Diverticular disease consists of three conditions that involve the development of small sacs or pockets in the wall of the colon, including diverticulosis, diverticular bleeding, and diverticulitis.
Diverticulosis is the formation of numerous tiny pockets, or diverticula, in the lining of the bowel. Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid. They are most common in the lower portion of the large intestine (called the sigmoid colon).
Diverticulosis is very common and occurs in 10% of people over age 40 and in greater than 50% of people over age 60. Most people will have no or few symptoms from diverticula.
Complications can occur in about 20% of people with diverticulosis. One of these complications is rectal bleeding, called diverticular bleeding, and another is diverticular infection, called diverticulitis.
Diverticular bleeding occurs with chronic injury to the small blood vessels that are next to the diverticula. Bleeding can be brisk and occur suddenly without prior warning. Evaluation is often done in the hospital setting by our physicians. Colonoscopy can be used to localize and treat the source of bleeding.
Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with waste, allowing bacteria to build up, causing infection.
What Are the Symptoms of Diverticulosis?
Diverticulosis does not cause any troublesome symptoms.
What Are the Symptoms of Diverticulitis?
Diverticulitis, infection and inflammation of diverticula, can occur suddenly and without warning.
Symptoms of diverticulitis may include:
• Painful cramps or tenderness in the lower abdomen. Often but not always in the left lower part of the abdomen.
• Alternating diarrhea with constipation or a change in bowel pattern.
• Chills or fever.
How Is Diverticulosis Diagnosed?
Because people with diverticulosis do not have any symptoms, it is usually found through tests ordered for an unrelated reason, ie. Colonoscopy or imaging studies of the abdomen.
How Is Diverticulitis Diagnosed?
If you are experiencing the symptoms of diverticulitis, it is important to see your doctor. The typical symptoms and physical exam findings of tenderness in the left lower quadrant of the abdomen lead a physician to suspect Diverticulitis. CT scanning of the abdomen and pelvis confirms the diagnosis but is not always necessary. CT scans can detect complications such as perforation of the colon or abscess formation. Colonoscopy can localize the segment of colon involved and rule out other problems but is not typically performed during the acute infection.
How Is Diverticulosis Treated?
People who have diverticulosis without symptoms or complications do not need specific treatment, yet it is important to adopt a high-fiber diet to prevent the further formation of diverticula.
Laxatives and/or enemas should not be used to treat diverticulosis.
What Are the Complications of Diverticulitis?
Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity causing the following problems:
• Peritonitis (a painful infection of the abdominal cavity)
• Abscesses (“walled off” infections in the abdomen)
• Obstruction (blockages of the intestine)