Diverticulitis vs. ulcerative colitis: A comparison

Diverticulitis refers to inflammation of the diverticula, which are small pouches that form in the colon lining. Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) where people develop inflammation and ulcers in the lining of the large intestine.

In this article, we compare symptoms, diagnosis, treatment, complications, and outlook of both conditions.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Small pouches called diverticula can form in the colon lining and push out through weak spots in the outer wall of the colon. If a person has diverticula in their colon, they have what health experts refer to as diverticulosis.

Diverticulitis is a condition where the diverticula become inflamed. Around 10–25% of individuals with diverticulosis may have diverticulitis.

People may also use the term “diverticular disease” for diverticulitis or diverticular bleeding or if diverticula cause chronic symptoms.

UC is an IBD where an overreactive immune system causes inflammation and ulcers to develop in the lining of the large intestine.

UC is a chronic condition, and people may go through periods of remission, when they experience no symptoms of UC.

In the table below, we compare the two conditions:

	Diverticulitis	UC
Definition	Diverticulitis is a condition where small pouches form in the intestinal lining and become inflamed.	UC is a type of IBD where an overactive immune response causes inflammation and ulcers in the intestinal lining.
Symptoms	Symptoms can include: • abdominal pain on one side • constipation • diarrhea • nausea • vomiting • fever • chills • rectal bleeding	Symptoms can include: • diarrhea • an urgent need for bowel movements • blood or mucus in stool • abdominal pain and cramping
Causes	There is no known cause, but the following may play a part: • genetics • diet low in fiber and high in red meat • immune system problems • changes in the microbiome • bacteria trapped in the diverticula	There is no known cause, but the following may play a role: • genetics • unusual immune system reactions • microbiomes in the digestive tract • environmental factors
Triggers	Low fiber consumption and high red meat intake may increase the risk of diverticulitis and complications.	Certain foods, such as spicy foods, lactose, and sugary foods, may trigger UC flares.
Treatment	Treatment options include: • antibiotics • a temporary clear liquid diet • pain relief medication • surgery to remove part of the colon, in some cases	Treatment can include medications to reduce inflammation, and, in some cases, surgery to remove the colon and rectum.
Cancer risk	There may be a slightly increased risk of colorectal cancer, with older adults and those with complicated diverticulitis being at higher risk.	There is an increased risk of developing colorectal cancer.
Complications	Complications can include: • pelvic abscess • intestinal perforation • fistulas • peritonitis • bowel obstruction • sepsis • rectal bleeding	Complications can include: • rectal bleeding • iron deficiency anemia • expansion or tears in the colon • blood clots • primary sclerosing cholangitis (PSC) • toxic megacolon • intestinal perforation
Outlook	The outlook depends on a person’s age and overall health and the severity of diverticulitis. Treatment may result in none to mild symptoms in two-thirds of people.	UC requires long-term management. Treatment can help people maintain remission and live a relatively normal life.

In the sections below, we outline the symptoms of diverticulitis and UC.

Diverticulitis

Symptoms of diverticulitis may include:

• abdominal pain
• constipation or diarrhea
• fever
• chills
• nausea or vomiting
• increased urgency, frequency, or discomfort when urinating, if an inflamed part of the colon comes into contact with the wall of the bladder
• rectal bleeding

People with diverticulitis usually experience severe and sudden abdominal pain, but they may also have mild pain that worsens over several days. The pain may be constant or come and go. Also, over time, the pain intensity may vary.

UC

Symptoms of UC can be mild to severe and can include:

• persistent diarrhea
• rectal bleeding or blood in stool
• cramping or abdominal pain
• mucus or pus in stool
• an urgent need to have a bowel movement
• a persistent urge to have a bowel movement, even if bowels are empty

UC symptoms can come on suddenly or start gradually and then worsen over time.

Most people with UC have flares, which is when symptoms are present, and periods of remission, which is when no symptoms occur. Remission may last for weeks or years.

Healthcare professionals do not know the exact cause of either condition. However, they are aware of factors that can increase the likelihood of developing diverticulitis or UC.

