, affecting up to 50% of people over 60.

• Causes: The exact cause isn’t clear, but it is believed to be related to a low-fiber diet, which causes the colon to work harder to move stool. This increased pressure can cause weak spots in the colon to bulge out and form diverticula.

• Symptoms: Most people with diverticulosis do not have any symptoms, but if symptoms occur, they may include:

  • Mild cramping
  • Bloating
  • Changes in bowel habits (constipation or diarrhea)

2. Diverticulitis

Diverticulitis occurs when one or more diverticula become inflamed or infected. This is a more serious condition than diverticulosis and can lead to complications if left untreated.

• Causes: The exact mechanism of diverticulitis is not fully understood, but it may be caused by a blockage of the opening of the diverticula by stool, which leads to inflammation or infection. Other risk factors include obesity, smoking, physical inactivity, and a low-fiber diet.

• Symptoms:

  • Abdominal pain: Usually in the lower left side of the abdomen, which can be sudden and severe or develop gradually.
  • Fever
  • Nausea and vomiting
  • Bloating and gas
  • Constipation or diarrhea
  • Tenderness in the abdomen

3. Complications of Diverticulitis

In some cases, diverticulitis can lead to serious complications:

• Abscess: A pocket of pus can form in the colon wall.
• Perforation: A small hole or tear in the diverticulum can lead to peritonitis (infection in the abdominal cavity).
• Fistula: An abnormal connection can form between the colon and another organ, such as the bladder.
• Bowel Obstruction: Severe inflammation can cause scarring and blockage of the colon.

4. Diagnosis

To diagnose diverticulosis or diverticulitis, doctors may use:

• CT Scan: The most common imaging test to confirm diverticulitis and check for complications.
• Colonoscopy: Used to diagnose diverticulosis, but not recommended during an acute attack of diverticulitis because of the risk of perforation.
• Blood Tests: These may show signs of infection or inflammation (elevated white blood cell count).

5. Treatment

Diverticulosis:

• Dietary Changes: A high-fiber diet, which includes fruits, vegetables, whole grains, and legumes, can help prevent further diverticula from forming and may reduce symptoms.
• Fiber Supplements: Such as psyllium, can be taken if dietary fiber is insufficient.
• Hydration: Drinking plenty of water helps prevent constipation, which can worsen diverticulosis.

Diverticulitis:

• Mild Diverticulitis:
  • Antibiotics: Used to treat the infection, though recent research suggests antibiotics may not always be necessary in very mild cases.
  • Rest and Diet: A clear liquid diet for a few days to allow the colon to heal, gradually transitioning back to solid foods.
• Severe or Complicated Diverticulitis:
  • Hospitalization: May be required if the patient has complications like abscesses, perforation, or bowel obstruction.
  • Surgery: Necessary if there are complications such as perforation, abscess, fistulas, or repeated episodes of diverticulitis. Surgery may involve removing the affected part of the colon (partial colectomy).

6. Prevention

Preventing diverticular disease focuses on lifestyle changes, particularly related to diet:

• High-Fiber Diet: Fiber helps soften stool and reduce pressure on the colon. Aim for 25-30 grams of fiber per day.
• Staying Hydrated: Drinking enough water ensures that fiber can move through the digestive system smoothly.
• Exercise: Regular physical activity helps promote healthy bowel function.
• Avoiding Smoking and Excessive Alcohol: Both are associated with an increased risk of diverticulitis.

7. Long-Term Outlook

• Diverticulosis: Most people with diverticulosis never develop symptoms or complications, and the condition can often be managed with dietary changes.
• Diverticulitis: Mild cases are typically managed with medication and rest. However, people who experience recurrent diverticulitis may need surgery to prevent further episodes.