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Diverticulosis

and Diverticulitis
National Digestive Diseases Information Clearinghouse

What are diverticulosis and


diverticulitis?
Many people have small pouches in the lin
Colon (large intestine)
ing of the colon, or large intestine, that bulge
U.S. Department
of Health and outward through weak spots. Each pouch is
Human Services called a diverticulum. Multiple pouches are
called diverticula. The condition of having
NATIONAL
diverticula is called diverticulosis. About
INSTITUTES

OF HEALTH

10 percent of Americans older than 40 have


diverticulosis.1 The condition becomes more
common as people age. About half of all
people older than 60 have diverticulosis.2
Diverticula are most common in the lower
portion of the large intestine, called the
sigmoid colon. When the pouches become Diverticula
inamed, the condition is called diverticulitis.
Ten to 25 percent of people with diverticulosis
get diverticulitis.3 Diverticulosis and divertic
Many people have small pouches in their colon that
ulitis together are called diverticular disease. bulge outward through weak spots. Each pouch is
called a diverticulum. Multiple pouches are called
diverticula. The condition of having diverticula is
What are the symptoms called diverticulosis.
of diverticulosis and
diverticulitis? not always mean a person has diverticulosis.
Diverticulosis People with chronic symptoms should visit
Most people with diverticulosis do not have their doctor or health care provider.
any discomfort or symptoms. However, Diverticulitis
some people may experience crampy pain or
discomfort in the lower abdomen, bloating, The most common symptom of diverticulitis
and constipation. Other conditions such as is abdominal pain. The most common sign
irritable bowel syndrome and stomach ulcers on examination is tenderness in the lower
cause similar problems, so the symptoms do left side of the abdomen. Usually, the pain is
severe and comes on suddenly, but it can also
1Bogardus ST. What do we know about diverticular
be mild and become worse over several days.
disease? A brief overview. Journal of Clinical
The intensity of the pain can uctuate. A per
Gastroenterology. 2006;40:S108S111.
son may experience cramping, nausea, vomit
2Ibid.

3Ibid.

ing, fever, chills, or a change in bowel habits.


What are the complications Infected diverticula may develop perfora
tions. Sometimes the perforations leak pus
of diverticulitis? out of the colon and form a large abscess
Diverticulitis can lead to bleeding; infections; in the abdominal cavity, a condition called
small tears, called perforations; or blockages peritonitis. A person with peritonitis may be
in the colon. These complications always extremely ill with nausea, vomiting, fever, and
require treatment to prevent them from pro severe abdominal tenderness. The condi
gressing and causing serious illness. tion requires immediate surgery to clean the
abdominal cavity and remove the damaged
Bleeding part of the colon. Without prompt treatment,
Rectal bleeding from diverticula is a rare peritonitis can be fatal.
complication. Doctors believe the bleeding
is caused by a small blood vessel in a diver Fistula
ticulum that weakens and then bursts. When A stula is an abnormal connection of tissue
diverticula bleed, blood may appear in the between two organs or between an organ and
toilet or in the stool. Bleeding can be severe, the skin. When damaged tissues come into
but it may stop by itself and not require treat contact with each other during infection, they
ment. A person who has bleeding from the sometimes stick together. If they heal that
rectumeven a small amountshould see way, a stula may form. When diverticulitis-
a doctor right away. Often, colonoscopy is related infection spreads outside the colon,
used to identify the site of bleeding and stop the colons tissue may stick to nearby tissues.
the bleeding. Sometimes the doctor injects The organs usually involved are the bladder,
dye into an arterya procedure called small intestine, and skin.
angiographyto identify and treat diver
The most common type of stula occurs
ticular bleeding. If the bleeding does not
between the bladder and the colon. This
stop, surgery may be necessary to remove the
type of stula affects men more often than
involved portion of the colon.
women. It can result in a severe, long-lasting
Abscess, Perforation, and infection of the urinary tract. The problem
can be corrected with surgery to remove the
Peritonitis stula and the affected part of the colon.
Diverticulitis may lead to infection, which
often clears up after a few days of treatment Intestinal Obstruction
with antibiotics. If the infection gets worse, Scarring caused by infection may lead to par
an abscess may form in the wall of the colon. tial or total blockage of the intestine, called
An abscess is a localized collection of pus intestinal obstruction. When the intestine is
that may cause swelling and destroy tissue. blocked, the colon is unable to move bowel
If the abscess is small and remains in the wall contents normally. If the intestine is com
of the colon, it may clear up after treatment pletely blocked, emergency surgery is neces
with antibiotics. If the abscess does not clear sary. Partial blockage is not an emergency,
up with antibiotics, the doctor may need to so the surgery to correct it can be planned.
drain it using a cathetera small tube
placed into the abscess through the skin.
After giving the patient numbing medicine,
the doctor inserts the needle through the skin
until reaching the abscess and then drains the
uid through the catheter. This process may
be guided by sonography or x ray.

