What are the main types of diverticular disease. How does diverticulosis differ from diverticulitis. What causes bleeding in diverticular disease. How is diverticular disease diagnosed and treated. Can diverticular disease be prevented.

Understanding Diverticular Disease: A Comprehensive Overview

Diverticular disease encompasses three distinct conditions affecting the colon: diverticulosis, diverticular bleeding, and diverticulitis. These conditions involve the formation and potential complications of small sacs or pockets, known as diverticula, in the colon wall.

What is Diverticulosis?

Diverticulosis is characterized by the presence of diverticula in the colon lining. These pockets, ranging from pea-sized to larger, form due to increased pressure on weak spots in the intestinal walls. This pressure can be caused by gas, waste, or liquid, and often occurs during straining associated with constipation.

The sigmoid colon, the lower portion of the large intestine, is the most common site for diverticula formation. Diverticulosis is prevalent, affecting 10% of individuals over 40 and 50% of those over 60. Most people with diverticulosis experience few or no symptoms.

When Does Diverticulosis Become Problematic?

Complications arise in approximately 20% of people with diverticulosis. These complications primarily manifest as diverticular bleeding or diverticulitis.

Diverticular Bleeding: Causes and Implications

Diverticular bleeding occurs when there is chronic injury to the small blood vessels adjacent to the diverticula. This can lead to rectal bleeding, which is one of the primary complications of diverticulosis.

How Serious is Diverticular Bleeding?

While diverticular bleeding can be alarming, it is often self-limiting. However, in cases of rapid, heavy rectal bleeding, medical attention is necessary. Doctors may perform a colonoscopy to identify the source of bleeding and determine the appropriate treatment.

Diverticulitis: When Diverticula Become Inflamed

Diverticulitis occurs when one or more diverticula become inflamed and infected. This typically happens when the outpouchings become blocked with waste, allowing bacteria to proliferate and cause infection.

What Triggers Diverticulitis?

The exact triggers for diverticulitis are not always clear, but factors such as a low-fiber diet, obesity, and lack of physical activity may contribute to its development. Smoking and certain medications, like nonsteroidal anti-inflammatory drugs (NSAIDs), may also increase the risk.

Recognizing the Symptoms: Diverticulosis vs. Diverticulitis

Understanding the symptoms of these conditions is crucial for timely diagnosis and treatment.

Are There Any Symptoms of Diverticulosis?

Diverticulosis typically does not cause noticeable symptoms. Most people with this condition are unaware they have it unless it’s discovered during tests for other medical issues.

What Are the Warning Signs of Diverticulitis?

Diverticulitis, on the other hand, can present with sudden and severe symptoms, including:

• Abdominal pain, particularly in the lower left side
• Fever and chills
• Nausea and vomiting
• Changes in bowel habits (constipation or diarrhea)
• Bloating and gas

If you experience these symptoms, especially persistent abdominal pain, it’s important to seek medical attention promptly.

Diagnostic Approaches for Diverticular Disease

Accurate diagnosis is essential for appropriate management of diverticular disease.

How is Diverticulosis Diagnosed?

Since diverticulosis is often asymptomatic, it’s typically discovered incidentally during tests for other conditions. Common diagnostic procedures include:

• Colonoscopy
• Barium enema
• CT scan

These tests allow visualization of the colon and can reveal the presence of diverticula.

What Tests Are Used to Diagnose Diverticulitis?

When diverticulitis is suspected, doctors may employ a combination of diagnostic tools:

1. Physical examination and medical history review
2. Blood tests to check for signs of infection
3. CT scan to visualize the affected area and detect complications
4. Stool samples to rule out other causes of infection

In some cases, a colonoscopy may be recommended after the acute phase of diverticulitis has resolved to rule out other conditions such as colorectal cancer.

Treatment Strategies for Diverticular Disease

Treatment approaches vary depending on the specific condition and its severity.

How is Uncomplicated Diverticulosis Managed?

For individuals with asymptomatic diverticulosis, specific treatment is not usually necessary. However, preventive measures are recommended:

• Adopting a high-fiber diet
• Staying well-hydrated
• Regular exercise
• Avoiding constipation

It’s important to note that laxatives and frequent enemas should be avoided, as they may irritate the colon.

What Are the Treatment Options for Diverticulitis?

Treatment for diverticulitis depends on the severity of the condition:

1. Mild cases may be treated at home with:
   • Oral antibiotics
   • Temporary liquid diet
   • Pain relief medications
2. Severe cases or those with complications may require:
   • Hospitalization
   • Intravenous antibiotics
   • Bowel rest (no food by mouth)
   • Possible surgical intervention

In recurring or complicated cases, surgery to remove the affected part of the colon may be necessary.

