What is diverticulosis?
‘Diverticulosis’ is a term that refers to abnormal ‘pockets’ in the colon. It is a common condition in North America. These ‘pockets’ form in the colon as patients age, and occur in more than 50% of Americans by age 65. Diverticular disease will affect almost all Americans by age 80. These ‘pockets’, or diverticulae, (singular-diverticula) cannot become malignant (cancerous) and will never cause problems in the majority of patients who have them.
What are the symptoms of diverticulosis?
In most patients, diverticulosis causes no symptoms. The major cause of diverticulosis is increased pressure within the colon. This is thought to result from an inadequate amount of fiber in the diet. This can cause the colon musculature to contract and may result in a feeling of cramping or abdominal spasm. The discomfort may be felt anywhere in the abdomen, and often in the left lower region.
In a small percentage of patients, complications of diverticulosis can occur. Rare, but possible complications of diverticulosis include diverticulitis (colonic inflammation) and gastrointestinal bleeding. For these patients, hospitalization and an operation may become necessary.
What is diverticulitis?
‘Diverticulitis’ is a potential complication of diverticulosis. Diverticulitis refers to an inflammation or infection of one of the ‘pockets’. This occurs when a small hole develops in a pocket, releasing a small amount of infected material into the surrounding tissues. The cause of this is not known. Patients with diverticulitis are usually ill, and have serious abdominal pain and an associated fever. Mild cases can usually be treated with bowel rest and antibiotics. Severe cases can cause abscesses to develop in the abdomen. Often, the abscess must be drained in the radiology suite using X-ray guidance and interventional techniques. Failing this, operative intervention may be required. The most ill patients may even require an urgent operation.
Complications of diverticulitis can include a colon perforation, fistulas (tunnels) to the bladder or vagina, and narrowing or blockage of the intestine. Operative repair is almost always required in these serious cases.
Bleeding typically does not occur with diverticulitis, but usually occurs from one of the non-inflamed pockets (diverticulosis). Most bleeding from diverticulosis stops on its own, but blood transfusions and an operation are occasionally required.
If I have been diagnosed with diverticulosis do I need a special diet?
In the past, patients with diverticular disease were placed on a special diet in the hope that this would help to prevent complications. We now know that it is acceptable to eat seeds, nuts, tomatoes, strawberries, popcorn etc., and that this will not increase the likelihood of developing complications of diverticulosis. This is true even in patients who have had a previous episode of diverticulitis or bleeding.
Colon pockets are caused by increased pressure in the colon due to low dietary fiber. A diet high in fiber will help reduce this pressure, and more pockets will be less likely to form and complications less likely to occur. This dietary fiber is found in unprocessed grains such as bran, and is not found in sufficient quantities in vegetables such as peas and carrots. Therefore, your doctor will likely recommend starting on a fiber supplement
Is there anything I can do to help prevent future problems with my diverticulosis?
Once pockets have developed in the colon there is no guaranteed way to prevent future complications from occurring. However, increasing dietary fiber is the best way to help reduce the likelihood of future problems. In those patients who are having repeated episodes of diverticulitis or bleeding, an operation to remove the affected part of the colon is usually recommended.