Diverticulosis And Diverticulitis
Many people have small pouches in the lining of the colon, or large intestine, that bulge outward through weak spots. Each pouch is called a diverticulum. Multiple pouches are called diverticula. The condition of having diverticula is called diverticulosis. About 10 percent of Americans older than 40 have diverticulosis. The condition becomes more common as people age. About half of all people older than 60 have diverticulosis.
Diverticula are most common in the lower portion of the large intestine, called the sigmoid colon. When the pouches become inflamed, the condition is called diverticulitis. Ten to 25 percent of people with diverticulosis get diverticulitis. Diverticulosis and diverticulitis together are called diverticular disease.
What are the symptoms of diverticulosis and diverticulitis?
Most people with diverticulosis do not have any discomfort or symptoms. However, some people may experience crampy pain or discomfort in the lower abdomen, bloating, and constipation. Other conditions such as irritable bowel syndrome and stomach ulcers cause similar problems, so the symptoms do not always mean a person has diverticulosis. People with chronic symptoms should visit their doctor or health care provider.
The most common symptom of diverticulitis is abdominal pain. The most common sign on examination is tenderness in the lower left side of the abdomen. Usually, the pain is severe and comes on suddenly, but it can also be mild and become worse over several days. The intensity of the pain can fluctuate. A person may experience cramping, nausea, vomiting, fever, chills, or a change in bowel habits.
What are the complications of diverticulitis?
Diverticulitis can lead to bleeding; infections; small tears, called perforations; or blockages in the colon. These complications always require treatment to prevent them from progressing and causing serious illness.
Rectal bleeding from diverticula is a rare complication. Doctors believe the bleeding is caused by a small blood vessel in a diverticulum that weakens and then bursts. When diverticula bleed, blood may appear in the toilet or in the stool. Bleeding can be severe, but it may stop by itself and not require treatment. A person who has bleeding from the rectum—even a small amount—should see a doctor right away. Often, colonoscopy is used to identify the site of bleeding and stop the bleeding. Sometimes the doctor injects dye into an artery—a procedure called angiography—to identify and treat diverticular bleeding. If the bleeding does not stop, surgery may be necessary to remove the involved portion of the colon.
Abscess, Perforation, and Peritonitis
Diverticulitis may lead to infection, which often clears up after a few days of treatment with antibiotics. If the infection gets worse, an abscess may form in the wall of the colon.
An abscess is a localized collection of pus that may cause swelling and destroy tissue. If the abscess is small and remains in the wall of the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it using a catheter—a small tube—placed into the abscess through the skin. After giving the patient numbing medicine, the doctor inserts the needle through the skin until reaching the abscess and then drains the fluid through the catheter. This process may be guided by sonography or x ray.
Infected diverticula may develop perforations. Sometimes the perforations leak pus out of the colon and form a large abscess in the abdominal cavity, a condition called peritonitis. A person with peritonitis may be extremely ill with nausea, vomiting, fever, and severe abdominal tenderness. The condition requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without prompt treatment, peritonitis can be fatal.
A fistula is an abnormal connection of tissue between two organs or between an organ and the skin. When damaged tissues come into contact with each other during infection, they sometimes stick together. If they heal that way, a fistula may form. When diverticulitis-related infection spreads outside the colon, the colon’s tissue may stick to nearby tissues. The organs usually involved are the bladder, small intestine, and skin.
The most common type of fistula occurs between the bladder and the colon. This type of fistula affects men more often than women. It can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.
Scarring caused by infection may lead to partial or total blockage of the intestine, called intestinal obstruction. When the intestine is blocked, the colon is unable to move bowel contents normally. If the intestine is completely blocked, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned.
What causes diverticular disease?
Although not proven, the dominant theory is that a low-fiber diet causes diverticular disease. The disease was first noticed in the United States in the early 1900s, around the time processed foods were introduced into the American diet. Consumption of processed foods greatly reduced Americans’ fiber intake.
Diverticular disease is common in developed or industrialized countries—particularly the United States, England, and Australia—where low-fiber diets are consumed. The disease is rare in Asia and Africa, where most people eat high-fiber diets.
Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber, called soluble fiber, dissolves easily in water. It takes on a soft, jelly-like texture in the intestines. Insoluble fiber passes almost unchanged through the intestines. Both kinds of fiber help prevent constipation by making stools soft and easy to pass.
Constipation—or hard stool—may cause people to strain when passing stool during a bowel movement. Straining may cause increased pressure in the colon, which may cause the colon lining to bulge out through weak spots in the colon wall. These bulges are diverticula.
Lack of exercise also may be associated with a greater risk of forming diverticula, although the reasons for this are not well understood.
Doctors are not certain what causes diverticula to become inflamed. The inflammation may begin when bacteria or stool are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.
How is diverticular disease diagnosed?
To diagnose diverticular disease, the doctor asks about medical history, does a physical exam, and may perform one or more diagnostic tests. Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment. For example, diverticulosis is often found during a colonoscopy done to screen for cancer or polyps or to evaluate complaints of pain or rectal bleeding.