Diverticulitis

There is no known cause of diverticulitis. Certain factors, however, may increase the risk of diverticular disease or cause its development. These include:

• genetics
• stool or bacteria becoming trapped in a pouch in the colon
• a change to the microbiome in the intestines
• issues with muscles, nerves, or connective tissue in the colon
• issues with the immune system

Lifestyle factors may also play a role, including:

• following a low fiber diet
• eating a diet high in red meat
• not engaging in physical activity
• taking nonsteroidal anti-inflammatory drugs and steroids
• having obesity
• smoking

Diverticulitis affects both males and females. It is more common in males under the age of 50 years and in females aged 50–70 years. In people over 70 years, diverticulitis is more common in females.

UC

Health experts do not know the exact cause of UC. They think, however, that the following may play a role:

• Genetics: UC can run in families, so having certain genes may increase the risk of developing UC.
• Overactive immune system: The immune system creates temporary inflammation to help protect and heal the body from infection or illness. With UC, inflammation continues for longer than necessary, leading to chronic inflammation and ulcers in the intestinal lining.
• Microbiome: There may be differences between the microbiomes in the digestive tract of people with IBD and individuals without IBD.
• Environment: External factors and surroundings may affect a person’s genes, immune system, and microbiome, potentially playing a role in IBD.

People with UC or diverticulitis need to be careful about their dietary choices.

Diverticulitis

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a diet low in fiber and high in red meat may increase the risk of diverticulitis.

Consuming more fiber and reducing red meat intake may lower the risk of diverticulitis and complications.

There is no evidence to suggest a link between eating nuts, seeds, or popcorn and an increased risk of diverticulitis or diverticular bleeding.

Learn more about the best foods for diverticulitis here.

UC

People may find that certain foods can trigger or worsen symptoms of UC.

Although different for each person, the following foods may trigger symptoms in some individuals:

• insoluble fiber, such as raw cruciferous vegetables, whole nuts, and whole grains
• lactose
• sugary foods
• high fat, fried, or greasy foods
• alcohol and caffeine
• spicy foods

Learn more about foods to eat and avoid with UC here.

Healthcare professionals may recommend the following treatment options:

Diverticulitis

Treatment for diverticulitis may include:

• antibiotics
• a temporary clear liquid diet, to allow the colon to rest
• pain relief medication, such as acetaminophen

In severe cases, people may require surgery to remove a section of the colon.

UC

Treatment for UC may include long-term use of medications to control inflammation, such as:

• immunosuppressants
• biologics
• corticosteroids
• aminosalicylates

A person may require surgery to remove the colon and rectum if their symptoms do not improve or if they have colorectal cancer or any serious complications.

Surgeons may also perform an ileostomy. They will attach the end of the ileum, which is a part of the small intestine, to an opening in the abdomen called a stoma. This allows the body to store and remove stools in an alternative way.

To diagnose each of the two conditions, doctors may carry out a physical examination and order the following:

• blood tests
• stool tests
• imaging tests, such as a CT scan, an MRI scan, and an ultrasound
• colonoscopy

A healthcare professional may order a colonoscopy to help diagnose diverticulitis and an endoscopy to diagnose UC.

Diverticulitis and UC can cause the following complications:

Diverticulitis

Complications of diverticulitis may include:

• a pelvic abscess, when an infection causes a pus-filled pocket in the pelvic area
• an intestinal perforation, which is a hole in the wall of the intestine
• a fistula, which is an abnormal opening that allows contents to leak out
• peritonitis, an infection in the lining of the abdomen
• a blockage in the intestines
• sepsis
• rectal bleeding

According to a 2020 meta-analysis, there is a small risk of colorectal cancer with diverticulitis. Older adults and those with complicated diverticulitis have a higher risk of developing this type of cancer.

UC

Complications of UC may include:

• rectal bleeding
• iron deficiency anemia
• expansion or tears in the colon
• blood clots
• PSC

Moreover, toxic megacolon and perforation are potential complications that may warrant emergency surgery and colectomy.

