IBS and Diverticulitis: Differences, Causes, Treatments

Irritable bowel syndrome (IBS) refers to a group of symptoms that affect your digestive system. It often includes abdominal pain, diarrhea, constipation, and bloating.

Diverticulitis falls into a group of diseases called diverticular disease. It’s characterized by inflammation of bulging pouches in your digestive tract called diverticula.

Some studies suggest that IBS is more common among people with diverticular disease, but the connection still is not clear.

Keep reading to learn more about the similarities and differences between IBS and diverticulitis and how they may be linked.

	IBS	Diverticulitis
Common symptoms	• constipation • abdominal pain • cramps • bloating • diarrhea	• constipation • abdominal pain • nausea and vomiting • fever • diarrhea (less common)
Causes	not completely known	inflammation of pouches in your intestines called diverticula
Prevalence	affects about 10 to 15 percent of people	• affects about 15 percent of people over age 60 who have diverticulosis (the presence of pouches) • about 200,000 people hospitalized with diverticulitis each year in the United States
Sex differences	1. 5 to 2 times more common in women than men	• under age 50, more common in men • over age 50, more common in women
Most common age	most commonly onsets in people younger than 50	• more common in older adults • average age of hospital admission is 63 years old

IBS is a common gastrointestinal disease. It’s characterized by abdominal pain and changes in the frequency and quality of your bowel movements. Symptoms tend to flare up periodically.

How IBS develops still is not well understood. But it’s been linked to:

• food passing through your gut too quickly or slowly
• an oversensitivity of the nerves in your gut
• stress
• family history (genetics)

Diverticulitis is a condition that develops in your large intestine (also called your colon). It’s caused by an infection in a diverticulum, which is a weakened area of your colon wall that can bulge out and form a pocket or pouch. Diverticula can range from pea-size to much larger pockets.

Diverticulitis develops when one of these pockets becomes inflamed and infected by bacteria in stool that gets pushed into the diverticula. You may feel pain in your abdomen and may also feel nauseous and feverish.

People with diverticulitis in Western societies, such as the United States or Europe, are much more likely to develop diverticula on their left side. But people of Asian descent are more likely to develop diverticula on their right side.

Some people have both IBS and diverticulitis, and misdiagnosis of the two conditions is common. A 2020 study found that about 1 in 5 initial cases of diverticulitis diagnosed without imaging were misdiagnosed.

Some studies suggest that some people with diverticular disease are more likely to develop IBS. But more research is needed to fully understand the link.

A 2014 study found that diverticular disease on the left side or both sides was associated with a higher risk of IBS in a Japanese population. Right-sided diverticular disease was not associated with this risk.

A 2020 study evaluated the association between IBS and diverticulitis. The researchers found that diverticulitis was 3.95 times more common in people with IBS than people without IBS. They also found that IBS was associated with a higher recurrence of diverticulitis.

Both diverticulitis and IBS can cause abdominal pain or discomfort. IBS pain usually relieves after a bowel movement, while diverticulitis pain is constant.

Diverticulitis most often causes pain in the lower left area of the abdomen. People of Asian descent are more likely to develop pain in their right side.

People with diverticulitis tend to be over 40 years old. Most cases of IBS develop before the age of 50.

Symptoms shared by both conditions include:

• abdominal pain
• constipation
• bloating

Symptoms more likely with IBS include:

• cramping
• mucus in bowel movements
• diarrhea
• pain easing after a bowel movement

Symptoms more likely with diverticulitis include:

• fever and chills
• nausea and vomiting
• abdominal tenderness
• pain coming on suddenly
• pain not easing after a bowel movement

The exact cause of IBS still is not known. It’s thought that an overly sensitive colon or immune system may contribute to this condition. Some evidence suggests that IBS is more common in people with diverticulitis.

Diverticulitis is caused by pouches in your large intestine that become inflamed and infected. These pouches can become inflamed or infected when bacteria or stool gets trapped in them.

