Health Topics for Digestive System

James A. Clifton Center for Digestive Diseases

Cancers of the Digestive System

Liver Failure Clinic

Liver Service

Diverticulosis and Diverticulitis

A diverticulum is a pouch or sac that bulges out from the lining of the wall of the intestine. When a person has one or more of these, it is called diverticulosis. They usually occur in the colon or large intestine. However, it may occur anywhere in the gastrointestinal tract. About one-third of people over 50 and two- thirds of people over 80 have diverticulosis. Most people do not have any symptoms, so they do not know they have it. The most common complication is diverticulitis. This happens when a diverticulum becomes inflamed.

Doctors believe that the major cause of diverticulosis is eating a low fiber diet over many years. In fact, the disease was first noticed in the United States at the same time that people began eating processed foods. Most processed foods are low in dietary fiber. The low fiber diet can cause constipation, which can cause increased pressure in the colon. The increased pressure is thought to cause weak spots that bulge and form the diverticula.

Even though most people do not have any symptoms with diverticulosis, a few may have. The symptoms might be a mild abdominal pain that comes and goes, a change in bowel habits, bloating or gas. These are the same symptoms that a person with irritable bowel syndrome has. The two diseases can be confused. That is why it can be important to have x-rays or tests. The most common x-ray is the barium enema, or lower GI x-ray. A colonoscopy may also be done. It is done with a long thin-lighted tube with a telescope on the end that the provider puts in through the rectum. The tube or colonoscope is long enough to look at most of the bowel.

The treatment for diverticulosis is a high fiber diet. It is recommended that 20 to 35 grams of fiber are necessary a day. Fiber foods include: fresh fruits and vegetables, beans and other legumes, and bran. If enough fiber cannot be taken through the diet, a bulk-forming laxative like Metamucil or FiberCon may be used. When more fiber is taken in, water in the diet needs to be increased.

Most people will never have any complications from diverticulosis. A few people will have complications. Besides diverticulitis, there may be painless rectal bleeding, a fistula, an abscess, or a bowel obstruction. A fistula is a tunnel going from the colon to another organ, often the bladder. Occasionally, an infected diverticulum may become worse and rupture. If this happens, fluid from the colon can get into the surrounding abdomen, and cause a severe infection. This is a medical emergency, and almost always needs surgery.

The main symptom of diverticulitis is usually left lower abdominal pain. If there is an infection, other symptoms may be:

• fever
• nausea or vomiting
• chills
• cramping constipation or change in bowel habits

Diverticulitis is treated with antibiotics, and rest. The colon needs to be rested, so a liquid diet is recommended. The provider may order pain relievers. An acute attack may require a hospital stay. Intravenous (IV) fluids are usually given, and surgery may be required.

If there are several attacks of diverticulitis, the provider may recommend surgery. The surgeon will wait until the attack is over, and the colon has had time to heal. The problem area of the colon is removed, and the ends are stitched together. Sometimes surgery is necessary for complications from a fistula or bowel obstruction.

The best prevention is eating a high fiber diet. Try to get 20 to 35 grams of fiber a day. Drink plenty of fluids. Drink at least eight glasses of water a day. Go to the bathroom when feeling the urge to go. Exercise regularly. These steps will help to prevent constipation, and attacks of diverticulitis.

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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