In long-term cases of UC, there is an increased risk of precancerous changes and colorectal cancer. PSC can also increase the risk of bile duct cancer.

People can take the following steps to help prevent UC and diverticulitis from developing:

Diverticulitis

Factors that may help lower the risk of developing diverticulitis include:

• eating a diet high in fiber and low in red meat
• engaging in regular physical activity
• avoiding smoking
• reaching or maintaining a moderate body weight

If people have diverticulitis without any complications, a doctor may suggest surgery to remove part of the colon to prevent diverticulitis from reoccurring.

UC

Preventive measures for UC include:

• avoiding smoking
• getting regular exercise
• eating a balanced diet
• avoiding trigger foods

The outlook for each condition can depend on a variety of factors.

Diverticulitis

The outlook for people with diverticulitis can depend on a range of factors, including:

• severity of the condition
• a person’s age and overall health
• any coexisting conditions

Most people with uncomplicated diverticulitis will have a positive response to treatment. Around 15% of people may require surgery to treat diverticulitis. After successful treatment, one-third of people will not have any symptoms, one-third will experience mild symptoms, and one-third will have recurrent diverticulitis.

UC

UC is a chronic condition that a person will need to manage throughout their life.

Managing flare-ups and uncomfortable symptoms can be difficult for some individuals, but effective treatment can help people lead a relatively normal life.

By managing their condition, some individuals with UC may experience remission for weeks or even years.

Diverticulitis is a condition where small pouches form in the intestinal lining and become inflamed. UC is a type of IBD in which an overactive immune response causes inflammation and ulcers in the large intestine.

Medication and lifestyle factors can help manage both conditions, which in turn may help a person relieve symptoms or maintain remission.

In severe cases, people may require surgery to remove part of the colon or rectum.

Ulcerative Colitis vs. Diverticulitis: How They Differ

Ulcerative colitis and diverticulitis are both conditions that affect your digestive system. Although they have some common symptoms, they are entirely different conditions, with unique causes and treatment plans.

Both ulcerative colitis and diverticulitis are digestive conditions that can cause uncomfortable symptoms like stomach pain, diarrhea, and blood in your stool. But there are key differences between the two.

Diverticulitis is a condition characterized by the development of small, bulging sacs in the colon (large intestine). On the other hand, ulcerative colitis is a chronic condition where the inner lining of the colon becomes inflamed and causes ulcers to develop.

Diverticulitis and ulcerative colitis require different treatment plans, which is why it’s important that you visit your healthcare professional if you have symptoms of either condition.

Let’s take a look at the differences and similarities between ulcerative colitis and diverticulitis, as well as how to get a diagnosis and treatment.

While both conditions affect your digestive system and have several overlapping symptoms, ulcerative colitis and diverticulitis are two distinct conditions with unique causes and symptoms. Here’s what to know about each condition.

Ulcerative colitis: Causes and symptoms

Ulcerative colitis is a type of inflammatory bowel disease (IBD). People with ulcerative colitis develop inflammation and ulcers in their large intestine. It’s considered chronic, meaning that people who have the condition have it for life. Still, with the right treatment, many people are able to effectively manage their symptoms.

It’s not known exactly what causes ulcerative colitis. Medical experts believe the following factors may play a role:

• Your genes: If your parents or grandparents had ulcerative colitis, you may have inherited certain genes that make you more prone to developing it too.
• Unusual immune reactions: It’s thought that ulcerative colitis may be triggered by abnormal reactions in the immune system.
• Microbiome differences: Certain bacteria, viruses, and fungi in your digestive tract (known as your microbiome) may play a role in triggering ulcerative colitis.
• Environmental factors: Experts believe that your surroundings may play a role in causing ulcerative colitis, especially if you have other risk factors.

Ulcerative colitis symptoms can vary a lot from person to person. Some of the most common symptoms include:

• diarrhea
• stomach pain
• blood in stool
• decreased appetite
• weight loss
• fatigue
• malnutrition, such as anemia
• decreased growth (in children)

Diverticulitis: Causes and symptoms

Diverticulitis is a condition where small pouches or sacs develop in the lining of your colon (large intestine). These pouches in the wall of your colon can become infected or inflamed, causing a diverticulitis flare-up.

