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Diverticulosis is a condition whereby diverticula (small pouches) develop in the lining of the large intestine, extending into and through the muscular tissue surrounding the intestine. If these pouches become infected or inflamed, the condition becomes known as diverticulitis. Rarely, diverticula may also occur in the stomach or small intestine.
Incidence; Causes & Development
Diverticulosis used to be a rare disease and even today it is almost nonexistent in certain parts of the world. However, in developed countries like the United States over half of people over 60 have it and most of them are unaware of their condition.
Diverticulosis is a "lifestyle disease" that is easily prevented through dietary modifications. Insufficient fiber in the diet is the chief cause as the large intestine must work overtime to produce small, hard stools that ultimately stress the colon beyond its endurance. In addition, increasing pressure in the colon is experienced when trying to evacuate the firmer stools. This pressure causes weak spots in the wall, forcing the tissue to bulge out.
Signs & Symptoms
The disease usually remains dormant, with the pockets uninfected. Unfortunately, by the time most people realize they have it, it's too late and the disease is established.
Diagnosis & Tests
In over 90% of cases, serious diverticulitis affects the sigmoid colon, in the lower left side of the abdomen. The diagnosis can be confirmed by a barium enema X-ray. If it is known that pockets are present, signs and symptoms alone are enough to make the diagnosis of diverticulitis, and further testing is not usually required.
Laboratory Findings:Treatment & Prevention
The good news is that simple changes in the diet will prevent it from ever becoming a serious problem.
Conventional treatment of minor diverticulitis can take place at home with rest, a liquid diet, and oral antibiotics. Symptoms usually subside rapidly. The diet transitions to soft low-roughage foods and a daily psyllium seed preparation. Eventually a high-roughage diet is resumed. If the patient has severe symptoms or complications such as peritonitis or obstruction, hospitalization is necessary.
Prognosis; Complications
Overall, about 80% of patients can be treated successfully without surgery.
Possible complications include Intestinal haemorrhage; Peritonitis due to perforation; Obstruction of colon; Pyelonephritis or cystitis due to inflammation from adherent diverticulitis.
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Signs, symptoms & indicators of Diverticular Disease:
Conditions that suggest Diverticular Disease:
Risk factors for Diverticular Disease:
Diverticular Disease suggests the following may be present:
Diverticular Disease can lead to:
Recommendations and treatments for Diverticular Disease: | | | | | Diet |  Liquid Diet | The liquid diet should be used for a short time when symptoms are present, in order to give the colon a rest. |
High/Increased Fiber Diet| | A high fiber diet can help relieve symptoms for most people with diverticulosis. The suggested daily total should be 20-35gm. Both soluble and insoluble fibers are important in helping to maintain regular bowel movements. Complications from intestinal diseases such as diverticulosis or irritable bowel syndrome (IBS) are prevented by a diet rich in high fiber foods.
The fiber supplements of choice for diverticulosis are psyllium, methylcellulose or polycarbophil. These are available over-the-counter in commercial products such as Metamucil (psyllium), Citrucel (methylcellulose) and Fibercon (polycarbophil), among others.
If you suspect that your diverticulosis has turned into diverticulitis, call your doctor and restrict fiber until instructed otherwise. |
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Drug |
 Antibiotics |
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Preventive measures against Diverticular Disease: | | | | | Habits | Aerobic Exercise| | In one of the few studies that have been done, the most active men had a 37% lower risk of symptomatic diverticular disease than the least active men. Most of the protection against diverticulitis was due to vigorous activities such as jogging and running, rather than moderate activities like walking. [Gut 36: p.276, 1995] |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link |  | | Strongly counter-indicative |  | | Very strongly or absolutely counter-indicative | | | Likely to help | | | Highly recommended |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Colon (Colonic)
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Cystitis
Inflammation of the urinary bladder.
Dietary Fiber (Insoluble Fiber, Insoluble Fibers, Soluble Fiber, Soluble Fibers)
There are two types of dietary fiber - soluble and insoluble. Insoluble fiber acts like a sponge; it absorbs water and moves solid waste out of the intestines. It is found mainly in whole grains and on the outside of seeds, fruits, and legumes. Soluble fiber is found in fruits, vegetables, seeds, brown rice, barley, oats and oat bran. It forms a gel when mixed with liquid producing a softer stool. It also prevents and reduces the absorption of certain substances from the intestines into the bloodstream.
Diverticular Disease (Diverticulitis, Diverticulosis)
Some people develop small pouches (diverticula) that bulge outward through weak spots in the colon. Diverticulosis is the condition of having these pouches; diverticulitis is an inflammation or infection in these pouches. The conditions diverticulosis and diverticulitis are both referred to as diverticular disease. Diverticulosis may not cause any symptoms but could include mild cramps, bloating and constipation - all of which are common to other conditions such as IBS or ulcers. The most common symptoms of diverticulitis are abdominal pain and tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping and constipation may also occur.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Irritable Bowel Syndrome (IBS)
A condition that causes upset intestines for a long period of time. It is very unpleasant to the sufferer but tends to be harmless and usually does not lead to more serious complaints. The symptoms vary from person to person and from day to day. In order to be diagnosed with IBS, a person must have at least three of the following symptoms: pain in the lower abdomen; bloating; constipation; diarrhea or alternating diarrhea and constipation; nausea; loss of appetite; tummy rumbling; flatulence; mucous in stools; indigestion; constant tiredness; frequent urination; low back pain; painful intercourse for women.
Leukocytosis
Having abnormally high numbers of white blood cells, usually the result of a non-viral infection.
Occult Blood
Usually detected through an occult blood test: A test used in screening for blood found in the stool, sputum or urine. The most common test is for hidden blood in the stool, also known as a stool guaiac or hemoccult test, which usually indicates the presence of ulceration or cancer.
Over-The-Counter (OTC, Over The Counter)
A drug or medication that can legally be bought without a doctor's prescription being required.
Pyelonephritis (Pyelitis)
Inflammation of the renal pelvis. Pyelitis: An inflammation of the kidney pelvis, the interface between the urine-secreting inner surface of the kidney and the muscular ureter that drains into the bladder. It can be caused by kidney stones or an infection that has progressed up from the lower urinary tract. It alone is a serious condition; the next stage, pyelonephritis, since it involves the whole kidney, is still worse.
Small Intestine (Small Bowel)
The small intestine lies between the stomach and the large intestine. It is about 6 meters (20 feet) long and its primary function is to digest (break down) food and absorb nutrients (vitamins, minerals, proteins, carbohydrates, and fats). The small intestine makes up more than 70% of the length and 90% of the surface area of the gastrointestinal (GI) tract.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Jul 06, 2008
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