When taking a medical history, the doctor may ask about bowel habits, pain, other symptoms, diet, and medications. The physical exam usually involves a digital rectal exam. To perform this test, the doc
Frequently Asked Questions
Q: Do I need to worry about lowering my blood cholesterol now that I’m over 65?
A: Yes. Older Americans have the Nation’s highest rate of coronary heart disease (CHD) and can benefit greatly from lowering elevated cholesterol. Cholesterol lowering also has been shown to reduce the risk of strokes. For seniors who do not have heart disease, cholesterol lowering will reduce their high risk of developing CHD. Older Americans should have their cholesterol numbers (total cholesterol, LDL, HDL, and triglycerides) measured once every 5 years. Older Americans should keep their cholesterol low by following an eating pattern lower in saturated fat, total fat, and cholesterol, being physically active, and maintaining a healthy weight.
Q: Should I be concerned about my child’s blood cholesterol?
A: Yes. Everyone older than age 2 should care about cholesterol to reduce the risk of developing heart disease as an adult. Children as well as adults can improve the health of their hearts by following a low-saturated-fat and low-cholesterol diet, avoiding obesity, and being physically active. Only children from families in which the father or grandfather has had heart disease at the age of 55 or younger, or the mother or grandmother has had heart disease at the age of 65 or younger, or in which a parent has high blood cholesterol (240 mg/dL or higher), should have their cholesterol levels tested. If a child from such a “high-risk” family has a high cholesterol level, it should be lowered under medical supervision, primarily through dietary changes and increased physical activity.
Q: How useful is it to know my cholesterol ratio?
A: Although the cholesterol ratio can be a useful predictor of heart disease risk, especially in the elderly, it is more important for treatment purposes to know the value for each level separately because both LDL- and HDL-cholesterol separately affect your risk of heart disease and the levels of both may need to be improved by treatment. The ratio is useful if it helps you and your doctor keep the entire picture of your LDL and HDL levels in mind, but it should not take the place of knowing your separate LDL and HDL levels.
Q: What is a heart-healthy diet?
A: A heart-healthy diet emphasizes foods low in saturated fat, total fat, and cholesterol to help lower blood cholesterol. This is the recommended eating pattern for Americans older than 2:
- 8-10 percent of calories from saturated fat;
- An average of 30 percent of calories or less from total fat; and
- Less than 300 mg a day of dietary cholesterol.
Saturated fat increases blood cholesterol more than anything else you eat, so choose foods low in saturated fat to reduce blood cholesterol. If you are overweight, losing weight is important for lowering blood cholesterol. Being physically active also helps improve blood cholesterol levels because it can raise HDL (“good”) cholesterol and lower LDL (“bad”) cholesterol, as well as help you lose weight, lower your blood pressure, and improve the fitness of your heart and blood vessels.
Q: Is margarine better than butter in a cholesterol-lowering eating pattern?
A: Yes. Butter is high in saturated fat, which raises blood cholesterol more than anything else you eat. Most margarines are made from vegetable oils that are hardened through a process called “hydrogenation.” Hydrogenation forms a type of unsaturated fat called “trans” fat that appears to raise blood cholesterol more than other unsaturated fats but not as much as saturated fats. There are now margarines available that contain no “trans” fats. You can also read food labels and choose margarines that contain liquid vegetable oil as the first ingredient (rather than hydrogenated or partially hydrogenated oil) and the least amount of saturated fat.
Q: My last cholesterol level was within my goal. Does that mean I do not have to worry about my cholesterol any more?
A: High cholesterol and heart disease are not cured but are only controlled by diet and drug therapy. Stopping your treatment quickly returns your cholesterol to the level that existed before therapy was started.
Q: How does smoking affect my cholesterol?
A: Smoking has several harmful effects on cholesterol. Smoking reduces HDL (“good”) cholesterol and in all likelihood changes LDL (“bad”) cholesterol to a form that promotes the buildup of deposits in the walls of the coronary arteries. In addition, smoking has harmful effects on the heart and blood vessels. In these ways, smoking substantially raises the risk for coronary heart disease if you are healthy and multiplies that risk many more times if you have other risk factors such as high blood cholesterol. All in all, smoking is the leading preventable cause of death.
Q: How can I raise my HDL (“good”) cholesterol?
- Quit smoking. The more you smoke, the lower your HDL cholesterol is likely to be.
- Lose weight if you’re overweight. Being overweight is often associated with low HDL levels.
- Increase physical activity. This has a slow but steady elevating effect on HDL, which tends to rise in direct proportion to the amount of physical activity per week.
Q: Is lowering my cholesterol safe?
A: Yes. Cholesterol lowering itself is safe, as is the diet used to lower cholesterol. Like all medications, drugs used to lower cholesterol can have side effects, but when used by people who have a high risk of developing coronary heart disease (CHD), the benefits outweigh the risks. Four recent studies, three in patients who already had CHD and one in people free of CHD, showed that, over a period of 5 years, large reductions in total and LDL (“bad”) cholesterol substantially reduced the chances of having a heart attack or dying from heart disease, reduced overall death rates, and produced no increase in any noncardiovascular causes of death, such as cancer, suicide, homicide, or accidents. These results have been confirmed by a combined analysis of 16 recent studies.
Q: I’m young and healthy. Do I need to have my cholesterol checked?