Although there’s no single cause of diverticulitis, it does become more common as you age. There are several other factors that can increase your risk of developing diverticulitis, such as:

• a family history of diverticulitis
• a diet that’s low in fiber
• a diet that’s high in red meat
• having obesity
• a sedentary lifestyle
• smoking
• decreased immune function
• certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids.

Symptoms of diverticulitis are mainly digestive in nature, and may be moderate to more severe. Typical symptoms of diverticulitis include:

• stomach pain, usually on the left side
• abdominal bloating
• constipation
• diarrhea
• vomiting
• nausea
• fever
• chills

Because both ulcerative colitis and diverticulitis have digestive symptoms — and many symptoms that overlap — it’s not possible to tell which condition you have from symptoms alone. That’s why it’s vital to talk with your doctor if you have symptoms of either condition.

The type of physician that diagnoses these conditions is called a gastroenterologist. Many people visit their primary care provider (PCP) first with digestive symptoms, and then get a referral to a gastroenterologist if their PCP thinks a full workup and diagnosis is necessary.

Many of the tests used to help diagnose ulcerative colitis and diverticulitis are the same. Testing may include:

• blood tests to look for nutritional deficiencies and signs of infections
• stool tests
• a colonoscopy, to visualize the lining of the rectum and colon

If your doctor thinks you may have diverticulitis, you may also have imaging tests, such as an MRI, CT scan, or an ultrasound.

If ulcerative colitis is suspected, your doctor may also order a flexible sigmoidoscopy, which is used to view and analyze the lining of the rectum and lower colon. An ulcerative colitis diagnosis often also involves a biopsy of the large intestine.

Ulcerative colitis and diverticulitis have different treatment plans and treatment durations. Again, this is why it’s imperative to get a proper diagnosis so that your treatment plan is geared toward the correct condition.

Treatment for diverticulitis

Typically, treatment for diverticulitis has involved antibiotics to treat infections, along with dietary changes like increased fiber or fiber supplements. However, more recently, experts recommend preserving antibiotics for the most complicated cases of diverticulitis.

Sometimes medications are prescribed to decrease inflammation, and pain relievers are often used to reduce pain and discomfort as the infection clears.

Treatment for ulcerative colitis

Treatment for ulcerative colitis involves a combination of medication and dietary changes, and less commonly, surgery.

Most medications prescribed for ulcerative colitis aim to reduce inflammation in the colon. The type of medicine that’s prescribed will depend on the severity of the disease. Common medications include:

• Aminosalicylates: Recommended for people with mild to moderate ulcerative colitis, this type of medication (also known as 5-ASA drugs), helps ease symptoms by decreasing inflammation in the colon.
• Corticosteroids: Used for mild to moderate ulcerative colitis, corticosteroids help decrease your body’s overall immune system response, which reduces inflammation. This medication is usually prescribed for people who don’t get symptom relief from aminosalicylates.
• Immunosuppressants: Prescribed for people with moderate to severe ulcerative colitis, immunosuppressants decrease your body’s response to its own immune system.
• Biologics: Developed in a lab from a living organism, these drugs prevent specific proteins in your body from causing inflammation. Biologic drugs are usually used to treat moderate to severe ulcerative colitis.

Surgery is usually only recommended when patients don’t respond to other medical treatments.

Both ulcerative colitis and diverticulitis can be serious, especially if untreated. While most people recover after an acute episode of diverticulitis, ulcerative colitis requires lifelong treatment.

If left untreated, ulcerative colitis can be severe. Complications may lead to:

• a perforated colon (hole in the wall of the large intestine)
• fulminant colitis (swelling and distention of the colon)
• toxic megacolon (abnormal and severe dilation of the colon)
• severe dehydration

Treatment of ulcerative colitis is usually effective and long periods of remission are possible. However, having ulcerative colitis may increase your risk of colorectal cancer, especially if the condition is more severe, starts at a younger age, or involves a larger portion of your intestine.

