DIVERTICULAR DISEASE

General Information

DEFINITION--Diverticulosis is the presence of small, saclike swellings (diverticula) in the wall of the colon. Diverticula may be present without any symptoms. Diverticulitis is the inflammation of diverticula. It is not contagious or cancerous.

BODY PARTS INVOLVED--Left side of the large intestine.

SEX OR AGE MOST AFFECTED--Adults. Diverticula are present in 30% to 40% of persons over age 50. They increase with each decade of life.

SIGNS & SYMPTOMS

Diverticulosis symptoms:

• Mild cramping or tenderness in the left side of the abdomen that is relieved by passing gas or moving bowels.
• Occasional bright red blood in the stool. Non-infected diverticula sometimes bleed.
• Constipation (sometimes).
• No symptoms (usually).

Diverticulitis symptoms:

• Intermittent cramping, abdominal pain that becomes constant. Pain may be disabling at the onset or may not become disabling for days.
• Fever or nausea.
• Tenderness over affected area of the colon.

CAUSES--Unknown, but the tendency is inherited. Recent evidence suggests that the highly refined, low-residue diet common in the U.S. and other developed countries may contribute to the formation of diverticula. Pressure builds up inside the sigmoid colon as a result of spasm due to lack of dietary bulk. The inner lining eventually pushes through to form the small pouches.

RISK INCREASES WITH

• Improper diet that lacks fiber.
• Family history of diverticulosis.
• Coronary-artery disease or gallbladder disease or obesity.

HOW TO PREVENT--

Cannot be prevented at present, but risk can be reduced by:

• Eating a diet high in fiber throughout life.
• Drink plenty of fluids.
• Don't strain when moving bowels.
• Maintaining good cardiovascular fitness. This disease may be related to vascular disorders.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• X-rays of the lower intestine (barium enema).
• Sigmoidoscopy (See Glossary).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Hospitalization (complications only).
• Surgery to remove part of the colon if diverticula become infected or bleed significantly. (See Sigmoid-Colon Removal in Surgery section.)

POSSIBLE COMPLICATIONS--If diverticula become infected, they may bleed profusely or perforate (erode through the intestinal wall) and cause peritonitis. Both are emergencies.

PROBABLE OUTCOME--Diverticulosis is dangerous only if diverticula become infected or bleed. Diverticulitis is curable with surgery.

How To Treat

GENERAL MEASURES--

• Treatment is usually unnecessary if there are no symptoms. For mild symptoms, a change in diet and the use of stool softeners may be sufficient. For more severe symptoms, you may require bed rest, medications and surgery.
• Try to have a bowel movement at about the same time each day. Allow at least 10 minutes, and don't strain.
• Check your stool daily for bleeding. If the stool is black, remove it from the toilet and take it to your doctor's office for analysis.
• To relieve mild pain and spasms, apply a heating pad to the abdomen.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Antibiotics, if the diverticula are infected.
• Stool-softeners or bulk-producing laxatives, if you are unable to eat a high-fiber diet. Don't take laxatives unless prescribed.

ACTIVITY--If you have fever or severe pain, stay in bed. Resume normal activity as soon as symptoms improve.

DIET--

• Eat a well-balanced diet that is high in fiber, low in salt and low in fat (see diets in Appendix).
• Avoid foods that may constipate (bananas, applesauce, rice) and foods with small indigestible seeds that could plug the diverticula (poppy, sesame, raspberry, strawberry, etc.).

Call Your Doctor If

• You have symptoms of diverticulosis or diverticulitis (e.g. blood in stool).
• Severe pain continues despite treatment.
• Fever, vomiting or abdominal swelling occurs during treatment.