Diverticulitis

Overview

Dealing with diverticular disease in Orange County? With Hoag in your corner, you’re ready for a comeback.

A diagnosis of diverticulosis and diverticulitis can come at you out of nowhere, bringing pain, serious complications and a whole new slate of uncertainties. Am I going to be dealing with this forever? Who can I turn to for help?

When you need to heal, Hoag is ready. As the area’s highest-volume treatment center Hoag just sees, diagnoses and successfully treats more cases of diverticulitis than anyone else in Orange County. That experience can make a big difference in your care. So don’t wait. Hoag can help.

What Is Diverticulitis?

Diverticulitis occurs when small pouches that can form in the lining of the large intestine called diverticula become inflamed or infected.

While many older people can have diverticula in their colon wall for years without major or even noticeable issues, a diverticulitis attack can come on suddenly if one of these pouches becomes infected and can lead to serious and often painful symptoms.

Depending on the extent of the infection, diverticulitis can cause a range of issues, often including severe abdominal pain, usually in the form of sharp pain on the lower abdomen on the left side. Most diverticulitis attacks are short term (AKA acute diverticulitis), don’t lead to chronic symptoms and can be successfully treated with therapies like antibiotics and/or a temporary diet of only clear liquids.

In rare instances and severe cases, however, the symptoms of diverticular disease can continue long term, developing into what’s known as chronic diverticulitis or diverticular disease.

Understanding the Connection Between Diverticulosis and Diverticulitis

Diverticulosis and diverticulitis are related, in that diverticulosis is the condition that can sometimes develop into diverticulitis. According to studies, around four percent of people who have diverticulosis will develop diverticulitis, making it a fairly uncommon complication.

Diverticulosis occurs when small pouches, known as diverticula, develop in the lining of the digestive tract — usually in the lower part of the large intestine.

The diverticula, which can be about the size of a marble, bulge outward through weak spots in the colon. From outside the large intestine, they might look like round growths, but most are actually hollow inside, with a channel that connects the diverticula to the interior of the digestive system.

It’s through these channels that fecal material can intrude into the pouch-like diverticula. It’s believed that, in some cases, this can lead to the infection and chronic inflammation that causes diverticulitis.

Diverticulosis is common in older people, and often causes no symptoms. It’s estimated that up to 60 percent of Americans over the age of 60 have diverticulosis, but many might not know it. Though some people with diverticulosis may experience occasional symptoms like mild abdominal cramps, abdominal tenderness, bloating or constipation, most people with the condition experience no symptoms or complications at all.

However, if one or more diverticula become inflamed or infected, diverticulosis can become an acute diverticulitis, which often involves fever, chills, sudden belly pain (usually sharp abdominal pain on the lower left side of the abdomen), constipation and other issues.

What Are The Symptoms Of Diverticulitis?

While diverticulosis often produces few or no noticeable signs, in the rare event diverticulosis develops into diverticulitis, it can produce an array of serious issues and health problems. During an acute attack, these may include:

• Sudden belly pain that can range from severe to mild, primarily on the lower left side of the abdomen
• Constipation or diarrhea
• Fever, chills and other issues related to infection
• Nausea and vomiting
• Abdominal tenderness and pressure
• Loss of appetite
• Bloating
• A more frequent need to urinate

Complications Of Diverticulitis

If the condition isn’t treated promptly with antibiotics and other therapies, severe diverticulitis cases can lead to possible complications and issues in the digestive tract that may become a medical emergency.

Complications of severe or chronic diverticulitis may include:

• Infections in the abdominal cavity, including peritonitis
• Tears in the colon wall, also known as a perforation
• Internal or rectal bleeding due to ruptured blood vessels in the diverticula
• Intestinal obstruction due to scarring, which can cause a blockage in the intestine
• Abscesses, which are pockets of pus that can form near an infected diverticulum
• Fistulas, which are abnormal passageways can form between different parts of the bowel or between the bowel and other organs

What Causes Diverticulosis To Become Diverticulitis?

It’s not fully understood why some people with diverticulosis develop diverticulitis symptoms while others don’t, but it’s thought by some experts to potentially be a result of eating a low-fiber diet that’s high in animal fats, fecal matter and bacteria entering the diverticula or the presence of diverticular tears, which creates chronic inflammation and can become a pathway for infection in the colon.

What Are The Risk Factors For Developing Diverticulitis?

There are several factors which are known or suspected to increase a person’s risk for developing diverticulitis and diverticulosis. These factors include:

• Age, especially being over 50 years old
• Being male
• Being obese
• Eating a diet consisting mostly of low fiber foods
• Eating lots of red meat and few fruits and vegetables
• Lack of physical exercise
• Use of certain medications, including opioids, steroids and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and naproxen sodium
• Smoking tobacco

What Are The Different Types Of Diverticulitis?

Diverticulitis can manifest in various forms. According to information published by the National Institutes of Health, the condition is classified by looking at whether it is so-called uncomplicated diverticulosis or if the condition has been complicated by diverticulitis. The different types of diverticulosis and diverticulitis include:

• Type 0: Asymptomatic diverticulosis
• Type I: Acute uncomplicated diverticulitis
• Type II: Acute complicated diverticulitis
• Type III: Long-term, chronic diverticular disease

Visit here for more information about diverticulosis staging and the different types of diverticulitis from the National Institutes of Health.

How Is Diverticulitis Diagnosed?

