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Diverticular Disease

Diverticulosis (the condition) and diverticulitis (active inflammation) are very common, particularly here in the United States. The American Society of Colon and Rectal Surgeons estimates that up to half of all Americans have diverticulosis by the age of 60 and it is nearly a universal condition after the age of 80.  While mostly a symptomatic condition, those affected can have uncomfortable symptoms when the condition is acute and potentially life threatening complications without adequate treatment.

Diverticula are sac-like protrusions in the mucosa of the colon through the muscular layer. They are most common in the left side or sigmoid colon, but can appear virtually anywhere in the colon. The term Diverticulosis describes the existence of these pockets; diverticulitis is the inflammation or complications within them. The increasing lack of fiber in the U.S. population has been implicated in diverticular development, as the pressure to move small hard stool through the colon causes the muscular wall of the colon to work harder. 

Most people with divertcular disease do not have symptoms.  Diverticulosis is often found incidentally when running tests for abdominal pain or other gastrointestinal disease. Most often at this point in time it is discovered during routine colonoscopy for cancer screening.  Symptoms can be related to complications including infection and bleeding- diverticular disease is the most common cause of significant colonic bleeding.

An inflammation in one or more of the pockets is most commonly associated with acute abdominal pain, fever, chills, and change in bowel habits.  Nausea, vomiting, low grade fever and abdominal discomfort are common.  More intense symptoms develop when the wall of the pocket ruptures, and an abscess or fistula form. A fistula is an abnormal connection between the colon and the skin or another organ and serves as an escalating area of infection.

In divertula without symptoms, increasing dietary fiber, such as grains, vegetables, and legumes reduces pressure within the colon and helps the transit of waste material through the gastrointestinal system.  High fiber diets or use of fiber supplements such as bran powder decrease the likelihood of future complications. While diverticula are permanent anatomic conditions, they can remain without problem virtually forever. When diverticulitis occurs and is acute, most affected are treated successfully through medical management with a clear liquid diet and antibiotics.

At times diverticulitis can become acute and necessitate surgical management. A ruptured abscess or persistent fistula may require surgery and even resection of the affected part of the colon. In those cases hospitalization and intravenous fluids are mandatory. Cases where there is perforation of a pocket and rupture of contents into the body and abscess formation have the highest degree of life threatening complications. Cancer is the number one "rule out" diagnosis and CT scanning and colonoscopy may be required once the infection is quieted.

To keep diverticulosis at bay, eat a high fiber diets, including fresh vegetables, fruits, and whole grain bread. Peaches, carrots and lettuce add bulk to stools. Foods with very high roughage contents that are not digestible (corn for example) are to be eaten sparingly. At least five to seven glasses of water a day is also important in keeping the gastrointestinal tract healthy.

Authored by Dr. Bob Goldstone, M.D.

The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.