What is Diverticulosis?
Diverticulosis is a health condition where multiple balloon-like bulges, called diverticula, emerge within the digestive tract. While these bulges can occur anywhere in the digestive system, they are most commonly found in the large intestine, especially in a part called the sigmoid colon.
Most people with diverticulosis don’t show any symptoms. However, problems can arise if the condition progresses. For example, diverticular disease describes the situation where diverticulosis causes symptoms like bleeding. Diverticulitis refers to a condition where these bulges get inflamed, which can cause further complications such as forming abscesses, creating abnormal connections (fistulas), blocking the intestine, or triggering a hole in the digestive tract. In some cases, inflammation may occur in specific segments of the intestinal lining located between the bulges.
What Causes Diverticulosis?
Diverticulosis is a condition believed to result from issues with the movement of the digestive tract, such as spasms or high pressure within the intestines. While the exact cause isn’t well-known, researchers have linked the condition to several risk factors in our environment and lifestyle.
For instance, evidence suggests that a diet low in fiber and high in red meat could potentially heighten the risk of developing diverticulosis. Interestingly, a fiber-rich diet doesn’t seem to alleviate symptoms if you already have simple diverticular disease. However, if you have a more complex form of the disease that involves symptoms like inflammation or bleeding, eating plenty of fiber might help. It could possibly decrease inflammation and positively influence the array of microscopic organisms living in your intestines.
Certain physical conditions and habits can also raise your risk of experiencing complications from diverticulosis. For example, obesity or a larger waist size seem to significantly elevate the risk of diverticulitis (an inflammation of the sacs) and bleeding. Similarly, people who smoke are more likely to experience complications such as the formation of abscesses or ruptures in the intestine.
Similarly, some medications might increase the risk of diverticular bleeding or diverticulitis. These drugs include nonsteroidal anti-inflammatory drugs, opiates, and steroids.
Risk Factors and Frequency for Diverticulosis
Diverticulosis is a common condition in the Western world, affecting 5% to 45% of people. It becomes more common as people age, with 60% of individuals over the age of 60 having it. In the Western world, 95% of cases occur in the sigmoid colon. In Asia, diverticulosis affects 13% to 25% of people and is usually found in the right side of the colon. Bleeding occurs in 5% to 15% of patients with diverticulosis, with a third experiencing severe bleeding. Diverticulitis, a complication of diverticulosis, occurs in 4% to 15% of patients and is increasing in prevalence. Under the age of 50, diverticulosis is more common in males, but after the age of 50, it’s more commonly seen in females, with a significant difference past the age of 70.
Signs and Symptoms of Diverticulosis
Diverticulosis is a condition where most people don’t exhibit any symptoms and it isn’t harmful in itself. Sometimes though, some people might experience unusual belly pain or cramping, a change in their bowel movements, or see blood in their stool. This bleeding typically doesn’t cause any pain. If someone comes in with painless rectal bleeding, unexplained belly pain or cramping, or changes in their bowel behavior, they might have diverticulosis.
A more severe form of this illness is acute diverticulitis, which involves inflammation, infection, or rupture. This is typically suspected when a person comes in with lower belly pain (especially on the left side). They might also present with belly tenderness when touched and an increased white blood cell count signaling the presence of infection. In these instances, an abdominal CT scan can help doctors decide whether the disease is severe or not.
- No symptoms in most cases
- Unexplained abdominal pain or cramping
- Changes in bowel habits
- Painless rectal bleeding
- Lower abdominal pain, particularly on the left side for acute diverticulitis
- Abdominal tenderness to touch
- Increased white blood cell count (sign of infection)
Testing for Diverticulosis
A doctor can suspect diverticulosis if a person has symptoms like rectal bleeding, changes in bowel movements, or abdominal pain. To confirm the diagnosis, the doctor may perform a colonoscopy or take an X-ray after a barium enema. If the abdominal pain is severe, a CT scan may be done to prevent further complications. If there is blood in the stool, a colonoscopy is the most effective way to find the source. If the results are unclear, other techniques like angiography, CT scans, or radionuclide scanning may be used. Treatment for diverticulitis depends on the severity. Uncomplicated cases can be treated with antibiotics, while complicated cases may require additional treatment like surgery. Hospitalization may be necessary for individuals with other health conditions or who are not responding to treatment.