Risk factors for diverticulitis include:

• a diet low in fiber and high in red meat
• physical inactivity
• obesity
• smoking
• a change in the balance of microbes (good bacteria) in your digestive tract
• the use of steroids and nonsteroidal anti-inflammatory drugs (NSAIDs)
• genetic factors

A doctor can diagnose IBS by:

• reviewing your symptoms
• performing a physical exam
• reviewing your medical and family history

To diagnose diverticulitis, a doctor will likely:

• check your abdomen for tenderness
• review your medical history
• ask you about your symptoms and medications

To help confirm their diagnosis, a doctor may perform additional tests, such as:

• blood tests
• stool culture
• colonoscopy
• upper endoscopy
• computed tomography (CT) scan or X-ray
• pelvic exam
• urine test
• pregnancy test

IBS does not have a cure. Lifestyle changes, such as avoiding certain foods and following home remedies, may offer some relief. Medications can also help manage symptoms.

Mild diverticulitis can often be treated at home with rest and by avoiding foods that make symptoms worse. A doctor may prescribe antibiotics. Serious cases may require hospitalization or surgery.

You may be able to relieve your IBS symptoms by:

• eating no more than 3 portions of fresh fruit per day
• drinking no more than 3 cups of tea or coffee per day
• following a low FODMAP diet
• eating your food slowly
• limiting or avoiding spicy, processed, or fatty foods
• limiting or avoiding fizzy drinks
• taking probiotics
• cooking most of your meals at home using fresh ingredients

You may be able to ease diverticulitis symptoms by:

• following a liquid diet until pain subsides
• adding more high fiber foods to your diet
• avoiding foods that seem to trigger your symptoms

Incorporating the following habits into your daily life may help prevent or reduce symptoms of IBS and diverticulitis:

• Keep a journal of your symptoms and the foods you eat. This may help you pinpoint the foods that are triggering your symptoms.
• Try to get regular exercise. Regular, moderate exercise can help boost your overall health and well-being as well as decrease the severity of IBS symptoms.
• Stay well-hydrated by drinking water or other sugar-free beverages throughout the day. Avoid drinks that are flavored with artificial sweeteners, as these are known to worsen gas and diarrhea if you have IBS.
• Limit or avoid tobacco, caffeine, and alcohol.
• Try to incorporate relaxation techniques into your daily life, like breathing exercises, yoga, or meditation.
• Reduce the nonessential use of NSAIDs.

IBS and diverticulitis are both gastrointestinal conditions that can cause symptoms such as abdominal discomfort and changes to your bowel movements. But they are not the same condition and have different causes.

How or why IBS develops is not well understood. On the other hand, diverticulitis is caused by the inflammation of pouches that can develop within weakened parts of the large intestine. This can be a serious condition that requires hospitalization if the symptoms become severe.

If you think you may have one of these conditions, contact a doctor to get a proper diagnosis. Once the condition has been accurately diagnosed, you can work with your doctor to build a treatment plan that’s right for you.

Is it diverticular disease or is it irritable bowel syndrome?

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Review

. 2012;30(1):64-9.

doi: 10.1159/000335721.

Epub 2012 May 3.

Robin Spiller 
¹

Affiliations

Affiliation

• ¹ NIHR Biomedical Research Unit, Nottingham Digestive Diseases Centre, Nottingham, UK. [email protected]

• PMID:

  22572688

• DOI:

  10.1159/000335721

Review

Robin Spiller.

Dig Dis.

2012.

. 2012;30(1):64-9.

doi: 10.1159/000335721.

Epub 2012 May 3.

Author

Robin Spiller 
¹

Affiliation

• ¹ NIHR Biomedical Research Unit, Nottingham Digestive Diseases Centre, Nottingham, UK. [email protected]

• PMID:

  22572688

• DOI:

  10.1159/000335721

Abstract

Symptomatic diverticular disease (SYMP-DD) and irritable bowel syndrome (IBS) share many features. Both are characterised by recurrent episodes of abdominal pain which may be slightly more frequent in IBS than SYMP-DD. They may also both exhibit an erratic bowel habit with diarrhoea, constipation and alternating types. It is important to assess anxiety, depression and somatisation since this can be increased in both types of patients and may be associated with visceral hypersensitivity. There are also significant differences between IBS and SYMP-DD. In particular, SYMP-DD patients are older, lack the female predominance seen in IBS and may often have fever with prolonged episodes of pain. For them, abnormalities of the gut are probably more important than cerebral factors, while for IBS the reverse is true. Treatments should be directed at the predominant abnormality which will vary in every patient.

Copyright © 2012 S. Karger AG, Basel.

