Ulcerative Colitis vs. Diverticulitis: What’s the Difference?

Written by Shishira Sreenivas

• Ulcerative Colitis and Diverticulitis: Similarities and Differences
• How Are Symptoms the Same and Different?
• How Are Causes and Risk Factors the Same and Different?
• How Is Diagnosis the Same and Different?
• How Is Treatment the Same and Different?
• Ulcerative Colitis and Diverticulitis: What’s the Outlook?
• More

If you’ve had stomach pain for a while and see blood when you poop, you might have ulcerative colitis (UC) or diverticulitis. The two conditions are different, but some of their symptoms can be the same because they’re both conditions in the large intestine or colon.

UC is a type of inflammatory bowel disease (IBD) that irritates the lining in your large intestine (also known as the colon). This causes tiny open sores, called ulcers, that produce pus and mucous.

Diverticulitis is a condition that you have when one or more tiny, bulging pouches (called diverticula) form over weak spots in the colon wall, and then tear and become infected or inflamed. Diverticula are usually pea-sized and can form anywhere throughout the colon. But they’re commonly found in the lower-left side of your large intestine called the sigmoid colon.

UC and diverticulitis both start out in the large intestine and share symptoms like belly pain and bloody poop. Both conditions are more likely the older you get, and both can range from mild to severe and vary for each person. But they differ in terms of what causes them and how your doctor might treat them.

UC is a lifelong condition that can lead to life-threatening problems. About a million Americans are affected by it. It can affect people at any age, including those in their 20s and 30s. If you have UC, you also might have weight loss or arthritis.

Diverticulitis, not a lifelong condition, is a complication of “diverticulosis.” It’s the term doctors use when one or more of the small bulging sacs grow on your colon wall. It usually starts in middle age and it’s common in older people. Diverticulitis can happen to you once and never happen again, or it might come and go. About 50% of those over the age of 60 have it, and almost everyone above 80 has it, too. Most are mild cases that don’t cause any symptoms and aren’t reasons to worry. Up to 30% of the people with diverticulosis go on to have diverticulitis. And among them, anywhere between 5%-15% will have symptoms like bloody poop.

UC and diverticulitis have some of the same symptoms, but they also have some that are different.

Shared ones include:

• Belly pain
• Cramping
• Diarrhea
• Bleeding
• Fever

If you have one or more of these symptoms, talk to your doctor. UC symptoms also include:

• Urgency to poop
• Trouble pooping despite the urgency
• Weight loss
• Fatigue
• Lack of growth in children

Diverticulitis symptoms also include:

• Nausea
• Vomiting
• Swelling or bloating
• Constipation

It’s important to note that if you have diverticulitis, you’re more likely to have constipation than diarrhea.

Doctors aren’t sure what causes you to get UC or diverticulitis, but the two conditions have some common risk factors:

• Age. Your odds for either condition go up as you get older.
• Race. White people are more likely than those of any other race to have UC or diverticulitis.

UC might be caused by an abnormal immune response in your body. This means that if your immune system is fighting off a virus or bacteria, it may mistakenly attack cells in your digestive tract, too.

Genes might also play a role. If a close relative like your parent or sibling has UC, you’re more likely to have it, too. If you’re of Ashkenazi Jewish descent (ancestors came from Eastern or Central Europe), your risk is even higher. Diet and stress don’t cause UC, but they may trigger your symptoms and cause flare-ups.

As for what causes diverticulitis, experts believe bacteria found in your poop might get pushed into the bulging sacs as it passes through the colon. This causes the sacs to become infected or inflamed. Another theory is that your poop, especially if you’re constipated, might put a lot of pressure against the colon walls as it passes through. This can cause tears in the sacs and increase your chances of an infection.

Other risk factors for diverticulitis include:

• Obesity
• Smoking
• Lack of exercise
• Diet low in fiber and high in animal fat
• Certain medications (like steroids, opioids, and nonsteroidal anti-inflammatory drugs like ibuprofen)

If you think you have either UC or diverticulitis, talk to your doctor about it. You might be referred to a gastroenterologist, a doctor who specializes in digestive issues, for a correct diagnosis.

Your doctor will first do a detailed medical exam. They’ll ask you about your medical history including things like your diet, your bowel movements, and medications you might be taking.

Common tests to diagnose UC and diverticulitis include:

• Blood tests. This is done to check for infections
• Stool sample test. This checks for bacteria or parasites that might cause your stomach pain, cramps, or diarrhea
• Colonoscopy. The doctor will use a thin, flexible tube with a camera on the tip to explore your entire colon. They may take small tissue samples to test.
• Flexible sigmoidoscopy. This is similar to a colonoscopy, except your doctor will only explore your rectum and s-shaped sigmoid colon – both of which are located at the lower end of your colon. This is usually done if you have severe inflammation.
• Barium enema. This test is also called lower gastrointestinal tract radiography. In this test, your doctor injects a liquid containing barium into your butt. The barium coats your entire colon and makes it easier to see clearly under an X-ray scan.
• CT scan. This test allows your doctor to scan your abdomen and pelvic area and spot inflamed areas in your colon. The scan can detect the irritated or inflamed pouches for diverticulitis and confirm the condition.

