When a patient comes in with abdominal pain or blood in their stool, one of the conditions that we consider is diverticulitis. You may not have heard about diverticulitis so this will attempt to answer some questions about diverticular disease.
A diverticulum is a small pouch-like structure that sometimes forms in the muscular wall of the colon. These little pouches often cause no pain and we become aware of them only after having a procedure such as a colonoscopy, flexible sigmoidoscopy, a barium enema or a CT scan.
What is diverticulosis? Diverticulosis simply means that there are diverticula present. Most people don’t have any symptoms and will remain free of symptoms throughout their life (about 15-25% of people develop diverticulitis which is more severe. I usually think about diverticulum as small areas where the colon balloons out. These are potentially weak areas that might become inflamed or may rupture under pressure.
What is diverticulitis? Diverticulitis is inflammation of a diverticulum that occurs when there is a thinning or breakdown of the wall of the colon. Diverticulitis is more severe than diverticulosis because now these pouches in the colon have become irritated/inflamed/stretched because of pressure within the colon or due to hard particles of stool that become lodged inside them. The diverticulum now becomes painful and may rupture (meaning the wall of the colon may break down and cause stool and bacteria to enter the abdomen). Diverticulitis may also cause bleeding within the colon because there are often blood vessels in the area where diverticulum occur and they can start bleeding when the area gets inflamed.
Symptoms of diverticulitis: The symptoms really depend on how bad the inflammation inside the colon is. The most common symptom is pain in the left lower abdominal area. Sometimes patients may have blood in their stool, nausea, vomiting, constipation, or diarrhea.
Classification of diverticulitis: Simple diverticulitis is more common and usually responds well to medical treatment without needing surgery. Complicated diverticulitis (about 25% of the cases) usually require surgery to remove the area of the colon that has become inflamed or ruptured.
Treatment: There is usually no treatment needed with diverticulosis (diverticulum that are not inflamed are generally not painful and don’t usually cause problems). Many medical providers however recommend increasing dietary to decrease the chances of becoming constipated. Constipation can increase the pressure within the colon that can in tern lead to diverticulitis. Increasing fruits, vegetables, hydration and fiber have not been proven to prevent diverticulitis however. We used to think that patient with diverticulosis should avoid seeds and nuts because we thought they may increase the risks for patients developing diverticulitis, however research has no proven that to be false.
Diverticulitis is usually treated. The treatment that you receive for diverticulitis depends on the severity of the symptoms. Mild abdominal pain caused from diverticulitis can usually be treated at home with a clear liquid diet and oral antibiotics. If the patient develops a fever greater than 100.1 degrees F, worsening or severe abdominal pain or inability to tolerate fluids then hospital treatment is usually recommended.
Hospitalization: If you need to be in the hospital for diverticulitis you will usually not be allowed to eat or drink until you start feeling better, and antibiotics and IV fluids are given. If you develop an abscess inside the colon then a surgeon may need to help drain the abscess by putting a tube through the abdominal wall.
Complications: Peritonitis is a generalized infection within the abdomen that occurs if the colon ruptures (the wall of your intestines breaks). An emergency operation is often required in these cases to remove the area of diseased colon and reconnect the un-affected colon back together. Sometimes these two procedures are done at separate times (the removal is done first) so that the colon is allowed to heal before reattaching the two pieces together.
Surgical treatment: Patients who don’t respond well after medical treatment or who have repeat attacks of diverticulitis may benefit from surgery to remove the diseased area of their colon.
Bleeding from diverticulitis: Most of the time the bleeding stops without needing any procedures but sometimes a colonoscopy or other procedures may be necessary to get the bleeding under control.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO