Between 10 and 25 percent of people with diverticulosis end up with infected or inflamed pouches and develop diverticulitis; of these, only a few develop serious complications.

Most people with diverticulosis never have any symptoms or discomfort. Symptoms may include mild cramps, bloating, and constipation.

The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. Fever, nausea, vomiting, chills, cramping, and constipation may occur as well.

Doctors believe that a low-fiber diet is the main cause of diverticulosis and diverticulitis, which are common in developed, industrialized countries -- particularly the United States, England and Australia -- where low-fiber diets are common. For most people with diverticulosis, eating a high-fiber diet is the only treatment needed.

Complications

Diverticulitis can lead to complications, such as infections, perforations or tears, blockages, or bleeding. These complications require treatment to prevent them from progressing and causing serious illness.

Bleeding from diverticula (the small pouches in the colon) is rare. When diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can be severe, but it may stop by itself and not require treatment. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary.

The infection causing diverticulitis often clears up after a few days of treatment with antibiotics. If the condition worsens, an abscess may form in the colon. An abscess is an infected area with pus that may cause swelling and destroy tissue. If the abscess is small and remains in the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it, either using a needle and a catheter or with surgery.

A large abscess can become a serious problem if the infection leaks out and contaminates areas outside the colon. Infection that spreads into the abdominal cavity is called peritonitis. Peritonitis requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without surgery, peritonitis can be fatal.

The scarring caused by infection may cause partial or total blockage of the large intestine. When this happens, the colon is unable to move bowels normally. When the obstruction totally blocks the intestine, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned.

Causes

Diverticulitis occurs when pouches that form in the walls of the intestines become infected and inflamed. No one knows for sure what causes the pouches to form. They may develop when increased pressure (caused primarily by constipation) is applied at weak spots in the wall of the colon.

This causes the inside wall to bulge out through the weak spots in the outer wall. Diverticulitis develops when one of the pouches becomes inflamed and infected, and bacteria enter small tears in the surface of the bowel. The infection may clear up by itself or spread to other areas.

Risk Factors

Both diverticulosis and diverticulitis are more common in cultures that eat a highly refined diet. Rural Indians and Africans-compared with people of Western cultures-rarely experience these disorders because they eat a large amount of fiber (roughage).

By contrast, diverticulosis and diverticulitis is common in developed or industrialized countries -- particularly the United States, England, and Australia -- where low-fiber diets are common.

Fiber is the part of fruits, vegetables and grains that the body cannot digest. It helps make stools soft and easy to pass and prevents constipation.

Constipation makes the muscles strain to move stool that is too hard and is the main cause of increased pressure in the colon. The excess pressure causes the weak spots in the colon to bulge out and become diverticula (small pouches). Diverticulitis occurs when the small pouches become infected or imflamed.

Simple Steps to Regularity

There are several things you can do to avoid developing diverticulitis:

• Eat foods high in fiber, such as whole-grain cereals and breads, fruits, and vegetables.
• Eat regular meals, chewing your food slowly and thoroughly.
• Drink plenty of liquids, including fruit and vegetable juices, milk, and water. Liquids are important to help your body function normally.
• Exercise daily, beginning with walking, bicycling, or swimming.
• Take care of the urge for a bowel movement promptly to avoid straining when going to the bathroom.
• Tell your doctor about any significant changes in bowel habits.

Symptoms

People with diverticulosis often do not have any discomfort or symptoms. When present, symptoms may include mild cramps, bloating, and constipation.

Other diseases such as irritable bowel syndrome and stomach ulcers cause similar problems, so these symptoms do not always mean a person has diverticulosis. You should visit your physician if you have these troubling symptoms.

The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, or constipation. The severity of the symptoms depends on the extent of the infection and the complications.

Diagnosis

To know whether a person has diverticulitis, a doctor needs to take a medical history and perform a physical examination. When taking a medical history, the doctor may ask about bowel habits, symptoms, pain, diet, and medications.

During the physical exam, the doctor will probably want to perform a barium enema X-ray and/or a colonoscopy, a procedure using a lighted instrument inserted through the rectum to view the inside of the colon. The physical exam may also include a digital rectal exam. To perform this test, the doctor inserts a gloved, lubricated finger into the rectum to detect tenderness, blockage, or blood. The doctor may check stool for signs of bleeding and test blood for signs of infection.

Treatment Options

People who have diverticulosis and no symptoms usually need no treatment, although eating a diet high in fiber and avoiding regular use of laxatives and enemas may help prevent their condition from getting worse. Fiber keeps the stool soft and lowers pressure inside the colon so that bowel contents can move through easily.

The American Dietetic Association recommends 20 to 35 grams of fiber each day. The doctor may also recommend drinking a fiber product once a day. These products are mixed with water and provide about four to six grams of fiber for an 8-ounce glass.

Some foods with high fiber content include raspberries, acorn squash, black-eyed peas, lima beans, brussels sprouts, kidney beans, apples, and brown rice.

Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early.

To help the colon rest, the doctor may recommend bed rest and a liquid diet, along with a pain reliever or a drug to control muscle spasms in the colon.

An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein.

Surgery may be necessary for certain complications of diverticulitis. If your case requires surgery, the surgeon opens the abdomen and removes the affected part of the colon. The remaining sections of the colon are then rejoined. This type of surgery, called colon resection, aims to keep attacks from coming back and to prevent complications.

If antibiotics do not correct an attack, you may need emergency surgery. Other reasons for emergency surgery include a large abscess, perforation, peritonitis, or continued bleeding.

Emergency surgery usually involves two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. Because of infection and sometimes obstruction, it is not safe to rejoin the colon during the first operation. Instead, the surgeon creates a temporary hole, or stoma, in the abdomen. The end of the colon is connected to the hole (this is known as a colostomy) to allow normal eating and bowel movements. The stool goes into a bag attached to the opening in the abdomen. In the second operation, the surgeon rejoins the ends of the colon.

References: National Digestive Diseases Information Clearing House
St. Luke's Texas Liver Institute
Last Updated: May 13, 2004