What is diverticular disease?
As people get older, it is common for small pouches called diverticula (singular: diverticulum) to form in the wall of the digestive tract, usually in your colon.
The condition called diverticulosis means these pouches have formed, but in the great majority of cases, diverticulosis does not cause illness. In fact, approximately half of individuals in the United States greater than 65 years of age have asymptomatic diverticulosis.
In fact, many people do not realize they have the condition. When diverticulosis symptoms do occur, they are usually mild, and can include cramping (typically in the lower left of the abdomen), bloating, or constipation.
What are the key risk factors?
Diet: Eating lots of animal protein and not enough fiber places additional pressure on your digestive tract during bowel movements and may cause pouches to form.
Age: Diverticulosis is uncommon before age 40 and becomes increasingly likely as you get older.
Obesity: Being overweight or obese increases your risk of diverticular disease.
Lifestyle: Smoking tobacco and not exercising appear to increase your risk of diverticulitis.
When is diverticulosis dangerous?
In a small percentage of people, the pouches and the wall of the adjacent colon become infected. This leads to a condition called acute infectious diverticulitis that can cause symptoms such as:
- Severe, persistent pain in your abdomen, usually the lower left side
- Fever and chills
- Change in bowel habits, typically constipation
Untreated, diverticulitis can lead to serious complications, including the formation of an abscess (a pocket of pus) in the wall of the colon, or perforation (hole) in your bowels.
In other individuals, small blood vessels leading to the pouch may burst, causing a condition called diverticular bleeding. This can result in hemorrhage, causing bright red rectal bleeding, and the symptoms of acute blood loss like fainting, weakness or dizziness.
Both acute infectious diverticulitis and diverticular bleeding require immediate medical attention.
What causes diverticular disease?
The exact cause of diverticular disease is unknown, but experts theorize that diverticula form in weakened places in the wall of your digestive tract in response to pressure. It’s also not clear why diverticula lead to symptoms and complications in some people and not in others.
How do we treat diverticular disease?
As a preventive measure, your doctor may recommend eating a diet high in fiber (roughage), and drinking lots of water. This creates a softer and bulkier stool, which your colon can handle more easily, reducing the pressure inside the colon and the stress on the colon wall.
Treatment for diverticular disease depends on your symptoms.
Typically, we treat acute infectious diverticulitis with antibiotics. We can generally administer these by mouth, but in acute and severe cases, you may require intravenous treatment. Your doctor may also recommend a liquid diet to allow your colon to heal. If you have severe, repeated attacks of diverticulitis, your doctor may advise surgery to remove the vulnerable segment of the colon. Ideally, when performed non-emergently, we perform this resection with minimally invasive surgery without the need for a colostomy bag. Once you have surgery, your risk for further attacks of infectious diverticulitis is extremely low.
We typically manage diverticular bleeding in a hospital due to the risk of severe blood loss. The bleeding often resolves on its own. If it does not, we can generally manage it successfully surgical, endoscopic or radiological obliteration of the culprit blood vessel.