Complications of Diverticulitis: When to Be Concerned

While many cases of diverticulitis resolve with treatment, serious complications can occur.

What Are the Potential Complications of Diverticulitis?

Severe or untreated diverticulitis can lead to several serious complications:

• Abscess formation: Localized pockets of infection
• Perforation: A tear in the intestinal wall
• Peritonitis: Infection of the abdominal cavity
• Fistula: Abnormal connection between organs
• Intestinal obstruction: Blockage of the colon

These complications often require immediate medical attention and may necessitate surgical intervention.

How Are Complications of Diverticulitis Treated?

Treatment of complications depends on their nature and severity:

1. Abscesses may be drained using needle aspiration or surgery
2. Perforation and peritonitis typically require emergency surgery
3. Fistulas often necessitate surgical repair
4. Intestinal obstruction may require surgery if complete

Prompt recognition and treatment of these complications are crucial to prevent life-threatening situations.

Preventing Diverticular Disease: Lifestyle and Dietary Approaches

While not all cases of diverticular disease can be prevented, certain lifestyle modifications can reduce the risk and manage existing conditions.

How Can Diet Help Prevent Diverticular Disease?

A high-fiber diet is cornerstone in the prevention of diverticular disease. The American Dietetic Association recommends 20 to 35 grams of fiber daily. Good sources of fiber include:

• Whole grains
• Fresh fruits and vegetables
• Legumes
• Nuts and seeds

Adequate hydration is also crucial, as it helps fiber work effectively in the digestive system.

What Lifestyle Changes Can Reduce the Risk of Diverticular Disease?

In addition to dietary modifications, other lifestyle changes can help prevent diverticular disease:

1. Regular exercise to promote healthy bowel function
2. Maintaining a healthy weight
3. Quitting smoking
4. Limiting alcohol consumption
5. Managing stress

These changes not only reduce the risk of diverticular disease but also promote overall digestive and general health.

Living with Diverticular Disease: Long-term Management and Outlook

For individuals diagnosed with diverticular disease, long-term management is key to preventing complications and maintaining quality of life.

What Is the Long-term Outlook for People with Diverticular Disease?

The prognosis for most people with diverticular disease is generally good, especially with proper management. Many individuals with diverticulosis never develop complications. For those who experience diverticulitis, most recover fully with appropriate treatment.

How Can Individuals Manage Diverticular Disease in Daily Life?

Long-term management of diverticular disease involves:

• Adhering to a high-fiber diet
• Staying physically active
• Regular medical check-ups
• Promptly addressing any new or worsening symptoms
• Following prescribed treatment plans

By adopting these strategies, individuals with diverticular disease can often lead normal, healthy lives with minimal disruption.

Are There Any Emerging Treatments for Diverticular Disease?

Research into diverticular disease is ongoing, with potential new treatments on the horizon. Some areas of investigation include:

1. Probiotics to maintain gut health
2. Anti-inflammatory medications to manage diverticulitis
3. Minimally invasive surgical techniques for complicated cases
4. Personalized diet plans based on individual gut microbiome

While these approaches show promise, it’s important to consult with healthcare providers for the most current and appropriate treatment options.

Understanding diverticular disease, its causes, symptoms, and treatment options is crucial for effective management and prevention. By adopting a healthy lifestyle, maintaining a balanced diet, and seeking prompt medical attention when needed, individuals can significantly reduce their risk of complications and enjoy a high quality of life. As research continues to advance our understanding of this condition, we can look forward to even more effective strategies for prevention and treatment in the future.

Diverticular Disease & Bleeding: Causes, Symptoms, and Treatments

Written by WebMD Editorial Contributors

• Diverticulosis
• What Are the Symptoms of Diverticulosis?
• What Are the Symptoms of Diverticulitis?
• How Is Diverticulosis Diagnosed?
• How Is Diverticulitis Diagnosed?
• How Is Diverticulosis Treated?
• What Are the Complications of Diverticulitis?
• How Can Diverticulosis Be Prevented?
• More

Diverticular disease consists of three conditions that involve the development of small sacs or pockets in the wall of the colon, including diverticulosis, diverticular bleeding, and diverticulitis.

Diverticulosis is the formation of numerous tiny pockets, or diverticula, in the lining of the bowel. Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid. Diverticula can form while straining during a bowel movement, such as with constipation. They are most common in the lower portion of the large intestine (called the sigmoid colon).

Diverticulosis is very common and occurs in 10% of people over age 40 and in 50% of people over age 60. Most people will have no or few symptoms from diverticula.