2 Diverticulosis and Diverticulitis


What causes diverticular How is diverticular disease
disease? diagnosed?
Although not proven, the dominant theory To diagnose diverticular disease, the doctor
is that a low-ber diet causes diverticular asks about medical history, does a physical
disease. The disease was rst noticed in the exam, and may perform one or more diag
United States in the early 1900s, around nostic tests. Because most people do not
the time processed foods were introduced have symptoms, diverticulosis is often found
into the American diet. Consumption of through tests ordered for another ailment.
processed foods greatly reduced Americans For example, diverticulosis is often found
ber intake. during a colonoscopy done to screen for
cancer or polyps or to evaluate complaints of
Diverticular disease is common in developed pain or rectal bleeding.
or industrialized countriesparticularly
the United States, England, and Austra When taking a medical history, the doc
liawhere low-ber diets are consumed. tor may ask about bowel habits, pain, other
The disease is rare in Asia and Africa, where symptoms, diet, and medications. The
most people eat high-ber diets. physical exam usually involves a digital rectal
exam. To perform this test, the doctor inserts
Fiber is the part of fruits, vegetables, and a gloved, lubricated nger into the rectum to
grains that the body cannot digest. Some detect tenderness, blockage, or blood. The
ber, called soluble ber, dissolves easily in doctor may check stool for signs of bleeding
water. It takes on a soft, jelly-like texture in and test blood for signs of infection. If diver
the intestines. Insoluble ber passes almost ticulitis is suspected, the doctor may order
unchanged through the intestines. Both one of the following radiologic tests:
kinds of ber help prevent constipation by
making stools soft and easy to pass. Abdominal ultrasound. Sound waves
are sent toward the colon through
Constipationor hard stoolmay cause a handheld device that a technician
people to strain when passing stool during glides over the abdomen. The sound
a bowel movement. Straining may cause waves bounce off the colon and other
increased pressure in the colon, which may organs, and their echoes make electrical
cause the colon lining to bulge out through impulses that create a picturecalled
weak spots in the colon wall. These bulges a sonogramon a video monitor. If
are diverticula. the diverticula are inamed, the sound
Lack of exercise also may be associated waves will also bounce off of them,
with a greater risk of forming diverticula, showing their location.
although the reasons for this are not well Computerized tomography (CT) scan.
understood. The CT scan is a noninvasive x ray that
Doctors are not certain what causes divertic produces cross-section images of the
ula to become inamed. The inammation body. The doctor may inject dye into
may begin when bacteria or stool are caught a vein and the person may be given a
in the diverticula. An attack of diverticulitis similar mixture to swallow. The person
can develop suddenly and without warning. lies on a table that slides into a donut-
shaped machine. The dye helps to show
complications of diverticulitis such as
perforations and abscesses.

3 Diverticulosis and Diverticulitis


How is diverticular disease data support this treatment measure. Eat
ing a high-ber diet is the only require
treated? ment highly emphasized across the medical
A high-ber diet and pain medications help literature. Eliminating specic foods is not
relieve symptoms in most cases of diverticu necessary. The seeds in tomatoes, zucchini,
losis. Uncomplicated diverticulitis with mild cucumbers, strawberries, and raspberries, as
symptoms usually requires the person to rest, well as poppy seeds, are generally considered
take oral antibiotics, and be on a liquid diet harmless. People differ in the amounts and
for a period of time. Sometimes an attack types of foods they can eat. Decisions about
of diverticulitis is serious enough to require diet should be made based on what works
a hospital stay, intravenous (IV) antibiotics, best for each person. Keeping a food diary
and possibly surgery. may help identify what foods may cause
symptoms.
Diverticulosis
Increasing the amount of ber in the diet If cramps, bloating, and constipation are
may reduce symptoms of diverticulosis and problems, the doctor may prescribe a short
prevent complications such as diverticulitis. course of pain medication. However, some
Fiber keeps stool soft and lowers pressure pain medications actually cause constipation.
inside the colon so that bowel contents can
move through easily. The American Dietetic
Diverticulitis
Association recommends consuming Treatment for diverticulitis focuses on clear
20 to 35 grams of ber each day. The table ing up the inammation and infection, rest
What foods have ber? shows the amount ing the colon, and preventing or minimizing
of ber in some foods that a person can eas complications.
ily add to the diet. Depending on the severity of symptoms,
The doctor may also recommend taking the doctor may recommend bed rest, oral
a ber product such as methylcellulose antibiotics, a pain reliever, and a liquid diet.
(Citrucel) or psyllium (Metamucil) one to If symptoms ease after a few days, the doctor
three times a day. These products are avail will recommend gradually increasing the
able in powder, pills, or wafers, and provide amount of high-ber foods in the diet.
2 to 3.5 grams of ber per dose. Fiber prod Severe cases of diverticulitis with acute
ucts should be taken with at least 8 ounces pain and complications will likely require
of water. a hospital stay. Most cases of severe diver
Avoidance of nuts, popcorn, and sunower, ticulitis are treated with IV antibiotics and
pumpkin, caraway, and sesame seeds has a few days without food or drink to help the
been recommended by physicians out of fear colon rest. In some cases, surgery may be
that food particles could enter, block, or irri- necessary.
tate the diverticula. However, no scientic