Complications of diverticulitis can include:

• an abscess in the intestine
• phlegmon (a reaction where the body tries to contain an infection)
• a fistula (an unnatural connection between one structure and another, for instance an opening between the bladder and colon)
• a perforated colon
• bowel obstruction (a blockage in the colon)
• secondary bouts of diverticulitis

Although treatment of diverticulitis is usually effective, about 20% to 50% of people will have recurrent symptoms. Diverticulitis is rarely fatal, though some studies have found that the condition slightly increases your chance of colorectal cancer.

Yes, it’s possible to have both ulcerative colitis and diverticulitis at the same time. While there’s not a lot of research about this phenomenon, it’s considered a rare occurrence.

If you have any symptoms of diverticulitis or ulcerative colitis, it’s important to get a proper diagnosis to determine if you have one or the other condition, or both at the same time.

Ulcerative colitis and diverticulitis are both conditions that affect your digestive system. They have some symptoms in common, such as abdominal pain, diarrhea, and blood in the stool. However, they are entirely different conditions, with different diagnoses and treatment plans.

If you have symptoms of either condition, it’s important to see your doctor to determine whether you have either of these conditions. Without the right treatment, both ulcerative colitis and diverticulitis can get worse and lead to potentially serious complications.

Colitis vs diverticulitis: difference and comparison

Inflammatory diseases of the colon include colitis and diverticulitis. Colitis is an inflammation of the large intestine. Diverticulitis is an inflammation of the diverticula in the colon.

Science quiz

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The filament of a light bulb consists of

tungsten

nichrome

graph um

iron

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The first link in all food chains is

Herbivores

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Green plants

All of the above

3 / 10 90 003

Which of the following glands is located in the human mouth?

Adrenal

Pituitary

Genital

salivary

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Galvanized iron sheets coated

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Permanent water hardness can be eliminated by adding

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potassium permanganate

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What is another name for Newton’s first law?

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Law of inertia

Constant momentum

7 / 10

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Radium

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The bond between non-metals and non-metals is called ___________.

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Vitamin

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Key findings

1. Colitis includes inflammation of the colon, and diverticulitis occurs when small sacs in the colon (diverticula) become inflamed or infected.
2. Colitis has several types, including ulcerative and infectious colitis, and diverticulitis is a specific disease.
3. Treatment for colitis varies depending on the cause, while treatment for diverticulitis often includes antibiotics, pain medication, and dietary changes.

Colitis vs. diverticulitis

Colitis is a disease caused by inflammation of the lining of the colon, which can be caused by infection, allergic reactions, or inflammatory bowel disease. Diverticulitis is a gastrointestinal disease that forms in the wall of the colon and inflames the diverticula.

Colitis is an inflammation of the inner lining of the large intestine. Infection, inflammatory bowel disease, ischemic colitis, allergic reactions, and small colitis are just some of the causes of colitis.

Diverticulitis, especially colonic diverticulitis, is a gastrointestinal disease. It can form in the colon wall and cause diverticula to become inflamed.

Comparison table

Comparison parameters
Definition digestive system.	Diverticulitis is inflammation of a diverticulum, especially in the colon and intestines.
Location	Rectum, colon, lower intestine.	Lower abdomen.
symptoms	Severe stomach discomfort and tenderness, diarrhea, fecal incontinence, flatulence, emaciation, loss of appetite, and unexplained weight loss are all symptoms of this condition.	pain in the lower quadrant of the abdomen, dizziness, diarrhea and blood in the stool.
Diagnostic method	Colon x-ray, fecal analysis, sigmoidoscopy and colonoscopy.	Fecal analysis, CT, colonoscopy.
Type	Ulcerative colitis, microscopic colitis, pseudomembranous colitis, ischemic colitis and Crohn’s colitis.	Simple or complex.
Risk of cancer	High risk of cancer.	Negligible risk of cancer.

What is colitis?

The large intestine, often referred to as the large intestine, becomes inflamed in colitis. If you have colitis, you will have abdominal discomfort and pain that can range from mild to severe and come on quickly.

