Diverticulosis

A Common Colonic Condition in the Western World 

          Diverticulosis is a condition characterized by a series of small, pea to marble sized pouches that extend outward from the colon into the abdominal space, almost like a small hernia in the muscle wall of the colon.  The inside of the pouch is connected to the inside of the colon and it is lined only by the mucosal tissue layer.  It occurs most commonly in the distal or sigmoid colon on the left side of the abdomen and the number of diverticula present may vary from one to many.  Diverticulosis is quite common in the western world, affecting half of individuals in their 70s and 80s.  On the other hand, it is much less common in those under 40 years of age, those living in the rural regions of Asia and Africa and those following a vegetarian diet. 

Cause of Diverticular Disease 

          Now that we have seen who is most likely to develop diverticular disease, we get a hint as to the cause of this common condition.  Most of the research points to a combination of insufficient dietary fiber, increased pressure and contractility of the colon and reduced transit time through the intestine.  Diets high in fats and refined carbohydrates are also thought to contribute to the development of diverticulosis.  Obesity, constipation and postponement of defecation are other possible contributing factors.  Tics, as they are affectionately known in the medical world, are most often asymptomatic and unless they flare up, do not need any treatment other than perhaps to increase the fiber in the diet. 

Diverticulitis 

          The main significance of having diverticulosis is that it can progress to diverticulitis.  Diverticulitis is an inflammation in the pouch protruding from the colon caused by obstruction at the neck of the diverticulum, usually by fecal matter.  A bacterial infection can develop in the pouch, in a manner similar to the mechanism that causes the usually quiescent appendix to progress to appendicitis.  Occasionally this can lead to perforation and the development of peritonitis, an infection of the peritoneum which is a thin membrane that lines the inner abdominal wall and covers the organs contained therein.  Between 15 and 25% of patients with diverticulosis will develop diverticulitis. 

Symptoms and Diagnosis 

          Diverticulosis is usually asymptomatic and often detected only as an incidental finding during a routine colonoscopy.  Some patients may, however, experience abdominal discomfort, bloating, constipation or rectal bleeding.  Up to 85% of diverticula occur in the sigmoid or descending colon, which are located on the left side.  For this reason the most common symptom of diverticulitis is left lower abdominal pain, often with fever.  Patients may also have a change in bowel habits, rectal bleeding, nausea and vomiting, and symptoms related to the urinary tract.  As is often the case, a good history and physical examination is one of the best ways to diagnosis diverticulitis, but a CT scan of the abdomen and pelvis is the definitive confirmatory test.  In addition, a CBC or complete blood count will usually show an elevated white blood cell count. 

Treatment and Prevention 

          Increasing the amount of fiber in the diet is a good idea for individuals of all ages.  It may be especially important for those with known diverticula.  Avoiding constipation by increasing activity and drinking plenty of fluids may also help.  When diverticulitis is present, the treatment consists of antibiotics.  Mild diverticulitis without evidence of peritonitis can usually be treated at home with oral antibiotics, but patients with complicated diverticulitis or other significant medical conditions are usually treated in the hospital with intravenous antibiotics.  Surgery is usually not necessary after a single episode of diverticulitis since only 25% will go on to have another.  In cases of recurrent diverticulitis or in the presence of other complications, surgery may be necessary.  While colonoscopy is not advised during the acute phase of diverticulitis, it should be performed after it has resolved to rule out malignancy.  It is important to consult your health care provider if you have any questions about diverticular disease.

Video Clip Showing What Diverticula Look Like on Colonoscopy         

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