4 Diverticulosis and Diverticulitis


What foods have fiber?
Examples of foods that have ber include

Breads, cereals, and beans Fiber


1/2 cup of navy beans 9.5 grams
1/2 cup of kidney beans 8.2 grams
1/2 cup of black beans 7.5 grams

Whole-grain cereal, cold


1/2 cup of All-Bran 9.6 grams
3/4 cup of Total 2.4 grams
3/4 cup of Post Bran Flakes 5.3 grams

1 packet of whole-grain cereal, hot 3.0 grams


(oatmeal, Wheatena)

1 whole-wheat English mufn 4.4 grams

Fruits
1 medium apple, with skin 3.3 grams
1 medium pear, with skin 4.3 grams
1/2 cup of raspberries 4.0 grams
1/2 cup of stewed prunes 3.8 grams

Vegetables
1/2 cup of winter squash 2.9 grams
1 medium sweet potato with skin 4.8 grams
1/2 cup of green peas 4.4 grams
1 medium potato with skin 3.8 grams
1/2 cup of mixed vegetables 4.0 grams
1 cup of cauliower 2.5 grams
1/2 cup of spinach 3.5 grams
1/2 cup of turnip greens 2.5 grams

Source: U.S. Department of Agriculture and U.S. Department of Health and Human
Services, Dietary Guidelines for Americans, 2005.

5 Diverticulosis and Diverticulitis


When is surgery necessary
for diverticulitis? Points to Remember
If symptoms of diverticulitis are frequent, or Diverticulosis occurs when small
the patient does not respond to antibiotics pouches called diverticula bulge out
and resting the colon, the doctor may advise ward through weak spots in the colon,
surgery. The surgeon removes the affected or large intestine.
part of the colon and joins the remaining Most people with diverticulosis never
sections. This type of surgerycalled colon have any discomfort or symptoms.
resectionaims to prevent complications
Diverticula form when pressure builds
and future diverticulitis. The doctor may
inside the colon wall, usually because
also recommend surgery for complica
of constipation.
tions such as a stula or partial intestinal
obstruction. The most likely cause of diverticulosis
is a low-ber diet because it increases
Immediate surgery may be necessary when constipation and pressure inside the
the patient has other complications, such colon.
as perforation, a large abscess, peritonitis,
complete intestinal obstruction, or severe For most people with diverticulosis,
bleeding. In these cases, two surgeries may eating a high-ber diet is the only
be needed because it is not safe to rejoin the treatment needed.
colon right away. During the rst surgery, Fiber intake can be increased by eat
the surgeon cleans the infected abdominal ing whole-grain breads and cereals;
cavity, removes the portion of the affected fruits like apples and pears; vegetables
colon, and performs a temporary colostomy, like peas, spinach, and squash; and
creating an opening, or stoma, in the abdo starchy vegetables like kidney and
men. The end of the colon is connected to black beans.
the opening to allow normal eating while Diverticulitis occurs when the
healing occurs. Stool is collected in a pouch pouches become inamed and cause
attached to the stoma. In the second surgery pain and tenderness in the lower left
several months later, the surgeon rejoins the side of the abdomen.
ends of the colon and closes the stoma.
Diverticulitis can lead to bleeding;
infections; small tears, called perfo
rations; or blockages in the colon.
These complications always require
treatment to prevent them from pro
gressing and causing serious illness.
Severe cases of diverticulitis with
acute pain and complications will
likely require a hospital stay. When a
person has complications or does not
respond to medication, surgery may
be necessary.

6 Diverticulosis and Diverticulitis


Hope through Research For More Information
The National Institute of Diabetes and American College of Gastroenterology
Digestive and Kidney Diseases and the P.O. Box 342260
National Cancer Institute sponsor research Bethesda, MD 208272260
programs to investigate diverticulosis and Phone: 3012639000
diverticulitis. Fax: 3012639025
Internet: www.acg.gi.org
Investigation continues in several areas,
including American Gastroenterological
a possible link between diverticular dis Association
ease and inammatory bowel disease 4930 Del Ray Avenue
the management of recurrent diverticu Bethesda, MD 20814
lar disease Phone: 3016542055
Fax: 3016545920
the use of probiotics in the prevention Email: member@gastro.org
and treatment of diverticular disease Internet: www.gastro.org
indications for surgery for uncompli
cated diverticulitis American Society of Colon and Rectal
Surgeons
Participants in clinical trials can play 85 West Algonquin Road, Suite 550
a more active role in their own health care, Arlington Heights, IL 60005
gain access to new research treatments Phone: 8472909184
before they are widely available, and help Fax: 8472909203
others by contributing to medical research. Email: ascrs@fascrs.org
For information about current studies, visit Internet: www.fascrs.org
www.ClinicalTrials.gov.
International Foundation for Functional
Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 532178076
Phone: 18889642001
or 4149641799
Fax: 4149647176
Email: iffgd@iffgd.org
Internet: www.iffgd.org

7 Diverticulosis and Diverticulitis


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U.S. DEPARTMENT OF HEALTH


AND HUMAN SERVICES
National Institutes of Health

NIH Publication No. 081163


July 2008