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Diverticulitis and Chronic Diverticular Disease

 

What is diverticular disease?

Diverticular disease refers to a group of conditions that involve the presence of small pouches (diverticula) that form in the wall of the colon (large intestine). The two main conditions associated with diverticular disease are diverticulosis and diverticulitis.

Diverticulosis occurs when small pouches or pockets called diverticula develop in the lining of the colon, typically in the lower part of the large intestine. Diverticulosis is a common condition, especially among older adults. Many people with diverticulosis remain asymptomatic and may not even be aware that they have the condition. Diverticulosis is generally considered a benign condition and may not require treatment unless complications develop.

Diverticulitis occurs when one or more diverticula become inflamed or infected. This can happen if fecal matter becomes trapped in a diverticulum, leading to bacterial overgrowth and inflammation. 

What are risk factors for diverticular disease?

Risk factors for diverticular disease include:

  • Age: Diverticular disease becomes more common as people age, with the highest incidence occurring in individuals over the age of 60.
  • Diet: A diet low in fiber and high in processed foods, red meat, and fats may increase the risk of developing diverticular disease.
  • Obesity: Being overweight or obese is associated with an increased risk of diverticular disease.
  • Lack of physical activity: Sedentary lifestyle and lack of regular physical activity may contribute to the development of diverticular disease.
  • Genetics: There may be a genetic component to diverticular disease, as it tends to run in families.
  • Smoking: Smoking cigarettes has been linked to an increased risk of diverticular disease.

How can you prevent diverticular disease?

Preventive measures for diverticular disease include:

  • Consuming a high-fiber diet.
  • Staying hydrated.
  • Maintaining a healthy weight.
  • Exercising regularly.
  • Avoiding smoking.
  • Managing stress.
  • Practicing good bowel habits.

What are symptoms of diverticular disease?

Symptoms of diverticulitis, which occurs when one or more diverticula become inflamed or infected, can vary in severity and may include:

  • Abdominal pain
  • Fever and chills
  • Nausea and vomiting
  • Changes in Bowel Habits
  • Abdominal tenderness
  • Rectal bleeding
  • Other symptoms that may occur with diverticulitis include abdominal bloating or distention, fatigue, and a general feeling of malaise or discomfort.

It's important to note that the severity and combination of symptoms can vary from person to person, and some individuals may experience only a subset of the symptoms listed above. Additionally, complications of diverticulitis, such as abscess formation, perforation of the colon, fistula formation, or bowel obstruction, can cause additional symptoms such as severe abdominal pain, high fever, persistent vomiting, and signs of sepsis.

If you experience symptoms suggestive of diverticulitis, especially if they are severe or persistent, it's important to seek medical attention for proper evaluation and management.

How is diverticular disease diagnosed?

Diagnosing diverticulitis typically involves a combination of medical history, physical examination, and diagnostic tests. Here's an overview of the diagnostic process:

  • Medical History: The healthcare provider will begin by asking about the patient's symptoms, including the location, severity, and duration of abdominal pain, as well as any associated symptoms such as fever, nausea, vomiting, changes in bowel habits, and rectal bleeding. They will also inquire about any previous episodes of diverticulitis or other gastrointestinal conditions.
  • Physical Examination: Your healthcare provider will perform a physical examination, focusing on the abdomen. They may gently palpate (press) the abdomen to assess for tenderness, swelling, or other signs of inflammation. Abdominal tenderness, especially localized to the lower left side, is a common finding in diverticulitis.
  • Laboratory Tests: Blood tests may be ordered to help assess inflammation, infection, and other markers of diverticulitis. Common blood tests used in the diagnosis of diverticulitis include:
  • Complete blood count (CBC): Elevated white blood cell count (leukocytosis) may indicate an inflammatory response or infection.
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Elevated levels of CRP and ESR may also indicate inflammation.
  • Computed Tomography (CT) Scan: CT scan of the abdomen and pelvis is the most commonly used imaging test for diagnosing diverticulitis. CT scan can provide detailed images of the colon and surrounding structures, allowing the healthcare provider to visualize inflamed or infected diverticula, assess the severity of inflammation, and identify any complications such as abscesses or perforation. Oral and intravenous contrast may be used to enhance visualization.

A colonoscopy is not typically performed during an acute episode of diverticulitis due to the risk of perforation. However, colonoscopy may be recommended after the acute phase has resolved to evaluate the colon for diverticula, rule out other conditions, and assess the overall health of the colon.

The combination of medical history, physical examination, laboratory tests, and imaging studies helps healthcare providers diagnose diverticulitis and determine the appropriate treatment plan. Prompt diagnosis and treatment are essential to alleviate symptoms, prevent complications, and promote recovery. If you experience symptoms suggestive of diverticulitis, it's important to seek medical attention for proper evaluation and management.

What are treatment options for diverticular disease?

The treatment for diverticulitis depends on the severity of symptoms, the presence of complications, and other individual factors such as overall health and medical history. Here are common approaches to treating diverticulitis:

  • Dietary Modifications: During an acute episode of diverticulitis, the healthcare provider may recommend a temporary modification of the diet to allow the inflamed or infected diverticula to heal. This may involve:
  • Clear liquids: Initially, a clear liquid diet may be recommended to rest the digestive system and prevent further irritation. Clear liquids include broth, clear fruit juices, gelatin, and plain water.
  • Low-fiber diet: After the acute symptoms improve, a low-fiber diet may be recommended temporarily to reduce the risk of bowel obstruction or irritation. This typically involves avoiding high-fiber foods such as whole grains, raw fruits and vegetables, nuts, and seeds.
  • Gradual reintroduction of fiber: Once symptoms have resolved, gradually reintroducing fiber-rich foods into the diet can help promote regular bowel movements and prevent future episodes of diverticulitis. High-fiber foods include fruits, vegetables, whole grains, legumes, and nuts.

If diverticulitis is associated with signs of infection, such as fever or elevated white blood cell count, antibiotics may be prescribed to treat the infection and reduce inflammation. The choice of antibiotics depends on the severity of symptoms, the presence of complications, and local antibiotic resistance patterns.

Over-the-counter pain relievers such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to alleviate mild to moderate abdominal pain. However, NSAIDs should be used with caution in individuals with diverticulitis due to the risk of gastrointestinal irritation and bleeding.

Symptomatic Treatment

  • Heat therapy: Applying a heating pad or warm compress to the abdomen may help relieve abdominal discomfort and muscle spasms.
  • Rest: Resting and avoiding strenuous activities can help reduce abdominal strain and promote healing.
  • Hospitalization: In severe cases of diverticulitis, especially if complications such as abscess formation, perforation, or bowel obstruction occur, hospitalization may be necessary for close monitoring and intravenous antibiotics. In some cases, drainage of abscesses or surgical intervention may be required.
  • Surgery: Surgery for diverticulitis is generally reserved for recurrent or complicated cases that do not respond to conservative treatment. Surgical options may include removal of the affected portion of the colon (segmental resection) or creation of a colostomy or ileostomy in severe cases.

The specific treatment approach for diverticulitis is individualized based on factors such as the severity of symptoms, the presence of complications, and the patient's overall health and preferences.