Diverticulitis and Aging

Medically reviewed by: Liza M. Capiendo, MD

Diverticula, small pockets that develop in the lining of the colon, are common in adults over the age of 50. As you age, your risk of developing diverticular disease increases even further. Most people who have this condition, also known as diverticulosis, never know it, because the diverticula do not usually cause any major symptoms or complications.

Occasionally, though, these pockets become painfully infected. This is known as diverticulitis. Common symptoms include not only abdominal pain but other signs of an infection, such as fever and nausea. You may also develop diarrhea or constipation. Even without an infection, diverticulosis can sometimes cause bleeding and other complications.

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What Is Diverticular Disease?

Age is one of the most important risk factors in developing diverticulosis and related complications. By age 60, about one out of every three patients we see will have developed these pouches. By age 85, this increases to two out of every three patients. Only about 20 percent will develop diverticulitis, but it can cause significant issues for those who do.

Diverticula occur in weak parts of muscle in the colon lining. This area should be smooth, but the diverticula changes that. They are most commonly found in the sigmoid colon, where the colon is more narrow. A diet low in fiber causes pressure to this area, as hard stools try to pass through. Recent research shows age-related dysfunction in the colonic muscles may also play a role.

No one knows why some people develop an infection – diverticulitis – and others do not. However, some doctors have long recommended patients avoid eating seeds and other foods that could get caught in one of these pockets and cause inflammation.

Symptoms to Watch For

Diverticulitis is by far the most frequent complication of diverticula we see. It is easy to see why infection happens so commonly with the development of these pockets. They develop in the narrowest part of the colon, and stool has to pass directly over them on its way through the bowel. Diverticulitis occurs when one of these pockets develops a small hole or perforation and bacteria get into the adjacent tissue.  Stool carries millions of bacteria, and some of it likely gets caught in the pouches as it moves by. Infection seems inevitable, and it’s surprising only about 20 percent of people develop diverticulitis symptoms.

Pain is the most common reason patients see us. They usually experience extreme pain in the lower left quadrant of the abdomen, although this can differ if the diverticula is not in the sigmoid colon. Other symptoms our patients frequently report include:

  • Fever and chills
  • Nausea
  • Fatigue
  • Loss of appetite and weight loss
  • Constipation or diarrhea

When we run lab tests, we usually find an elevated white blood cell count. This indicates an infection and often confirms our suspicion that diverticulitis might be the issue.

If we believe you have diverticulitis after our in-office exam, we will likely recommend a computerized axial tomography (CT) scan to confirm the diagnosis. CT scans with contrast are the most common tests used to diagnose diverticulitis.

The Role of Fiber in Your Diet

While a low-fiber diet may not be the only reason older Americans develop diverticular disease at a higher rate than seniors in many other countries, increasing the fiber in your diet can certainly help reduce your risk.

When you eat meals low in dietary fiber, there is little bulk to your stool. The pieces are small and hard. They do no move through your system smoothly like bulkier stool does. It takes extra muscle contractions and stronger muscle contractions in the colon to move them along and to have a bowel movement. All this extra work can put pressure on the sigmoid colon, weakening the walls.

When you eat dietary fiber, it bulks up your stools. You cannot digest this type of insoluble fiber commonly found in whole grains, fruits, beans, and vegetables. Instead, it holds water and passes through the digestive system leaving you with soft, bulky stools that move faster through your system and prevent constipation.

We recommend a high-fiber diet to everyone, because it significantly lowers your risk of many colon and rectal problems, from hemorrhoids to even possibly colorectal polyps. It can also help prevent diverticular disease and stop diverticulosis from turning into diverticulitis.

What Can I Do to Prevent Future Symptoms?

In addition to adding more insoluble fiber to your diet, there are a number of other things you can do to treat your infection and prevent future complications. First, we will prescribe antibiotics to treat your diverticulitis. We typically use a broad-spectrum antibiotic for this, since the colon harbors such a wide range of bacteria.

The drug prescribed depends on a number of factors, including your health history and symptoms. We will also probably put you on a clear liquid diet for the first few days before allowing you to add back other drinks and soft foods. For some with severe infections, you may need to spend a few days in the hospital receiving intravenous antibiotics.

Once your infection clears, we will likely want to perform a colonoscopy to look at the diverticula and rule out any additional problems. Then, you should be able to resume your normal screening schedule and only see us if additional symptoms develop. In severe or recurrent cases, surgery may be required.  Talk to your doctor about the appropriate treatment strategy.

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