Complications can occur in about 20% of people with diverticulosis. One of these complications is rectal bleeding, called diverticular bleeding, and another is diverticular infection, called diverticulitis.

Diverticular Bleeding

Diverticular bleeding occurs with chronic injury to the small blood vessels that are next to the diverticula.

Diverticulitis

Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with waste, allowing bacteria to build up, causing infection.

Diverticulosis does not cause any troublesome symptoms.

Diverticulitis, infection and inflammation of diverticula, can occur suddenly and without warning.

Symptoms of diverticulitis may include:

• Diarrhea and/or constipation
• Painful cramps or tenderness in the lower abdomen
• Chills or fever

Because people with diverticulosis do not have any symptoms, it is usually found through tests ordered for an unrelated reason. They usually include barium enema, sigmoidoscopy and colonoscopy.

If you are experiencing the symptoms of diverticulitis, it is important to see your doctor.

Your doctor will ask questions about your medical history (such as bowel habits, symptoms, diet, and current medications) and perform a physical exam, possibly including an abdominal exam.

One or more diagnostic tests may be ordered. Tests usually include blood tests and CT scanning.

In people with rapid, heavy rectal bleeding, the doctor may order a colonoscopy to locate the source of bleeding. 

People who have diverticulosis without symptoms or complications do not need specific treatment, yet it is important to adopt a high-fiber diet to prevent the further formation of diverticula.

Laxatives should not be used to treat diverticulosis and enemas should also be avoided or used infrequently.

Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity causing the following problems:

• Peritonitis (a painful infection of the abdominal cavity)
• Abscesses (“walled off” infections in the abdomen)
• Obstruction (blockages of the intestine)

If an abscess is present, the doctor will need to drain the fluid by inserting a needle into the infected area. Sometimes surgery is needed to clean the abscess and remove part of the colon. If the infection spreads into the abdominal cavity (peritonitis), surgery is needed to clean the cavity and remove the damaged part of the colon. Without proper treatment, peritonitis can be fatal.

Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A partial blockage does not require emergency surgery. However, surgery is required with complete blockage.

Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. A common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.

To prevent diverticular disease or reduce the complications from it, maintain good bowel habits. Have regular bowel movements and avoid constipation and straining. Eating appropriate amounts of the right types of fiber and drinking plenty of water and exercising regularly will help keep bowels regulated.

The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day. Fiber is the indigestible part of plant foods. High-fiber foods include whole grain breads, cereals, and crackers; berries; fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash, and beans; brown rice; bran products; and cooked dried peas and beans, among other foods.

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Diverticular Disease & Bleeding: Causes, Symptoms, and Treatments

Written by WebMD Editorial Contributors

• Diverticulosis
• What Are the Symptoms of Diverticulosis?
• What Are the Symptoms of Diverticulitis?
• How Is Diverticulosis Diagnosed?
• How Is Diverticulitis Diagnosed?
• How Is Diverticulosis Treated?
• What Are the Complications of Diverticulitis?
• How Can Diverticulosis Be Prevented?
• More

Diverticular disease consists of three conditions that involve the development of small sacs or pockets in the wall of the colon, including diverticulosis, diverticular bleeding, and diverticulitis.

Diverticulosis is the formation of numerous tiny pockets, or diverticula, in the lining of the bowel. Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid. Diverticula can form while straining during a bowel movement, such as with constipation. They are most common in the lower portion of the large intestine (called the sigmoid colon).

Diverticulosis is very common and occurs in 10% of people over age 40 and in 50% of people over age 60. Most people will have no or few symptoms from diverticula.

Complications can occur in about 20% of people with diverticulosis. One of these complications is rectal bleeding, called diverticular bleeding, and another is diverticular infection, called diverticulitis.

Diverticular Bleeding

Diverticular bleeding occurs with chronic injury to the small blood vessels that are next to the diverticula.

Diverticulitis

Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with waste, allowing bacteria to build up, causing infection.

Diverticulosis does not cause any troublesome symptoms.

Diverticulitis, infection and inflammation of diverticula, can occur suddenly and without warning.

Symptoms of diverticulitis may include:

• Diarrhea and/or constipation
• Painful cramps or tenderness in the lower abdomen
• Chills or fever

Because people with diverticulosis do not have any symptoms, it is usually found through tests ordered for an unrelated reason. They usually include barium enema, sigmoidoscopy and colonoscopy.

If you are experiencing the symptoms of diverticulitis, it is important to see your doctor.

Your doctor will ask questions about your medical history (such as bowel habits, symptoms, diet, and current medications) and perform a physical exam, possibly including an abdominal exam.

One or more diagnostic tests may be ordered. Tests usually include blood tests and CT scanning.

