What Is Diverticulitis?
Diverticulosis is a condition where small pouches, called diverticula, form and push outward through weak spots usually in the wall of the lower part of your colon. About 35% of U.S. adults age 50 years or younger have diverticulosis, and roughly 200,000 people are hospitalized for diverticulitis each year.
“My patients often ask me about diverticulitis,” says J. Timothy Tolland, M.D., a board-certified colon and rectal surgeon at the Colon & Rectal Surgery Associates. “Diverticulitis, or diverticulosis more properly, is a disease where the colon, or the large bowel, get pockets on the bowel, like the weak spots on an inner tube of a bicycle.”
The Facts about Diverticulitis
Many individuals have diverticulosis but feel no ill effects. However, when a pouch becomes infected, it can be very painful. “That condition is called diverticulosis, and almost everybody in the United States and the industrialized world gets diverticulosis by the time they’re 80,” says Dr. Tolland. “Most of us start getting it in our 40s and most times it’s asymptomatic. If you’re worried about diverticulitis, there’s a set of symptoms that you get when you develop it.”
According to Dr. Tolland, diverticulosis in and of itself is not a problem, but when you have diverticulitis, that’s when the pockets rupture. “The rupturing of these pockets causes you to be sick because the abdominal cavity is a sterile cavity, and when the stool comes out of these pockets it makes you sick with peritonitis,” he says.
“It can be a minor attack, where it’s a micro-perforation, and you just need to be treated with antibiotics and a bland diet at home, and you get over it and never need surgery. It can also involve something major like getting an abscess around the colon. In that case, you may need to be hospitalized and given IV antibiotics. But you still get over it. And then it can be a major problem where it blows out, you get very sick and septic very quick, you come into the emergency room, and you end up with emergency surgery for it. So there’s a whole continuum of symptoms with this disease.”
While no conclusive evidence exists as to why diverticulitis occurs, it is thought that bacteria in the stool which can multiply and spread rapidly may be the source of the infection.
Risk factors of diverticulitis include:
- Older age
- Tobacco use
- Lack of physical exercise
- A diet high in animal fats and low in fiber
- Medications such as steroids, opiates, and non-steroidal anti-inflammatories (NSAIDs) like ibuprofen
As mentioned above, the majority of people with diverticulosis never experience any symptoms, referred to as asymptomatic diverticulosis. Some individuals may experience episodes of pain in the lower left side of the abdomen, typically when eating or passing stool.
Other symptoms of diverticulosis include:
- Change in bowel habits
- Small amounts of blood in the stool
More intense symptoms of diverticulitis are associated with serious complications such as:
- Persistent and severe pain on the left side of the abdomen
- Perforation (rupture)
- Fistula formation (an abnormal connection between the colon and another organ or the skin)
- Painful urination
- Nausea and vomiting
- Bleeding from the rectum
“There’s one more part of diverticulosis, and that’s the part where diverticulosis can bleed,” says Dr. Tolland. “Infection with diverticulitis and bleeding with diverticulosis usually don’t occur together. Diverticulosis bleeding can be a massive bleeding problem. When you have bleeding from diverticulosis, a blood vessel breaks, and you end up losing units of blood. Most people end up in the hospital, but the good news is, most times it stops on its own. 95% of the time people do not end up needing surgery, and you don’t bleed to death from it if you’re eventually seen, treated, and resuscitated with fluids, including sometimes blood.”
How Is Diverticular Disease Treated?
Increasing the amount of dietary fiber (grains, legumes, vegetables, etc.) – and sometimes restricting certain foods (such as nuts, popcorn, and seeds) reduces the pressure in the colon and may decrease the risk of complications due to diverticular disease.
Mild cases of diverticulitis may be managed with oral antibiotics, dietary restrictions and possibly stool softeners. More severe cases may require hospitalization with intravenous antibiotics and dietary restraints. Most acute attacks can be relieved with such methods.
When Is Surgery Necessary?
Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there’s little or no response to medication. Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.
Surgical treatment for diverticulitis removes the diseased part of the colon, most commonly, the left or sigmoid colon. Often the colon is hooked up or “anastomosed” again to the rectum, and complete recovery can be expected. Normal bowel function usually resumes in about three weeks. In emergency surgeries, patients may require a temporary colostomy bag. Patients are encouraged to see their doctor for abdominal symptoms early to help avoid complications and should seek medical attention if they experience heavy or constant rectal bleeding.