Diverticular Disease Basics: What You Need to Know

Learn all about diverticular disease including its treatment and potential complications.

doctor pressing on man's abdomen

Your stomach pain just wasn’t going away on its own. You finally went to your doctor and were diagnosed with diverticular disease. What is this condition and how did it happen to you?

Let’s start at the very beginning, says Akiva Marcus, MD, PhD, a gastroenterologist practicing at the Digestive Disease Center of the Palm Beaches and affiliated with Palms West Hospital, JFK Medical Center, and JFK Medical Center, North Campus in West Palm Beach, Florida.

Diverticulosis occurs when small pouches or pockets form in naturally weak areas of your colon and push outward through its wall. One pouch is called a diverticulum and multiple pouches are known as diverticula. These pouches can form anywhere in your colon, but usually occur in the sigmoid colon, which is the part of the large intestine that’s closest to your rectum.

Diverticulosis is pretty common. In the U.S., about half of all people older than 60 have diverticulosis, and nearly everyone has it by the time they reach 80. You wouldn’t necessarily know you had diverticulosis because it rarely causes any symptoms. Sometimes it’s detected during medical tests for other conditions, such as a routine colonoscopy.

When diverticulosis causes pain or other symptoms or complications, it is known as diverticular disease. This may include diverticular bleeding or diverticulitis, which occurs when these pockets become inflamed or infected. More recent estimates suggest that less than 5 percent of people with diverticulosis will develop diverticulitis.

What causes diverticulitis?

Exactly what causes diverticular disease is not fully understood. “Initially, it was thought that a low-fiber diet was the culprit and that resulting constipation leads to the out pouch,” Dr. Marcus says. But that theory hasn’t stood the test of time either. “Constipation and straining may play a role, but fiber may not.”

In the past, people with diverticulosis were warned to steer clear of seeds and nuts, as doctors thought these could get stuck in the pouch and cause an attack. This myth has been largely debunked.

So why do some people get diverticulitis? Here’s what doctors think happens: Bacteria may get trapped in the pouch that has formed on the colon, leading to inflammation, infection or a tear. The walls of the out-pouchings or pockets could be become thin or break down due to pressure inside the colon or hardened pieces of stool becoming stuck inside of them.

“The main symptom is pain on the left side of the colon that lasts for a few days,” Marcus says. Other symptoms may include nausea, vomiting, fever, tenderness or constipation. “Most people think nothing of the pain and blow it off until they experience nausea, vomiting or fever.”

Risk factors for diverticular disease

There are several factors known to increase your chances of developing diverticular disease—some of which you can control and others of which you can’t, including:

Your genes: There’s a genetic basis to diverticular disease. “If your parents had it, your chances of having it are higher,” Marcus says.

Advancing age: “It’s rare to see diverticular disease in people under 40 although these days we are diagnosing it earlier,” Marcus says.

Smoking: The odds of developing diverticular disease are higher for those who smoke than nonsmokers, according to Marcus. Researchers speculate that smoking restricts blood flow to the colon and also increases pressure within the colon, potentially setting the stage for diverticular disease.

Certain medications: Taking steroids, opioids or NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin and others) or naproxen sodium (Aleve and others) could increase your likelihood of developing diverticular disease, Marcus cautions. Opioids and narcotics slow colonic motility—the contraction of muscles needed to pass stool—which is why constipation is a known side effect of these potent painkillers.

Being overweight or obese: Researchers aren’t sure how obesity drives risk for diverticular disease, but one study found that women with the highest body mass index (BMI) were more likely to develop diverticulitis than women with lower BMIs. This study, which was published in 2018 in the journal Gastroenterology, also found that women who put on the most weight from age 18 on were more likely to develop diverticular disease compared to their counterparts who maintained their weight. The study included 46,079 women who took part in the Nurses’ Health Study and were aged 61 to 89. None of the women had any evidence of diverticulitis or diverticular bleeding when the study began.

Lack of exercise: “Being inactive affects motility,” Marcus says. This can lead to constipation but getting more physical activity can help.

Alcohol use: If you have diverticulosis and you drink too much alcohol, your risk of developing diverticulitis may be two to three times higher than people in the general population.

Diagnosing and treating diverticular disease

Your doctor can diagnose diverticular disease in several ways. Imaging tests such as a CT scan can identify perforation or inflammation in the small pockets. The CT scan is considered the gold standard test for diagnosing diverticular disease.

Blood or urine tests can also detect inflammation or infection. Sometimes diverticulosis is spotted during a routine colonoscopy or another medical test as an incidental finding.

“For uncomplicated diverticular disease, we prescribe antibiotics to treat the infection and it usually gets better in a few days,” Marcus says. It’s also important to consume only clear liquids for a few days after an attack and then gradually start eating soft solid foods, he says. Once you are fully healed, your doctor will discuss the importance of getting more fiber in your diet to make sure your stools are soft and easy to pass.

Treating complicated diverticular disease is another story, he says.

Diverticular disease complications may include:

  • A narrowing of the colon called a stricture, which prevents you from having bowel movements.
  • An abscess, or swollen area filled with pus, which could cause the colon to rupture and lead to peritonitis, or inflammation of the lining of the abdominal wall and organs.
  • An infection in the tissue that lines the inner wall of your abdomen, known as peritonitis.
  • A fistula, an abnormal tunnel linking two organs that aren’t supposed to be connected, such as the colon and the bladder.

Some of these complications will require surgery if they don’t heal on their own. For example, small abscesses may be treated with antibiotics, but larger ones may need to be drained surgically. Peritonitis usually requires emergency surgery as well. If you experience repeated attacks of diverticulitis, you may need surgery to remove the part of your colon that is affected.

“If you’re older than 40 and have persistent abdominal pain, especially on your left side, call your doctor,” Marcus advises. “It’s always better to be safe than sorry and get ahead of a diverticulitis attack and its related complications. The worst thing to do is ignore it.”

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