Colitis is not cured by nutrition. However, finding a balance between getting the nutrients you need and avoiding foods that can make your symptoms worse can help you manage your illness.

The colon is home to several microorganisms that coexist with the body and do not cause any symptoms. The most common species are Shigella, Campylobacter, Ecoli, Escherichia and Yersinia. bacteria that cause colitis.

Treatment for colitis is determined by the underlying cause and often focuses on the symptoms. reduction, supportive care, adequate hydration and analgesia.

What is diverticulitis?

Diverticulitis is a type of colitis, which is an inflammatory bowel disease. It can be serious and require surgery if not treated quickly.

Diverticulitis develops when the thin necks of diverticula become clogged with debris or indigestible food, and bacteria proliferate in blind sacs unchecked by the normal movement that keeps the intestines clean.

There are some indications that patients with diverticula, which are precursors of acute diverticulitis, have mild chronic inflammation.

Indigestion diverticulosis affects a large number of people in wealthy Western countries. Although most people with diverticular disease are asymptomatic, 10 to 25% of people with diverticulosis develop diverticulitis.

Key differences between colitis and diverticulitis

1. Inflammation in ulcerative colitis begins in the rectum and can spread to the large intestine. While diverticulitis pain is usually felt on the lower left side of the abdomen.
2. A person’s risk of developing cancer increases by about 0.5–1% each year after 8–10 years of non-specific ulcerative colitis. On the other hand, diverticulitis is associated with a very low risk of cancer.

Recommendations

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1981500/
2. https://www.nejm.org/doi/full/10.1056/nejmcp073228

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Piyush Yadav has worked as a physicist in the local community for the last 25 years. He is a physicist passionate about making science more accessible to our readers. He holds a Bachelor of Science degree and a Graduate Diploma in Environmental Science. You can read more about him on his bio page.

Diverticular disease (diverticulosis) of the colon

What is diverticular disease (diverticulosis) of the colon?

Diverticula (lat. diverticulum – literally “branch”, “road to the side”) are saccular protrusions of all layers of the colon wall or only the mucous membrane and submucosal layer through a defect in the muscular layer.

Figure 1. Cross section of the colon. Diverticulum

Colon diverticulosis is a condition in which there is at least one diverticulum in the colon.

Figure 2. Diverticulosis of the left departments of the colon of the colon

diverticular disease – a disease characterized by clinical manifestations of the inflammatory process and its possible complications – abscesses, perforation of diverticuls, the formation of fistulas, peritonitis, as well as bleeding.

What is the anatomy of the large intestine?

To better understand the pathogenesis of diverticular disease, consider the anatomy of the colon. The large intestine is a hollow muscular organ – a “tube” located in the abdominal cavity in the shape of a “horseshoe”, and is the final section of the gastrointestinal tract, where the formation and evacuation of feces occurs. It consists of the following sections: appendix, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.

The wall of the large intestine consists of four layers: mucous, submucosal, muscular and serous.

The mucosa of the large intestine is its inner membrane facing the lumen. It is a thin layer of cells – a cylindrical epithelium. The mucous membrane lies on its own plate, consisting of loose fibrous connective tissue, in which the glands, blood and lymphatic vessels are located. In the deepest layer of the mucous membrane, on the border with the submucosa, there is a muscular plate of the mucous membrane. The epithelium of the mucous membrane performs an integumentary function, is a link between the wall of the large intestine and its lumen – it ensures the absorption of water, the synthesis of B and K vitamins by intestinal bacteria, the formation of fecal masses and their preparation for evacuation, releasing the required amount of mucus.

The submucosa is the layer of the colon wall following the muscularis mucosa. The submucosa contains blood vessels that feed the intestinal wall and nerve plexuses that coordinate its contractions. Due to the submucosa, the mucosa can shift in relation to the next layers of the colon wall and form folds.

The muscle fibers of the intestinal wall are arranged both circularly and longitudinally. This layer acts as a framework, and also ensures the promotion of fecal masses due to contractions.

