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Diverticulitis

If you have diverticulosis, you know how debilitating diverticulitis flare-ups can be. To prevent these, your doctor may suggest that you eat more fiber, drink plenty of fluids, and exercise regularly.

When lifestyle changes aren't enough, you have other options to getting you back on the road to health.

Learn more about diverticulum, what the symptoms are, your surgical options and more.

What is diverticulitis?

Diverticulosis is the medical name for the presence of diverticulum, or small pouches formed in the colon wall. The cause for development of these is not well understood. It is possible the development is a side effect of having too low amount of fiber in your diet. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon. There also seems to be a genetic component, so it can run in families.

When the diverticulum are present but not causing problems, we call it Diverticulosis. We find diverticulum when we conduct a test for other reasons, like a colonoscopy or barium enema. Many people with diverticulosis have no symptoms. They will remain symptom free for the rest of their lives.

Diverticulum

Diverticulitis happens when the diverticulum become inflamed. Particles of stool or undigested food become stuck in these pouches. This creates both inflammation and infection in the wall of the colon. The infection is due in part to the bacteria that naturally live in the colon. The inflammation causes increased pressure in the diverticulum and discomfort for you.

In severe cases, the pressure can cause the diverticulum to burst. Then stool and bacteria flood your lower abdomen causing a severe wide-spread infection.

Symptoms of diverticulitis

The symptoms of diverticulitis depend upon the degree of inflammation and infection present. Symptoms can include:

  • Abdominal pain, many times in the lower abdomen, more often on the left side, but can be present on the right side as well
  • Fever and chills
  • Diarrhea or constipation, can have blood or mucous in the stool
  • Nausea with decreased appetite, sometimes with vomiting
  • Blood from the rectum
  • Pain in the pelvis area with urination (this is due to inflammation around your bladder and its proximity to the colon)

You should seek medical attention if you have any of these symptoms. Diverticulitis can progress into a severe, wide-spread infection if left untreated.

Testing for diverticulitis

Your doctor will assess your symptoms and do an examination of your abdomen, as well as the rest of your body. You will need tests to determine if you have diverticulitis.

  • Blood tests to look for signs of infection, check your kidney and liver functions
  • Urine test to look for infection in the urinary tract
  • A CT scan, or an image of your abdominal organs

Complications associated with diverticulitis

Simple diverticulitis accounts for 75 percent of cases. Treatments take place at home using antibiotics and lifestyle changes.

Complicated diverticulitis is more severe and accounts for 25 percent of cases. In most cases, you will need hospitalization and surgery. Complications associated with diverticulitis can include the following:

  • Abscess — This is a localized collection of infection next to the inflamed colon. This is usually caused by a “microperforation,” or a very small hole in the diverticulum. The hole allows bacteria to escape from the colon into the abdomen. The body is able to contain the infection to a small area by “walling off” the pus.
  • Recurrence — After you have one episode of diverticulitis, you are at higher risk of having another. Each flare up can become more severe. About 1/3 of patients that have one episode of diverticulitis will have future episode(s).
  • Fistula — This is a hole created between two areas not normally connected. For example, a hole forms between the colon and the bladder.
  • Obstruction — A blockage of the colon is due to inflammation of the colon. The colon wall thickens and stool is not able to pass through.
  • Peritonitis — If your colon develops a hole, the contents of your intestines spill into your abdomen. This wide-spread infection of the abdominal cavity has the diagnosis of peritonitis.
  • Sepsis — An overwhelming body-wide infection that can lead to failure of many organs.
  • Diverticular bleeding — When a small artery located within the diverticulum breaks through the colon lining and bleeds into the colon. This can happen with diverticulosis and diverticulitis. Diverticular bleeding usually causes painless bleeding from the rectum. In about 50 percent of cases, the person will see maroon or bright red blood with bowel movements. Bleeding with bowel movements is not normal and you should immediately seek medical attention. Most cases of diverticular bleeding resolve on their own. Some people will need further testing or treatment to stop bleeding. Testing may include a colonoscopy, angiography (blocking off the bleeding artery) or surgery.

Treatment for diverticulitis

Treatment of diverticulitis depends upon how severe your symptoms and disease are. People with diverticulosis who do not have symptoms do not need treatment.

  • Increase fiber to add bulk to the stool — Fiber can help to bulk up your stool. A high-fiber diet might prevent new diverticula, diverticulitis or diverticular bleeding. Fiber has not proven to prevent these conditions or get rid of current diverticuli. Fruits and vegetables are a good source of fiber. You calculate fiber content of packaged foods by reading the nutrition label.
  • Take fiber supplements — You can take fiber supplements like Metamucil, Citrucel or Benefiber to bulk up your stool.
  • Seeds and nuts — In the past we advised diverticulitis patients to avoid whole pieces of fiber, like seeds, corn and nuts. There was concern that these foods could cause an episode of diverticulitis. This belief is completely unproven. So we no longer recommend avoiding these high fiber foods.

After diverticulitis resolves

At the end of a diverticulitis episode, you should have the entire length of your colon examined. We usually perform this exam with a colonoscopy. This colon exam gives us the opportunity to determine the extent of your disease. We also can rule out the presence of abnormal lesions such as polyps or cancer.

In rare cases, people can present with what appears to be diverticulitis, but can turn out to be colon cancer.

Watch a video about diverticulitis

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