What Are Diverticula?

Diverticula are abnormal marble-sized pouches protruding out from the intestinal wall – most often from the sigmoid colon (Picture 1).

Diverticulosis as seen in colonoscopy

Picture 1. Diverticles in the colonic wall, as seen during colonoscopy

Symptoms of Diverticulosis

Diverticulosis refers to multiple intestinal (mostly colonic) diverticles, which commonly occur in old, but also in young constipated persons who constantly strain at defecation. Diverticula may cause no symptoms at all, or they may cause constipation, bloating, lower left side abdominal cramps or pain.

Symptoms of Diverticulitis

Diverticulitis refers to inflamed (mostly infected) diverticula. Symptoms may last from few hours to several days and include:

  • Lower left side abdominal pain and/or tenderness, or (in Asian populations) right side abdominal pain
  • Nausea
  • Diarrhea or constipation
  • Bloating and flatulence
  • Fever, chills
  • Vomiting (not common)

Complications

In both diverticulosis and diverticulitis the following complications may occur:

  • Inflammation of nearby organs: ureter, bladder, uterus.
  • Obstruction of the colon due to scaring after several episodes of  inflammation; urgent or planned surgery may be needed.
  • Collections of pus (abscesses) in or around the colonic wall. Abscesses may be treated with antibiotics or surgery.
  • Perforation of the colon, which can lead to life threatening inflammation of the lining of the abdominal cavity (peritonitis). Symptoms of perforation are severe pain, fever and (if shock develops) weak and fast heart pulse, rapid breathing, restlessness. Colon perforation often requires urgent surgery.
  • A fistula (a tunnel through the tissues) may connect colon with adjacent organs (small intestine, bladder, uterus, vagina, skin of abdominal wall..) and cause their inflammation.
  • Intestinal bleeding (not common); the source of bleeding should be found and treated.

Diagnosis of Diverticulitis

Diverticulosis or diverticulitis may be suspected from symptoms, mostly from lower left abdominal pain. The presence of diverticles can be confirmed by ultrasound or CT of the abdomen. Blood test may show increased leukocytes. X-ray with barium enema or colonoscopy to evaluate the extent of diverticulosis may be performed after the inflammation has subsided.

Treatment of Diverticulosis and Diverticulitis

Diverticles themselves are usually permanent – they do not disappear with time, diet or medications.

Measures during sudden diverticulitis attack:

  • Rest
  • Clear liquid diet (water, clear juices, pop-sickles without fruit particles, gelatin, broths) or low-fiber diet (white bread, white rice, pasta, eggs, poultry, fish without bones, fruits without peels, membranes, or seeds).  Avoid vegetables with hard skins, like beans or peas.
  • Oral antibiotics in mild and intravenous antibiotics in severe infection
  • Mild painkillers like paracetamol may be taken in pain. Strong painkillers (morphine) aggravate constipation so they should be avoided, if possible.

Diverticulosis and Surgery

If diverticles cause constant problems over the years, and diet does not help, a surgical removal of the affected part of the colon may help. Surgery can be performed through a classical open-abdomen surgery, or laparoscopic surgery with only few short incisions in the abdominal wall. In most cases, the remaining parts of the colon can be connected end-to-end but sometimes a temporary or permanent colostomy (a free end of the colon connected to abdominal wall) is needed.

Diet to Prevent Diverticulosis and Diverticulitis

After attack of diverticulitis is over, you can adjust your diet to avoid further developing of diverticles:

  • If you are constipated, eat enough fiber to soften the stool. Fruits, vegetables, cereals, nuts, whole-grain or half-white bread and fiber supplements, like psyllium husk, may all be appropriate. Introduce fibers slowly to prevent bloating (also do not exaggerate with an amount – you need enough, not a lot of fiber). Drink enough fluid together with the fiber.
  • If you are bloated, avoid fruits like apples, pears, plums, prunes and dried fruits in general, sugary foods and drinks. Citruses and berries may be fine.
  • Do not delay bowel movements when it is time to go, and avoid straining.
  • Be active. Exercise helps to prevent diverticles.

References:

  1. Diverticulitis  (merck.com)
  2. Diet in diverticulitis  (mayoclinic.com)

Article reviewed by Dr. Greg. Last updated on December 17, 2011