Outside, the large intestine is covered with a thin “film” – a serous membrane.

For a better understanding of the mechanism of diverticulum formation, one should also pay attention to the peculiarities of the blood supply to the colon wall.

The colon is nourished from the system of the superior and inferior mesenteric arteries, which originate from the aorta, the main vessel of our body. Their branches form a single marginal vessel that accompanies the large intestine throughout its entire length. Feeding branches depart from the marginal vessel, passing through the muscle layer and branching in the submucosa. With an increase in pressure inside the intestine, sections of the muscular layer through which the feeding vessels pass can serve as a “gateway” for the formation of diverticula.

How does diverticular disease manifest itself?

Uncomplicated diverticulosis is usually asymptomatic – you may not even notice the disease. Diverticula may be an incidental finding during a routine examination. In this situation, no special treatment is required. Recommendations include regular medical supervision, a diet high in fiber and low in refined carbohydrates, and regular physical activity and weight management.

The difficulty of timely detection of diverticular disease lies in the absence of specific symptoms. The clinical picture is presented mainly by cramping pains mainly on the left lower abdomen, increased gas formation, unstable stools with a tendency to constipation or with alternating constipation and diarrhea. Such complaints are mainly associated with dysmotility of the colon.

When they see a doctor, such patients are usually diagnosed with irritable bowel syndrome or dolichosigma, the patient is reassured, an abdominal ultrasound is recommended, and after light therapy, they are sent “home”.

However, in the event of such complaints, a colonoscopy is mandatory! The above symptoms can be manifestations not only of diverticular disease, but also of many other diseases of the colon, the timely detection of which can significantly improve the results of treatment.

Figure 3. Colonoscopy. Orifices of diverticula are visible

The clinical picture of diverticulitis is significantly different. Severe abdominal pain, bloating, lack of stool, may be accompanied by fever, nausea, and vomiting. Such complaints require urgent hospitalization in the coloproctology department, where patients receive antibacterial, anti-inflammatory therapy, and if this treatment is not effective enough, surgical intervention may be necessary.

The main cause of inflammation of a diverticulum – diverticulitis – is the ingress of dense stool into it, unable to come back. At this stage, inflammatory changes and the formation of an infiltrate (seal) of the surrounding tissues occur.

What causes diverticula?

Often at the doctor’s office, patients diagnosed with diverticular disease ask the question: “Why did this disease develop?” What are the causes of this disease? A large amount of information on the Internet does not always give a clear explanation. Let’s try to tell in more detail.

We believe that all the main causes of diverticular disease can be divided into two interrelated groups:

• Increased pressure in the intestinal lumen;
• Weakness of the intestinal wall.

Deficiency of vegetable fiber in the diet leads to a decrease in volume and an increase in the density of feces, which causes disturbances in the motor activity of the large intestine: even to a slight irritation, it reacts with chaotic contractions. Thus, short closed segments of the intestine with increased intraluminal pressure appear, which leads to bulging of the mucosa through the “weak” sections of the intestinal wall – the places where the blood vessels pass.

For a clear understanding of the formation of a diverticulum, we offer you an interesting comparison:

“The wall of the intestine is similar to the layered structure of a soccer ball – strong and hard skin on the outside, and a soft but elastic rubber chamber inside.

Now imagine that a hole, a hole, is formed in the outer hard shell of this ball. What will happen then? The high pressure inside the ball will push part of the soft and elastic inner rubber chamber outward: a pocket protruding outward is formed. This can be compared with a hernia on the abdomen – through a defect in the muscles, the contents “bulge out” outward.

Approximately the same thing happens with the large intestine in diverticulosis. If the pressure inside the intestinal lumen is large, and there are weak spots in the muscular layer, then the inner lining of the intestine tends outward through these holes, forming protrusions in the form of sacs. They are called diverticula.”

What tests should be performed if diverticular disease is suspected?

