Diverticulosis and Diverticulitis: Pouches in the Colon

Diverticula are small pouches that bulge outward through weak spots in the colon, mostly in its lower part. Having them is called diverticulosis. Most people with diverticulosis never have symptoms or problems, but the pouches can sometimes cause symptoms or become inflamed.

• Diverticulitis is when one or more pouches become inflamed. It may come on suddenly and can sometimes cause serious problems.
• Diverticular disease is when the pouches cause chronic (long-term) symptoms, diverticular bleeding, or diverticulitis and its complications.

Who gets it

Diverticulosis is common, especially with age. More than one-third of U.S. adults aged 50 to 59 have it, and more than two-thirds of those over 80. Most never have symptoms, but some develop diverticulitis.

Possible causes

Researchers are not sure what causes these conditions. Factors that may play a part, or raise the risk, include:

• genetics: certain genes may make some people more likely to develop them;
• lifestyle: a diet low in fiber and high in red meat, lack of physical activity, obesity and smoking;
• medicines: such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids.

Researchers are also studying the role of bacteria or stool trapped in a pouch, and of changes in the intestinal microbiome, the bacteria and other organisms living in the intestines.

Symptoms

Diverticulitis pain is usually severe and sudden, though less often it starts mild and worsens over several days.

Complications

• Diverticular bleeding: a small blood vessel in the wall of a pouch bursts. The bleeding can be severe, even life-threatening.
• With diverticulitis:
• • abscess, a painful, swollen, pus-filled area caused by infection;
  • fistula, an abnormal passage between the colon and another part of the body, such as the bladder or vagina;
  • intestinal obstruction, a partial or total blockage that stops food, fluids, air or stool from moving through;
  • perforation, a hole in the colon;
  • peritonitis, infection of the lining of the abdominal cavity.

Diagnosis

Diverticulosis is often found during tests done for another reason, and diverticulitis usually during an acute attack. A health care provider reviews the medical history, does a physical exam, and may order blood tests, stool tests, imaging such as a CT scan, ultrasound or MRI, or a colonoscopy.

Treatment

Diverticulosis with chronic symptoms may be treated with high-fiber foods or fiber supplements, antibiotics, anti-inflammatory medicines, or probiotics.

Diverticulitis without complications can often be treated at home. Severe diverticulitis, complications, or a high risk of them usually mean hospital care. Treatment may include:

• antibiotics, except in very mild cases;
• a clear liquid diet for a short time to rest the colon, then solid foods added back slowly as symptoms improve;
• pain medicine, usually acetaminophen rather than NSAIDs, which may raise the chance of complications;
• antispasmodic medicines for spasms.

If diverticulitis does not improve with treatment, or causes complications, surgery to remove part of the colon may be needed.

Prevention

A provider may recommend eating a diet high in fiber and low in red meat, being physically active regularly, not smoking, and reaching and keeping a healthy weight.

Sources

• MedlinePlus, produced by the U.S. National Library of Medicine, "Diverticulosis and Diverticulitis": https://medlineplus.gov/diverticulosisanddiverticulitis.html — drawing on the National Institute of Diabetes and Digestive and Kidney Diseases (NIH).