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symptoms, diagnosis, treatment of diverticulitis – Department of the State Hospital NCC No. 2 (CCH RAS)

Diverticula are areas of the intestine in which protrusion of tissues is observed. When inflammation of these areas occurs, intestinal diverticulitis begins. Inflammation is provoked by fecal masses that enter the diverticula and accumulate in them, irritating the walls and leading to the development of infection. Long-term malnutrition is considered the main cause of the onset of the disease. Adult patients usually suffer from diverticulitis – it develops in women and men over 60 years of age.

Causes of disease

The main factor that provokes the disease is malnutrition. This refers to the use of a large number of semi-finished products, low-quality food rich in fat and refined foods. Also, malnutrition includes reduced fiber intake. It is fiber in food that helps the proper movement of the masses through the intestines.

Localization of diverticulitis

The disease can affect different parts of the intestine:

• Diverticulitis of the small intestine – multiple protrusions of the mucosa through weak spots in the walls. In this zone, diverticula appear much less frequently than in the colon. The cause is believed to be a failure of peristalsis.
• Diverticulitis of the large intestine – masses up to two centimeters, often affecting elderly patients. The reason is malnutrition, the predominance of animal food over plant food.
• Diverticulitis of the sigmoid colon – a degenerative tissue disorder that appears as a result of a violation of peristalsis and vascular pathologies.

Symptoms of diverticulitis

When the disease begins, its symptoms in most cases are absent. Only when the disease passes into the chronic stage, there are signs by which it can be identified. Among the warning signs that indicate the presence of problems:

• Bloating, excessive flatulence.
• Traces of blood in the stool.
• Increased body temperature.
• Pain in the lower abdomen and back.
• Nausea, vomiting.
• Decreased appetite.
• Cold sweat.

Disease diagnosis

This serious complication requires immediate diagnosis, analysis of symptoms and treatment. The initial task of the doctor is to distinguish diverticulitis from stomach ulcers and irritable bowel syndrome. It all starts with a patient interview, a medical history, and an initial examination. Diagnostic methods that are used for suspected diverticulitis:

• Colonoscopy
• Sigmoidoscopy
• Irrigoscopy
• Computed tomography of the intestine
• X-ray of the intestines
• ultrasound
• Clinical analysis of urine and blood

Treatment of disease

There is a resolution of diverticulitis without special treatment due to the normalization of nutrition and diet. With a serious stage of the disease, how to treat it is determined individually and often in a hospital. In this case, the patient is given antibiotics and other supportive drugs. The operation is performed in order to separate the affected part of the intestine. Such a measure is required quite rarely:

• If the disease is severely advanced. There are fistulas, perforations, abscesses.
• When antibiotics do not help get rid of the problem.
• There is bleeding, peritonitis.

Risk of complications

Most of the complications of diverticulitis are associated with perforation, leakage of feces through the walls of the intestine:

• Abscess – removal of the affected part or puncture is required.
• Peritonitis is the spread of infection into the abdominal cavity. The operation is necessary to cleanse the abdominal cavity and remove part of the intestine.
• Intestinal obstruction – scarring resulting in partial or complete occlusion of the lumen.
• Fistula – An abnormal connection of an organ or organ to the skin.

Which doctor to contact

With diverticulitis of the colon, an appointment with a proctologist and gastroenterologist is necessary to determine the causes of the disease. You may also need to consult a surgeon, therapist, endoscopy.

To get a consultation with a proctologist, to go through other specialists, the clinic NCC No. 2 (Central Clinical Hospital of the Russian Academy of Sciences) offers. We have only highly professional staff, modern methods of effective diagnosis and treatment of any diseases.

Diverticular disease (diverticulosis) of the colon

What is diverticular disease (diverticulosis) of the colon?

Diverticula (lat. diverticulum – literally “branch”, “road to the side”) are sac-like 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 parts of the colon .

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.

Colon mucosa 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 control.

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, surgical intervention may be necessary.

The main cause of inflammation of a diverticulum – diverticulitis – is the ingress of dense fecal masses into it, unable to come back out. 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: it reacts even to slight irritation 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 diverticula of the colon. 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?

An urgent operation 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 case of planned surgical interventions for diverticulosis, the formation of an intestinal stoma is almost never required.