The first step in the diagnosis of diverticular disease without exacerbation is a colonoscopy. With the help of a video camera inserted through the anus, more than a meter of the intestine is examined – the entire large intestine and the final section of the small intestine. Colonoscopy allows not only to see the presence of a diverticulum, but also to determine the size of its gate, the condition of the wall, and the exact localization. If other changes are found in the intestine, colonoscopy allows you to take a piece of tissue for examination – perform a biopsy with further histological examination in order to understand the microscopic structure of the changes. This study can be performed under light anesthesia, which allows you to completely save the patient from the discomfort associated with the procedure.

The “gold standard” for diagnosing diverticular disease is barium enema. This method allows you to determine the number of diverticula, their exact location, size and shape. The essence of the procedure is the introduction of a radiopaque preparation into the colon, after which a series of x-ray images are taken to assess the condition of the colon. In the presented photographs, the arrows indicate the orifices of the colonic diverticula. We marked with blue arrows multiple diverticula of the colon. This is what they look like on a CT scan.

Figure 4. Irrigoscopy. Diverticulosis of the colon

X-rays taken during irrigoscopy clearly show multiple colonic diverticula. They look like sacs filled with radiopaque.

Equally important methods are ultrasound diagnostics and computed tomography. Due to its minimally invasiveness, ease of implementation, ultrasound diagnostics is very relevant at the stage of the initial examination. It allows you to see the presence of diverticula, identify indirect signs of their inflammation, such as infiltration, abscess, or suggest a generalized form – peritonitis.

In order to clarify the data obtained during the ultrasound examination, in case of doubt and to clarify the diagnosis, a spiral computed tomography is performed. Virtual computed tomography allows you to recreate a three-dimensional image of the colon, including the affected areas. Using this technique, you can accurately determine the boundaries of the infiltrate or abscess, other organs involved in the inflammatory process.

Figure 5. Virtual colonoscopy. Orifice of diverticulum

How to treat diverticular disease, diverticulosis and diverticulitis?

Medical treatment

When treated promptly, diverticulitis responds very well to medical treatment. Inflammatory changes are completely cured with the help of antibacterial and anti-inflammatory therapy.

In case of complications in patients, the treatment method should be selected as less traumatic and minimally invasive. The infiltrate can be completely cured with medication. The abscess can be punctured under ultrasound or CT guidance.

Surgical treatment

In case of peritonitis and the need for surgery in the early stages of the disease, intervention can be performed laparoscopically – through small punctures. Unfortunately, the development of fecal peritonitis usually requires a laparotomy – a “large incision” for thorough washing and examination of the abdominal cavity.

Surgical treatment of diverticular disease outside periods of exacerbation is especially important for active travelers, as well as patients living far from district centers. If an exacerbation of the disease occurs away from centers where you can get quality medical care, the consequences can be the most unpleasant. If there are three or more attacks of diverticulitis per year, the patient should contact the coloproctology department to determine the optimal treatment tactics outside the exacerbation period. If surgical treatment is necessary, the operation of choice in this case is the laparoscopic removal of the affected area of ​​the colon and the rectosigmoid junction as one of the causes of increased pressure in the intestinal lumen. Removal of the stoma (even temporarily) in this case is not required.

When is emergency surgery needed?

Urgent surgery is necessary if purulent inflammation spreads to the peritoneum, i.e. peritonitis, which is a life-threatening complication.

Is the bowel always exposed to the anterior abdominal wall during an emergency operation?

This issue is decided individually for each patient. Of course, the formation of a stoma is not shown in 100% of cases.

Benefits of minimally invasive surgery for diverticulosis and diverticulitis

The main advantages of minimally invasive surgeries are a satisfactory cosmetic effect (there are no large scars on the anterior abdominal wall) and a faster patient recovery after surgery.

Will the intestine be exposed to the anterior abdominal wall (stoma formation) during a planned operation?

In elective surgery for diverticulosis, the formation of an intestinal stoma is almost never required.

What happens after the operation?

You can celebrate your recovery with your friends by strictly following your diet and doctor’s orders.

Are there ways to prevent recurrence/recurrence of the disease?

First of all, avoid constipation and eating foods with small particles – nuts, seeds, fruits and vegetables with small stones.