In both conditions, treatments usually involve medications or, sometimes, surgery. In severe cases, your doctor may recommend a combination of the two to bring your symptoms under control. Certain over-the-counter medications may ease some of your pain-related symptoms. These include:

• Anti-diarrheal medications
• Pain relievers
• Antispasmodics to ease cramps and bloating
• Iron supplements, especially if you’re bleeding

UC treatments may include:

Anti-inflammatory drugs. This is usually the first line of treatment. This can include drugs like 5-aminosalicylates and corticosteroids. Some newer drugs like sulfasalazine and 5-ASAs (like mesalamine), which are called “steroid-sparing,” can be safely taken long-term. Your doctor may not want you to take steroids long-term because of their side effects.

Immunosuppressant drugs. This helps to reduce inflammation in your colon and cut down the immune response that might attack your digestive cells.

Biologics. This targets the proteins made by your immune system.

Surgery. About 30% of people who have UC need surgery. It’s sometimes the only cure, especially if medications don’t ease your symptoms or they become too difficult to manage. Your doctor may consider a surgery called proctocolectomy.

In this procedure, your entire colon and rectum are removed. Most surgeries also involve a procedure in which your doctor will attach a pouch at the end of the small intestine or outside your body to pass poop directly into it.

Diverticulitis treatments may include:

Antibiotics. If your case is mild, your doctor may prescribe oral antibiotics to bring the symptoms under control. If you have multiple bouts of diverticulitis episodes, you’ll need to go to the hospital for intravenous (IV) antibiotics and fluids. At this point, your doctor may consider surgery as an option, too.

Surgery. Your doctor may recommend you have surgery for diverticulitis because of issues in your colon such as:

• Abscess (a type of walled-off infection)
• Obstruction
• Tears that cause pus or poop to leak into your stomach cavity
• Tunnel-like opening in the colon that connects with other organs (fistula)
• Continuous bleeding (if your diverticulitis is recurring)

In some cases, you may need a colostomy bag after surgery. It’s a pouch that’s attached outside of your body to pass poop into if your colon needs time to heal. Once your colon is healthy, your doctor might remove the colostomy bag.

UC is a lifelong condition, and your symptoms may come and go. About 30% of people with UC have severe symptoms, and flare-ups might happen more frequently. While medications often help, surgery may also be needed.

In contrast, most cases of diverticulitis, even though it’s also considered a lifelong condition, clear up with a 7- to 10-day course of antibiotics and plenty of rest. If you have severe symptoms, talk to your doctor about other treatment options.

Managing your diet and stress and making time for regular physical exercise are key to lowering your risks for both conditions. However, because some of the symptoms are specific, there are steps you can take to avoid your condition flaring up or getting worse.

To prevent diverticulitis, you should:

• Eat more fiber. This helps your poop move better in your digestive tract and reduces any pressure on the colon walls
• Drink lots of water, this prevents constipation.

If you’re not sure what to eat, talk to your doctor.

To lower your odds for UC or manage flare-ups, you should:

• Get plenty of sleep. This can ease emotional stress and keep your immune system in check.
• Avoid using too many nonsteroidal anti-inflammatory drugs (NSAIDs). For pain relief and fever, switch to alternatives like acetaminophen (Tylenol).
• Be careful when you take antibiotics. These drugs can trigger UC flare-ups. Let your doctor know if it does.

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Ulcerative Colitis vs. Diverticulitis: What’s the Difference?

Written by Shishira Sreenivas

• Ulcerative Colitis and Diverticulitis: Similarities and Differences
• How Are Symptoms the Same and Different?
• How Are Causes and Risk Factors the Same and Different?
• How Is Diagnosis the Same and Different?
• How Is Treatment the Same and Different?
• Ulcerative Colitis and Diverticulitis: What’s the Outlook?
• More

If you’ve had stomach pain for a while and see blood when you poop, you might have ulcerative colitis (UC) or diverticulitis. The two conditions are different, but some of their symptoms can be the same because they’re both conditions in the large intestine or colon.

UC is a type of inflammatory bowel disease (IBD) that irritates the lining in your large intestine (also known as the colon). This causes tiny open sores, called ulcers, that produce pus and mucous.

Diverticulitis is a condition that you have when one or more tiny, bulging pouches (called diverticula) form over weak spots in the colon wall, and then tear and become infected or inflamed. Diverticula are usually pea-sized and can form anywhere throughout the colon. But they’re commonly found in the lower-left side of your large intestine called the sigmoid colon.

UC and diverticulitis both start out in the large intestine and share symptoms like belly pain and bloody poop. Both conditions are more likely the older you get, and both can range from mild to severe and vary for each person. But they differ in terms of what causes them and how your doctor might treat them.

