What is diverticular disease?
Diverticular disease, or diverticulosis, is a condition in which there exist “pockets” or outpouchings of the wall of the colon. The precise cause of this disease is unclear but likely relates to abnormal patterns of contraction of the wall of the colon. Diverticulosis is the presence of these pockets in the wall of the colon. A diet with inadequate fiber intake causes the colon to exert more pressure than usual. And, a low-fiber diet can increase the time stool remains in the bowel, adding to the high pressure, which can cause the pockets and ultimately diverticulosis. Diverticulitis describes inflammation or infection of these outpouchings.
What are the symptoms of diverticulosis?
Diverticulosis is often asymptomatic. However, if they do occur they are generally due to thickening and spasm of the colon wall and can include:
- Abdominal pain (typically on the lower left side)
- Change in bowel habits
- Diarrhea
- Bleeding, which may be severe and potentially life-threatening
- Symptoms of diverticulitis are generally more inflammatory in nature and may include:
- Abdominal pain
- Fever
- Vomiting
- Variety of other symptoms related to the nature and extent of inflammation
How is diverticulosis diagnosed?
The diagnosis of diverticulosis is made by endoscopic or x-ray evaluation of the colon.
The diagnosis of diverticulitis is often made by an evaluation of the patient symptoms and confirmed by additional testing.
How is diverticulosis treated?
Diverticulosis is often asymptomatic and generally requires no treatment. Once the condition has been identified, a high-fiber diet is usually recommended to prevent the development of further disease.
Crampy abdominal pain and irregular bowel movements that may accompany diverticulosis are usually managed by dietary modification and medications directed toward treating the muscular spasm of the colon.
Treatment of diverticulitis is individualized to the patient and his or her particular illness. Some people may be treated as an outpatient with oral antibiotics – others require hospitalization with bowel rest and intravenous antibiotics.
Patients with recurrent, complicated or severe diverticulitis may require surgery for their disease. Typically this involves removing a portion of the colon.
What is the follow-up like after diverticulosis treatment?
Patients who recover from an attack of diverticulitis without requiring surgery should have an evaluation of their colon to confirm that their illness was, in fact, due to diverticulitis and not some other pathologic process. This evaluation usually takes the form of colonoscopy.
