Diverticulosis & diverticular disease

Diverticulosis is common in Western and industrialized countries where low-fiber diets are common. Atrium Health Floyd and Harbin Clinic gastroenterologists will guide you through changes in your diet and recommend treatments such as medications for pain and antibiotics.

What is diverticulosis & diverticular disease?

Diverticular disease affects the lining of your large intestine. It’s caused by small pouches (called diverticula) that can form anywhere in your digestive tract. But they usually form in the last part of the large intestine (called the colon), which is located on the lower left side of the abdomen.

Types of diverticular disease

There are different types of diverticular disease that depend on the severity and types of symptoms.

• Diverticulosis: People who have diverticulosis have small pouches that bulge outward from the walls of their large intestine. Most people who have diverticulosis don’t have any symptoms and may not even know they have it.
• Diverticulitis: Diverticulitis occurs when the pouches become infected and inflamed. Pain is most often located on the lower left side of the abdomen. Complications of diverticulitis can include intestinal blockages and openings in the bowel wall.
• Diverticular bleeding: Diverticular bleeding occurs when a blood vessel next to a pouch (diverticulum) bursts. You may find blood in a bowel movement or in the toilet. If you notice blood coming from your rectum, you should call your doctor immediately.

Causes of diverticulitis & diverticular disease

Scientists are not sure what causes diverticulosis and diverticular disease.

Studies have also found links between diverticular disease and obesity, lack of exercise, smoking, and certain medications including nonsteroidal anti-inflammatory drugs, such as aspirin, and steroids.

Scientists agree that with diverticulitis, inflammation may begin when bacteria or stool get caught in a diverticulum. In the colon, inflammation also may be caused by a decrease in healthy bacteria and an increase in disease-causing bacteria. This change in the bacteria may allow chronic inflammation to develop in the colon.

Symptoms of diverticular disease

The most common symptom of this disease is pain in the lower left side of the abdomen. The pain is usually severe and comes on suddenly, though it can also be mild and then worsen over several days. The intensity of the pain can fluctuate.

Other symptoms of diverticulitis are:

• Fever and chills
• Nausea or vomiting
• A change in bowel habits – constipation or diarrhea
• Diverticular bleeding

In most cases, people with diverticular bleeding suddenly have a large amount of red or maroon-colored blood in their stool.

With diverticular bleeding, you may also have:

• Weakness
• Dizziness or light-headedness
• Abdominal cramping

Diagnosis of diverticular disease

You may be evaluated and diagnosed by different doctors in different settings. Primary care providers may be the first to recognize symptoms of diverticulosis or diverticulitis. If you have severe symptoms, you may be evaluated in an urgent care or emergency care clinic. Or you may be referred to a gastroenterologist – a doctor who specializes in digestive diseases. Based on symptoms, the following tests may be recommended:

• Blood tests: Blood tests can show the presence of inflammation or anemia. Anemia is a condition in which red blood cells are fewer or smaller than normal, which prevents the body’s cells from getting enough oxygen.
• CT scan: A CT scan of the colon is the most common test used to diagnose diverticular disease. CT scans can detect the appearance of diverticula and confirm the diagnosis of diverticulitis.
• Lower gastrointestinal (GI) series: A lower GI series is an X-ray exam that is used to look at the large intestine. The test is performed at a hospital or an outpatient center by an X-ray technician, and the images are interpreted by a radiologist.
• Colonoscopy: Colonoscopy is performed at a hospital or an outpatient center by a gastroenterologist. You’ll lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. Colonoscopy can show diverticulosis and diverticular disease.

Treatment of diverticular disease

A health care provider may treat the symptoms of diverticulosis by recommending a high-fiber diet or fiber supplements, medications and possibly probiotics. Treatment for diverticular disease varies, depending on whether a person has diverticulitis or diverticular bleeding.