Diverticular Disease

What is it?

A diverticulum is a small, out pouching of the colon. Diverticulosis describes just the presence of diverticula. Diverticulitis means inflammation of these diverticula.

Who gets it?

This is a very common disease, and is more common as you age. In people under 40, less than 5% are affected, 30% by age 50, and 65% by age 85. Though many people are affected, 70% will never have symptoms. Other people may develop diverticulitis, inflammation of the diverticulum (15-25%), or bleeding (5-15%).

Why does it happen?

This is not completely known, but it is thought that there may be a link to low levels of fiber in your diet, a lack of physical activity, and being overweight. Diverticula develop in sites of weakness in the colon wall, where the blood vessels dive into the muscle layer.

What are the symptoms?

As stated above, 70% of people with diverticulosis will have no symptoms. Often it is found on exams that were done for other reasons, such as, a CT scan of the abdomen and pelvis or a colonoscopy.

Some patients report the following symptoms, but these can also be attributed to other disorders:

  • Cramping
  • Bloating
  • Flatulence
  • Irregular bowel movements

What are the complications?

Major complications are diverticulitis and diverticular bleeding.

Diverticulitis is inflammation of the diverticulum with a tiny or large break in the tissue (perforation). This is thought to happen because of increased pressure inside the diverticulum, which, leads to inflammation and damage to the cells which can lead to a hole. Because of the hole, a small walled off infection (abscess) can form, or if other organs are involved a fistula (a tract connecting two organs inappropriately) or a blockage can develop. If the infection or hole in the diverticulum cannot be contained, a large hole, and widespread infection of the abdominal cavity (peritonitis) may result. The most common symptom is left sided, lower quadrant, abdominal pain.

Bleeding. As the colon tissue bulges out, forming the diverticulum, the blood vessel that serves that part of the tissue can be weakened and it eventually may rupture. The rectal bleeding is painless and usually stops by itself. Less commonly some type of intervention, including surgery, may be required to stop the bleeding.

How is it treated?

No treatment is necessary if there are no symptoms. Often a high fiber diet is recommended. High fiber may work, because it creates a large bulky bowel movement that reduces the pressure in the colon and that is less likely to cause the formation of new diverticula. There is no evidence that avoidance of nuts or seeds protects against diverticulitis.

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