In people with rapid, heavy rectal bleeding, the doctor may order a colonoscopy to locate the source of bleeding. 

People who have diverticulosis without symptoms or complications do not need specific treatment, yet it is important to adopt a high-fiber diet to prevent the further formation of diverticula.

Laxatives should not be used to treat diverticulosis and enemas should also be avoided or used infrequently.

Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity causing the following problems:

• Peritonitis (a painful infection of the abdominal cavity)
• Abscesses (“walled off” infections in the abdomen)
• Obstruction (blockages of the intestine)

If an abscess is present, the doctor will need to drain the fluid by inserting a needle into the infected area. Sometimes surgery is needed to clean the abscess and remove part of the colon. If the infection spreads into the abdominal cavity (peritonitis), surgery is needed to clean the cavity and remove the damaged part of the colon. Without proper treatment, peritonitis can be fatal.

Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A partial blockage does not require emergency surgery. However, surgery is required with complete blockage.

Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. A common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.

To prevent diverticular disease or reduce the complications from it, maintain good bowel habits. Have regular bowel movements and avoid constipation and straining. Eating appropriate amounts of the right types of fiber and drinking plenty of water and exercising regularly will help keep bowels regulated.

The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day. Fiber is the indigestible part of plant foods. High-fiber foods include whole grain breads, cereals, and crackers; berries; fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash, and beans; brown rice; bran products; and cooked dried peas and beans, among other foods.

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Diverticulitis, intestinal diverticulosis: symptoms and treatment in Odessa

Colon diverticulosis develops gradually, and for a long time the disease does not manifest itself. The cause of the disease is chronic constipation, intestinal motility disorders, age-related decrease in muscle tone and elasticity of the intestinal wall.

Intestinal diverticulosis can lead to the development of diverticulitis, which is manifested by complications – bleeding, abscesses, peritonitis, fistula formation (abnormal connection of infected tissues of various organs or an organ and skin) between the large intestine and other organs.

Diverticular disease of the colon occurs as a result of overstretching of the intestinal walls with a regular increase in intra-intestinal pressure. Diverticula appear in the intestinal wall – small, sac-like pockets 1–2 cm in diameter. Diverticula usually develop on weak areas of the intestinal wall. The intestinal wall at the site of diverticulum formation becomes thinner.

In women, the disease manifests itself twice as often as in men. The number of patients increases sharply with age. If up to 40 years of age, there are a few percent of patients with diverticulosis, then after 60 years, diverticular bowel disease is diagnosed in half of the population of economically developed countries. It is characteristic that in countries with a low standard of living, diverticulosis is observed much less frequently. This is due to the fact that the formation of diverticula is mainly influenced by nutrition with a predominance of refined foods and a low content of vegetable fiber.

Diverticulosis itself does not require treatment, but when intestinal contents enter the diverticula, inflammation develops – diverticulitis. The disease is manifested by dull aching pain, fever. On palpation of the abdomen, the doctor detects an inflammatory infiltrate in the abdominal cavity. Due to damage to the blood vessels, diverticulitis is complicated by bleeding – in this case, blood appears in the stool. Sometimes there is intestinal obstruction. With diverticulitis, abscesses are often formed – abscesses limited to the capsule. Perforation of abscesses or perforation of the intestinal wall leads to the penetration of infection and feces into the abdominal cavity – peritonitis (inflammation of the peritoneum) develops.

Most often in the large intestine, diverticula are localized in the left half of the colon: in this case, two-thirds of patients develop isolated diverticular disease of the sigmoid colon.

Diagnosis of diverticular disease

Various instrumental methods are used to diagnose diverticular disease. The most informative is irrigoscopy – an x-ray with a contrast agent, which is injected into the intestine with an enema. This method provides a reliable idea of ​​the presence of pathological changes in the intestinal wall and the location of the diverticula.

Fibrocolonoscopy is also used – an examination of the internal surface of the intestine using an endoscope with a video camera. In acute diverticulitis, endoscopic techniques are not recommended. In this case, computed tomography of the abdominal cavity with contrast is used for diagnosis.

Diverticular disease without inflammation is treated with a diet that promotes daily bowel movements.

Acute diverticulitis is initially treated with conservative anti-inflammatory antibiotics on an outpatient basis. If the symptoms of exacerbation go away, the patient is prescribed a balanced diet, which involves a gradual increase in dietary fiber, drugs to normalize bowel function, enzymes and vitamins, it is recommended to increase physical activity.