Treatment Options for Diverticulosis
Treatment for intestinal spasms involves increasing fiber and fluid intake to reduce spasms and pressure in the intestines. There is no proven link between certain foods and diverticular disease. Bleeding associated with diverticulosis often resolves on its own, but in some cases, procedures may be needed to stop persistent bleeding. These procedures can include using an endoscope, radiological methods, or surgery. If recurrent bleeding occurs and the cause is unknown, surgery to remove sections of the affected intestine may be considered. Surgery is also more likely for a large pouch that has a higher risk of infection or bursting.
What else can Diverticulosis be?
Diverticulosis often causes rectal bleeding, which is usually the main symptom. This condition can be mistaken for several others that share similar signs. These include:
- Hemorrhoids (swollen veins in your rectum and anus)
- Ulcers in the gut wall (sores in the lining of your stomach or small intestine)
- Inflammatory bowel disease (a group of conditions that cause long-lasting inflammation in your digestive tract)
- Anal fissure (a small cut or tear in the lining of your anus)
- Anal abscess or fistula (an infected tunnel between the skin and the anus)
- Colonic polyps (small clumps of cells that form on the lining of the colon)
- Colon cancer (cancer of the colon, the longest part of the large intestine)
- Constipation (hard, infrequent bowel movements)
- Radiation therapy (a cancer treatment that uses high doses of radiation)
- Angiodysplasias (abnormal blood vessels in the digestive tract)
- Colitis (inflammation of the colon)
- Proctitis (inflammation of the rectum lining)
It’s crucial that doctors take all these possibilities into account and carry out the necessary tests to ensure they reach the correct diagnosis.
What to expect with Diverticulosis
Diverticulosis often doesn’t show any symptoms, but in some cases, it can lead to episodes of bleeding. Around 15% of people with this condition may experience diverticular bleeding. When inflammation occurs in the diverticula, the small pouches in the digestive system, about 85% of individuals respond well to medical treatment. However, the rest might need surgery to treat the inflamed diverticula.
In general, most people with diverticulosis can expect a positive outcome if they make certain lifestyle changes. These include becoming more physically active, following a diet rich in fiber, and avoiding constipation.
Possible Complications When Diagnosed with Diverticulosis
Diverticulosis often goes unnoticed or may cause rectal bleeding. In cases of uncomplicated diverticular disease, individuals may experience consistent stomach pain, with the presence of small pouches in the colon but no inflammation of the colon or the pouches. Segmental colitis refers to inflammation in the lining of the pouches, but without the pouch openings being affected.
On the other hand, diverticulitis is when a pouch becomes inflamed. This condition can be sudden or long-term, straightforward, or complex. Complications of diverticulitis include abscesses, fistulas (abnormal connections between two body parts), bowel obstruction, or the sudden bursting of a pouch. Inflammation within the pouches can lead to the creation of a fistula between the colon and nearby organs.
The most typical fistulas include one between the bladder and the colon (colovesical fistula) that may lead to symptoms such as passing air or feces while urinating, or pain during urination. Similarly, a fistula between the colon and vagina (colovaginal fistula) might result in feces or gas escaping through the vagina.
Common Symptoms:
- Rectal bleeding
- Constant abdominal pain
- Inflammation in the pouches’ lining
- Complications such as abscesses, fistulas, bowel obstruction, or pouch rupture
- Passing air or feces while urinating (for colovesical fistula)
- Feces or gas escaping through the vagina (for colovaginal fistula)
Preventing Diverticulosis
Diverticulosis is a condition where small pouches form in the colon due to weak spots in its muscular wall. It can affect both men and women equally. If there are no symptoms, treatment is usually not necessary. However, if blood is noticed in the stool, immediate medical intervention is required. This could indicate diverticular bleeding, where an artery in one of the pouches starts to bleed into the colon. To manage this condition, a high-fiber diet is often recommended. It has been suggested to avoid seeds, corn, and nuts, but recent research has not found evidence to support this.
