Sometimes people form small pouches on the intestinal wall. These pouches don’t usually cause problems unless they get infected. Then people develop a painful digestive condition called diverticulitis.
Dr. Joshua Wolf, a surgeon at the LifeBridge Health division of colon and rectal surgery, talks about the complications caused by diverticulitis.
What is diverticulitis?
Let’s first define some words that are commonly used when speaking about diverticulitis. The colon is the large intestine, which is a tube in the abdomen about 5 feet long that helps move solid stool from the small intestine to the rectum. A diverticulum (the plural is diverticula) is an abnormal bulge from the colon wall. Someone who has diverticula has the condition known as diverticulosis. Diverticulosis by itself is not a serious medical problem and does not require any treatment, but it is a risk factor for developing certain complications. Ten to 20 percent of patients with diverticulosis develop a complication known as diverticulitis, in which the diverticula become inflamed, leading to chronic abdominal pain, perforation of the colon, or infection inside the abdomen.
What causes the disorder?
The short answer is, we are not entirely sure. The most traditional theory is that a diverticulum becomes blocked for one reason or another, leading to buildup of bacteria, mucus and fluid. As pressure increases inside the diverticulum, the cells inside get less blood flow and the wall can burst. If the diverticulum ruptures, bacteria escape into the abdomen, leading to a more widespread infection. Sometimes this seals off quickly and becomes contained. Other times it leads to a severe condition called sepsis.
Who is more likely to get it?
There are a few important risk factors to be familiar with that make some people more likely than others to get diverticulitis. A low-fiber diet, like the one we eat here in the United States, is a risk factor for both diverticulosis and diverticulitis. This may be because the diet leads to increased straining with bowel movements and therefore increased pressure on the colon wall. One common misconception is that seeds, popcorn and nuts lead to diverticulitis. A very large study with more than 47,000 subjects published in the Journal of the American Medical Association in 2008 found this idea to be false. Older age, male gender and obesity are other risk factors.
How is it diagnosed?
The first step to take if you think you may have diverticulitis is to see a physician. Your physician will perform a history and physical and use that evaluation to figure out the next steps. If diverticulitis is suspected, the best test is a computed tomography, or CT, scan of the abdomen and pelvis with oral and intravenous (IV) contrast. This study gives the physician a lot of information about the colon, and can find perforations, abscesses or obstructions. It is also able to identify many other causes for abdominal pain if the signs of diverticulitis are not seen. Other imaging tests, such as ultrasound or magnetic resonance imaging (MRI), are not usually used to diagnose diverticulitis in the acute setting.
What are the symptoms?
Most commonly, patients experiencing diverticulitis will have left lower abdominal pain, but the pain may be in other areas of the abdomen depending on where it occurs in the colon. Other classic symptoms include fever and abnormal bloodwork, or an elevated white blood cell count. Diverticulitis can be accompanied by either diarrhea or constipation, and more rarely rectal bleeding.
If diverticulitis goes untreated for a long time, it can lead to complications like fistula or stricture. A fistula is an abnormal connection between two organs. Male patients may have a fistula between the bladder and the abnormal colon, which can present as frequent urinary tract infections, pain with urination (dysuria), or air passing with urination (pneumaturia). Female patients are more likely to have a fistula between the colon and the gynecologic organs.
How is it treated?
Treatment depends on how it presents. In general, there are two patterns.
Uncomplicated diverticulitis: If an attack occurs without sepsis, without free perforation or any other complication, it can usually be treated without surgery. This means taking a course of antibiotics, either orally, or by IV in the hospital, and restricting the diet to only clear liquids while the attack subsides. If this strategy is successful, individuals should be able to eat again in a matter of days, and will then complete a one-to-two-week course of antibiotics. It is important to have a colonoscopy once the colon “cools down” from the attack, typically six weeks later. Uncomplicated diverticulitis can require an operation if the problem returns frequently.
Complicated diverticulitis: If an attack happens with a large perforation, obstruction, abscess or fistula, it will likely require surgery. If someone is very ill, the operation is done emergently. If not, there is time to plan an elective operation. Surgical treatment involves removal of the diseased portion of the colon. At LifeBridge Health, we prefer to perform this operation as minimally invasive surgery with either a laparoscopic or robotic approach. This leads to shorter hospital stays, earlier return to work and overall a faster recovery.
How can you prevent yourself from getting it?
The most important elements in preventing diverticulitis are maintaining a high-fiber diet, with supplements from over-the-counter products, and a healthy lifestyle that includes regular exercise. Anyone over the age of 50 should get a screening colonoscopy completed. Any questions related to chronic abdominal pain should be referred to a gastroenterologist or colon and rectal specialist.