What is diverticulosis?

Diverticulosis is a condition involving the formation of small pockets (diverticuli) extending out from the colon, or large intestine. The colon starts in the right lower abdomen, goes across the upper abdomen, and down the left side to the sigmoid colon. The sigmoid colon is a high pressure section of the colon that moves stool into the rectum. It is here that most diverticuli occur. Diverticuli occur at weak points in the bowel wall and develop over a long period of time. Prevalence of diverticulosis increases from less than 20% at age 40 to 60% by age 60.

What are the symptoms?

There are few noticeable symptoms with diverticulosis. Except for an occasional intermittent spastic discomfort in the lower abdomen, there are usually no symptoms unless a complication occurs. When diverticulosis is extensive, the lower colon can become fixed, distorted, or narrowed. This may result in pain, and/or a change in stool form or bowel habits. Constipation and diarrhea can occur in this situation, and stool can be thin or pellet-shaped. At times, bleeding can occur from a ruptured blood vessel in diverticuli.

How is diverticulosis diagnosed?

The diagnosis might be suspected if you are having pain in the lower abdomen. Uncomplicated diverticulosis is usually an incidental finding that is seen during a colonoscopy, which is done for routine screening or to diagnose a problem. In the test a long tube containing a camera is inserted into the rectum, allowing the doctor to visualize the inside of the colon. A barium study can be done to diagnose and determine the extent of the disorder, although it is not done frequently. This test involves administration of an enema containing dye, and images are taken as it moves through the colon.

What is the treatment?

All along it has been believed that diverticulosis may be prevented by a diet high in fiber, bran, roughage, and water content. The recommended daily intake of bran and fiber is about 20 to 30 grams. Stool bulking agents, such as psyllium and methylcellulose, are useful in creating a larger and softer stool that is easier to pass. There has been a practice of avoiding seeds and nuts in diverticulosis, but there is no proof that this practice reduces incidence of diverticulitis. These treatments may be beneficial when diverticulosis already exists, because they can prevent further progression of the problem. Sometimes, a medication is needed to relieve bowel spasms that can increase pressure in the colon, leading to diverticula formation.

Are there long term complications of this disease?

There are many bacteria that naturally live in your digestive tract and perform functions that are beneficial to the digestive process. Occasionally these “good” bacteria or other disease-causing bacteria can cause an infection inside of the diverticuli. This infection, termed diverticulitis , can cause pain in the left lower abdomen. This is diagnosed by clinical examination and usually confirmed by a CT scan of the abdomen. Diverticulitis requires a treatment of antibiotics and temporary avoidance of food until healing begins. In severe cases of diverticulitis, a patient may need to be hospitalized. If untreated, diverticulitis can lead to a rupture of the diverticuli, spilling the infectious contents into the abdomen. This is a severe complication, and surgery is typically needed in this setting.

Additional Information

Diverticulosis alone is not a major cause for concern. Many people have diverticuli in their colon and do not realize it. Prevention is the best treatment for diverticulosis. By maintaining a diet high in fiber, bran, roughage, and water over a long period of time, you may help to prevent the formation of new diverticuli. Also, such a diet will help prevent constipation, which contributes to diverticuli formation. If you have frequent constipation, you should discuss this with your doctor to find the appropriate treatment.