If a patient visits the doctor with symptoms of diverticulitis, physicians may use a variety of methods to confirm or rule out a diverticulitis diagnosis.
This process will usually begin with a thorough physical exam. During this exam, the doctor will likely inquire about your medical history, including:

• Symptoms you are experiencing
• Family history
• Your diet, including the amount of dietary fiber you eat
• Your bowel movements, including their frequency, consistency, whether you experience chronic constipation and whether you’ve experienced any recent rectal bleeding
• Current medical conditions
• Any medications you might be taking, including prescription, over-the-counter, supplements or herbal medications

During this evaluation, the physician will likely examine your abdomen for any bulges or abdominal tenderness, and may conduct a digital rectal exam to check for the presence of blood.

Which Tests Are Used To Diagnose Diverticulitis?

Your doctor may order tests to help rule out or diagnose diverticulitis, including:

• Blood tests: A blood test can help identify signs of diverticulitis or its complications, including infections due to a diverticula tear or an abscess
• Stool tests: This helps differentiate between diverticular disease and other conditions like irritable bowel syndrome, colon cancer, Crohn’s disease and other conditions that can produce symptoms similar to those of diverticulitis
• Colonoscopy, which utilizes a long, flexible tube with a camera at the tip called a colonoscope to inspect the rectum and colon lining. A colonoscopy can help confirm diverticular disease, detect the source of any bleeding and rule out other serious conditions of the digestive tract like colon cancer
• Imaging tests, which may include:
  • Computed tomography (CT) scans, to produce detailed images of the abdomen and colon
  • Ultrasound, which utilizes sound waves to create images of internal organs
  • Magnetic resonance imaging (MRI), which can create detailed images without x-rays.

How Is Diverticulitis Treated?

How physicians go about treating diverticulitis can vary from patient to patient, and may depend on whether the patient is experiencing mild diverticulitis or more serious diverticulitis complications that could indicate it is a chronic condition.

Methods used to treat diverticulitis may include:

• Recommending a high-fiber diet including high-fiber foods like vegetables, beans and whole grains
• Prescribed or over-the-counter pain medications, which can help reduce the abdominal pain that often occurs during a diverticulitis attack.
• Antibiotics to treat infection in the colon
• Medications to reduce inflammation that may be causing diverticular disease
• A short-term diet of only clear liquids. This can give your colon time to rest and heal from the infection and inflammation that can result from diverticulitis. Once the colon has healed, the clear liquid diet can be tapered off and solid foods slowly reintroduced.

Rare cases may involve more serious complications like abscesses, diverticular bleeding or peritonitis. Hospitalization or surgery to remove part of the colon may be required in certain cases to help these more serious symptoms improve.

Drugs To Avoid With Diverticulitis

Various studies have shown that taking certain medications may potentially increase your risk of developing diverticulitis or severe complications.

Always follow your healthcare provider’s instructions and do not stop taking any prescribed medications without consulting your doctor, but drugs to avoid if you have diverticulitis may potentially include:

• NSAID pain relievers: doctors usually recommended that patients displaying symptoms of diverticulitis or who may develop diverticulitis strictly avoid non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, naproxen sodium, ibuprofen and others, as they can increase the risk of developing diverticulitis complications.
• Steroids: some studies have shown an increased risk of diverticulitis and serious diverticulitis complications like colon perforation in patients who take corticosteroids like prednisone.
• Iron supplements: taking iron supplements can lead to certain side effects in the GI tract, potentially including constipation, which may lead to inflammation and/or contribute to the formation of the pouch-like diverticula that can become inflamed or infected and lead to diverticulitis.
• Tricyclic antidepressants, which may also contribute to constipation.

Foods To Avoid With Diverticulitis

Doctors once recommended that those with diverticulitis or diverticular disease should avoid eating seeds and small nuts, including those found in foods like strawberries and popcorn. The feeling was that these foods could potentially enter the small, pouch-like diverticula and cause irritation and inflammation, potentially leading to diverticulitis.

However, as medicine and internal imaging has advanced, it’s now believed these foods don’t contribute to diverticular disease at all.

These days, it’s recommended that those with a history of diverticular disease drink plenty of water and eat a diet that’s rich in high-fiber foods like vegetables, lentils, fruits and whole grains.

Upping your fiber intake and drinking more water can help reduce the risk of constipation, making the feces softer so it can move through the colon more quickly and with less straining during bowel movements. This can reduce the pressure exerted on the colon, which may reduce the risk that new diverticula can form.

How Can I Reduce My Risk Of Developing Diverticulitis?

While there’s no known way to definitively prevent diverticulosis and diverticulitis, there are certain steps you can take to potentially reduce the risk of developing diverticulitis if you have diverticulosis.

Ways to reduce your risk of developing diverticulosis and diverticulitis include:

• Eating a high-fiber diet: Eating more fiber helps soften the feces so it can pass more easily through the colon and prevent constipation. This can be important because development of the pouch-like diverticula associated with diverticulosis and diverticulitis are thought to be connected to straining during bowel movements.
• Drink plenty of water, which — like eating more fiber — can also reduce constipation and help prevent diverticulitis
• Get regular exercise and maintain a healthy weight
• Avoid certain drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium, which can potentially increase the risk of more serious symptoms of diverticulitis and diverticulitis complications
• Avoid smoking tobacco, which is a major risk factor for diverticular disease