What Newly Diagnosed Diverticulosis Patients Should Know

Medically reviewed by: Eiman Firoozmand, MD

Have you recently been diagnosed with diverticulosis? If the answer is yes, you are not alone. Diverticulosis is common in the developed world, where people consume less fiber in their food. It is diagnosed in around 200,000 people every year in the United States.

Diverticulosis is not a problematic disease itself and rarely causes symptoms. Most patients don’t even know that they have diverticulosis. It is the complications of this disease that suggest its presence.

In this article, we will discuss what diverticulosis is, why it happens, how it’s treated, and more.

What is Diverticulosis?

Diverticulosis means the formation of multiple small pockets — called “diverticula” — in the walls of the gastrointestinal tract (the long tube that runs from the mouth to the anus). It primarily affects the colon, also known as the large intestine.

These pockets form in areas of the wall that are weak, and therefore prone to ballooning under increased pressure.

Your gut is made up of multiple layers. When pressure inside the gut increases, the inner layer pushes the outer layer outwards, creating an outpouching.  Diverticulosis is usually harmless and does not cause problems. It presents with vague symptoms, such as cramps, bloating, or constipation.

However, it becomes serious when the outpouchings get infected and cause severe symptoms like fever, pain, vomiting, and chills. This condition is called diverticulitis. Although the two words sound similar, there is a big difference between diverticulosis and diverticulitis.

Risk factors for diverticulosis include old age, obesity, a diet high in animal fat and low in fiber, and smoking.

What Causes Diverticulosis?

The exact cause of diverticulosis is not known, However, researchers think the following are the most likely causes:

  • Straining: Straining causes pressure inside the abdomen to increase and exerts pressure on the wall of the gut.
  • Muscle spasms: The gut is a muscular organ. Like other muscles in the body, muscles of the gut can also contract. When this contraction is abnormal and strong, we call it a muscle spasm. This increases pressure inside the colon and can lead to the formation of diverticula.
  • Low fiber diet: Consuming foods that do not provide adequate fiber are a known cause of constipation. Constipation, in turn, causes people to strain and put them at risk for diverticulosis.

Which is Worse, Diverticulosis or Diverticulitis?

Diverticulitis is worse than diverticulosis. It is a serious disease and can give rise to life-threatening complications. This is unlike diverticulosis, which barely causes any symptoms.

In contrast to diverticulosis, diverticulitis causes severe abdominal pain and can lead to major complications like rectal bleeding, abscess formation, fistula, and even peritonitis (life-threatening inflammation of the membrane covering the inside of the abdomen). And these complications often require surgery for treatment.

How is Diverticulosis Diagnosed?

Because diverticulosis does not cause any major symptoms, it usually goes unnoticed. Instead, it is commonly diagnosed when doctors are screening patients for another disease.

Once your doctor suspects you have diverticulosis, they may do the following to establish a diagnosis:

  • Take a comprehensive history: As part of your history, your doctor will ask you questions regarding your diet, your bowel movements, and symptoms to rule out other causes and narrow down the diagnosis.
  • Digital rectal exam: Your doctor will use a gloved finger to check the anus for signs like pain and bleeding.
  • Imaging: This involves various imaging techniques to view the gut and look for diverticula. These include a CT scan and X-ray (Barium enema).
  • Colonoscopy:  If appropriate, your doctor may recommend looking in the colon with a flexible camera to evaluate and be able to directly see the diverticula and to rule out more serious problems such as colon polyps or cancer.

These are also used to diagnose diverticulitis.

What Should you Avoid When you have Diverticulosis?

Since constipation is a risk factor for diverticulosis, it’s a good idea to avoid foods that are low in fiber. Intake of foods high in sugar and fat should also be kept to a minimum. Such foods can worsen your condition. A few examples of foods you should avoid include red meat, fried food, and full fat dairy products.  Foods high in fiber promote softer, easier bowel movements and seem to exert less outward pressure on the colon, lessening the risk of developing diverticulosis.

It is also worthwhile to clear a misconception regarding foods like nuts and popcorn, which were thought to block diverticula and cause diverticulitis. Recent research has proven that this is not true.

How is Diverticulosis Treated?

Diverticula do not go away on their own, and surgical treatment is only required in setting of complications such as recurrent diverticulitis or severe bleeding.

Unlike diverticulosis, diverticulitis does cause symptoms and needs to be treated. It can be treated by medicines, surgery, or a combination of both.

Medicines

These include:

  • Antibiotics: Because diverticulitis is caused by an infection, your doctor will prescribe you antibiotics. Examples include metronidazole, trimethoprim-sulfamethoxazole, and ciprofloxacin.
  • Painkillers: These are usually over-the-counter medications to relieve the associated pain.

Surgery

Your doctor may recommend surgery when one of the following complications arise:

  • Abscess: Persistent infection in diverticulitis may become walled-off, leading to an abscess. The treatment for a diverticulitis colon abscess is usually drainage. If the abscess can not be drained with a needle or catheter, surgery may be needed to remove it.
  • Peritonitis: Diverticulitis can cause the affected gut to rupture. This causes stool and pus to leak into the abdominal cavity, causing the peritoneum (a thin membrane that covers the inside of the abdominal cavity) and surrounding tissues to become inflamed and lead to sepsis. This is a life-threatening condition and needs emergency surgery. 
  • Stricture: These are narrowed areas of the colon that arise because of inflammation. These can partially or completely block the colon. A complete block requires surgery to relieve the obstruction.
  • Fistula: An abscess can further complicate into a fistula, which is an abnormal passage between two distinct sites in the body. Because fistulas do not close up and can create an abnormal connection, they have to be treated surgically.
  • Bleeding: If a vessel near a diverticula ruptures and bleeds, it will usually stop on its own. However, surgery is needed if the bleeding remains persistent.

Now you Know What a Newly Diagnosed Diverticulosis Patient Should Know!

Remember, diverticulosis is the formation of small pouches in the gut and usually does not cause any symptoms. It is thought to be caused by straining, muscle spasms, and eating a low-fiber diet.

Diverticulosis is usually discovered incidentally when screening for another disease or when these pouches get infected. When infection occurs, the condition is called diverticulitis. Diverticulitis is a much more serious disease compared to diverticulosis as it can cause intestinal bleeding, abscesses, fistulas, and even life-threatening peritonitis or sepsis.

If you have diverticulosis, you should avoid eating high amounts of sugar, fat, and low-fiber food. Diverticulosis usually does not need to be treated as it causes no symptoms. When conservative methods fail to treat diverticulitis, an operation may be required.