Diverticulosis and Diverticulitis

Diverticula are small pouches or pockets in the lining of the gastrointestinal tract, usually in the colon. Diverticular disease affects more than half of people over age 60 and almost everyone over 80. It’s not clear why this happens, but low-fiber diet, constipation, genetic factors, or chronic colon spasms may play a role. Diverticulitis and bleeding due to diverticulosis are the most common complications, leading to nearly 6,000 hospital admissions in the Chicago area each year.

Symptoms of diverticular disease

• Bloating or cramps
• Constipation
• Infection (see Diverticulitis below)
• Bleeding (see below)

Most of the time, there are no symptoms.

Treatment of diverticular disease

Diverticula are permanent – and since most cause no symptoms, treatment is rarely needed. For people with abdominal pain, bloating, or constipation, a high-fiber diet may help. This means 20-35 grams of fiber per day, introduced slowly (adding fiber too fast can cause discomfort). Fruits and vegetables have fiber: bran, whole wheat, apples, pears, broccoli, carrots, squash, and black beans are some examples. Psyllium or methylcellulose packaged fiber can also help. A high-fiber diet might decrease the progression of diverticula formation or expansion.

Bleeding

Diverticula can (uncommonly) cause large amounts of bleeding, called diverticular bleeding. This is usually painless or is associated with mild cramping. It occurs in a small percentage of people with diverticulosis. The bleeding can be serious, requiring hospitalization and blood transfusion. A colonoscopy may be needed to stop the bleeding, but more importantly to make sure that the bleeding is not due to another cause such as colorectal cancer. Other tests may be needed (nuclear bleeding scan or angiography). If bleeding cannot be stopped, surgery may be needed – this is rare. Diverticular bleeding leads to approximately 1,000 hospital admissions in the Chicago area every year.

Diverticulitis

Diverticulitis is infection or inflammation of a diverticulum. This can cause abdominal pain and fever. Constipation or signs of serious infection, such as chills, nausea, and vomiting may also occur. A perforation or abscess may develop, and over time a narrowing (stricture) or a fistula (abnormal connection to skin, bladder, or elsewhere) can form. A CAT scan may be needed to validate the diagnosis. Hospital admission may be needed for IV antibiotics, treatment of abscesses, or other complications – nearly 5,000 Chicago-area patients are admitted to the hospital for diverticulitis every year. It may be necessary to have a colonoscopy a few weeks later to rule out other findings (such as cancer). It is said that eating foods such as nuts, seeds, or popcorn can block a diverticulum and cause diverticulitis, but there is no evidence that this is true.