In case of acute diverticulitis complicated by bleeding, obstruction, perforation, patients are hospitalized in a hospital, where an emergency surgical operation is performed in combination with antibiotic therapy to relieve inflammation. Elective surgery is also performed for acute diverticulitis, when conservative methods of treatment have been ineffective. The operation involves a partial resection of the colon, followed by the connection of healthy tissues.

The length of stay in the hospital depends on the condition in which the patient was admitted to the hospital. At the first symptoms of acute diverticulitis, it is necessary to consult a doctor, without waiting for peritonitis and intoxication of the whole organism. Otherwise, there is a real threat to human life.

Q&A

Can anemia occur with bleeding during diverticular disease?

Intestinal bleeding is usually not heavy. After conservative treatment of intestinal diverticulosis, they usually stop. If bleeding from diverticula cannot be stopped conservatively, then surgical intervention is necessary.

What should be the diet for diverticular disease?

It is necessary to increase fluid intake – up to 1.5-2 liters. Refuse flour products, sugar, semi-finished products. Introduce fermented milk products, vegetable oils and cereals, natural vegetables and fruits, fiber into the diet. Exclude foods that cause increased gas formation – legumes, cabbage, grapes, seeds and nuts are also undesirable. For the prevention of constipation, instead of medicines, it is better to use prunes and dried apricots, infusions of laxative herbs. It is necessary to completely abandon alcohol.

What are the symptoms of peritonitis?

When diverticular bowel disease is complicated by peritonitis, there is severe persistent pain, fever, thirst, and vomiting. With these symptoms, it is necessary to provide the patient with qualified medical care as soon as possible.

Is there congenital diverticulosis?

There is no congenital diverticulosis, but there are abnormalities in the development of the large intestine. In most cases, this disease is acquired. The main causes of occurrence: predominant nutrition of easily digestible foods and lack of fiber, constipation, overweight, sedentary lifestyle.

Diverticulum of the rectum. Causes. Symptoms. Treatment

Rectal diverticulum is a pathological process when the intestinal mucosa protrudes into the abdominal cavity. The disease affects the large intestine, including its terminal section. Diverticulosis appears if there are frequent failures of intestinal motility. A person experiences difficulty with defecation, pain, persistent gas formation. At an early stage, the disease can be cured with conservative therapy against the background of lifestyle adjustments and eating habits. In advanced cases, surgical intervention is indicated.

Causes of diverticulosis

Frequent constipation and decreased intestinal motility lead to protrusion of parts of the intestine. Improper carbohydrate nutrition with a low fiber content, lack of clean water provokes the formation of dense feces that stretch the walls of the rectum. Overweight people who lead a sedentary lifestyle are also at risk.

Symptoms of rectal diverticulum

Doctors distinguish three forms of the development of the disease: asymptomatic, uncomplicated and acute processes with complications. In the uncomplicated stage, the disease manifests itself as irritable bowel syndrome. Periodic discomfort and unpleasant signs appear:

• slight tingling in the intestines;
• intermittent colicky pains;
• increased flatulence and rumbling;
• alternating diarrhea and constipation;
• blood and mucus in the stool.

Complications of the disease

A common complication of diverticulum is diverticulitis (inflammatory process). The disease becomes chronic with alternating acute phases and periods of asymptomatic course. In the acute period, a person has a fever, the pain intensifies, diarrhea with an admixture of blood opens. With constant relapses, adhesions are formed. This can cause intestinal obstruction.

Advanced diverticulosis and diverticulitis also lead to the formation of anal and intestinal fistulas. This can cause internal bleeding, feces entering the bladder. Complications include abscesses and peritonitis.

Diverticulum can be confused with other proctological or intestinal pathologies. The diagnosis is made only by a doctor on the basis of instrumental studies. Squeezing or bursting pain may indicate that inflammation has begun. With pain in the rectum, you can not drink painkillers. Consultation with a coloproctologist is necessary.

Diagnostic methods

With a problem, you need to contact a gastroenterologist or proctologist. The doctor will assess the symptoms and conduct an examination. In uncomplicated rectal diverticulum, ultrasound and instrumental examination are sufficient to confirm the diagnosis. In case of damage to the colon with complications, the patient is prescribed:

• irrigoscopy – radiography with contrast;
• colonoscopy – endoscopy of the lower intestine through the anus.

In an acute condition, the patient needs a blood test. With diverticulitis, leukocyte counts will be elevated.

Prevention of diverticulum

Most often the problem occurs in people aged 35-45 years. It is important to prevent a decrease in physical activity. If you have a sedentary job, you should take breaks to warm up, walk more, and actively relax. To reduce the risk of diverticula, you need to eat regularly, drink clean water, stop smoking and limit alcohol consumption. If there is a tendency to constipation, you need to get the recommendations of a gastroenterologist and follow them.