UC is a lifelong condition that can lead to life-threatening problems. About a million Americans are affected by it. It can affect people at any age, including those in their 20s and 30s. If you have UC, you also might have weight loss or arthritis.

Diverticulitis, not a lifelong condition, is a complication of “diverticulosis.” It’s the term doctors use when one or more of the small bulging sacs grow on your colon wall. It usually starts in middle age and it’s common in older people. Diverticulitis can happen to you once and never happen again, or it might come and go. About 50% of those over the age of 60 have it, and almost everyone above 80 has it, too. Most are mild cases that don’t cause any symptoms and aren’t reasons to worry. Up to 30% of the people with diverticulosis go on to have diverticulitis. And among them, anywhere between 5%-15% will have symptoms like bloody poop.

UC and diverticulitis have some of the same symptoms, but they also have some that are different.

Shared ones include:

• Belly pain
• Cramping
• Diarrhea
• Bleeding
• Fever

If you have one or more of these symptoms, talk to your doctor. UC symptoms also include:

• Urgency to poop
• Trouble pooping despite the urgency
• Weight loss
• Fatigue
• Lack of growth in children

Diverticulitis symptoms also include:

• Nausea
• Vomiting
• Swelling or bloating
• Constipation

It’s important to note that if you have diverticulitis, you’re more likely to have constipation than diarrhea.

Doctors aren’t sure what causes you to get UC or diverticulitis, but the two conditions have some common risk factors:

• Age. Your odds for either condition go up as you get older.
• Race. White people are more likely than those of any other race to have UC or diverticulitis.

UC might be caused by an abnormal immune response in your body. This means that if your immune system is fighting off a virus or bacteria, it may mistakenly attack cells in your digestive tract, too.

Genes might also play a role. If a close relative like your parent or sibling has UC, you’re more likely to have it, too. If you’re of Ashkenazi Jewish descent (ancestors came from Eastern or Central Europe), your risk is even higher. Diet and stress don’t cause UC, but they may trigger your symptoms and cause flare-ups.

As for what causes diverticulitis, experts believe bacteria found in your poop might get pushed into the bulging sacs as it passes through the colon. This causes the sacs to become infected or inflamed. Another theory is that your poop, especially if you’re constipated, might put a lot of pressure against the colon walls as it passes through. This can cause tears in the sacs and increase your chances of an infection.

Other risk factors for diverticulitis include:

• Obesity
• Smoking
• Lack of exercise
• Diet low in fiber and high in animal fat
• Certain medications (like steroids, opioids, and nonsteroidal anti-inflammatory drugs like ibuprofen)

If you think you have either UC or diverticulitis, talk to your doctor about it. You might be referred to a gastroenterologist, a doctor who specializes in digestive issues, for a correct diagnosis.

Your doctor will first do a detailed medical exam. They’ll ask you about your medical history including things like your diet, your bowel movements, and medications you might be taking.

Common tests to diagnose UC and diverticulitis include:

• Blood tests. This is done to check for infections
• Stool sample test. This checks for bacteria or parasites that might cause your stomach pain, cramps, or diarrhea
• Colonoscopy. The doctor will use a thin, flexible tube with a camera on the tip to explore your entire colon. They may take small tissue samples to test.
• Flexible sigmoidoscopy. This is similar to a colonoscopy, except your doctor will only explore your rectum and s-shaped sigmoid colon – both of which are located at the lower end of your colon. This is usually done if you have severe inflammation.
• Barium enema. This test is also called lower gastrointestinal tract radiography. In this test, your doctor injects a liquid containing barium into your butt. The barium coats your entire colon and makes it easier to see clearly under an X-ray scan.
• CT scan. This test allows your doctor to scan your abdomen and pelvic area and spot inflamed areas in your colon. The scan can detect the irritated or inflamed pouches for diverticulitis and confirm the condition.

In both conditions, treatments usually involve medications or, sometimes, surgery. In severe cases, your doctor may recommend a combination of the two to bring your symptoms under control. Certain over-the-counter medications may ease some of your pain-related symptoms. These include:

• Anti-diarrheal medications
• Pain relievers
• Antispasmodics to ease cramps and bloating
• Iron supplements, especially if you’re bleeding

UC treatments may include:

Anti-inflammatory drugs. This is usually the first line of treatment. This can include drugs like 5-aminosalicylates and corticosteroids. Some newer drugs like sulfasalazine and 5-ASAs (like mesalamine), which are called “steroid-sparing,” can be safely taken long-term. Your doctor may not want you to take steroids long-term because of their side effects.

Immunosuppressant drugs. This helps to reduce inflammation in your colon and cut down the immune response that might attack your digestive cells.

Biologics. This targets the proteins made by your immune system.

Surgery. About 30% of people who have UC need surgery. It’s sometimes the only cure, especially if medications don’t ease your symptoms or they become too difficult to manage. Your doctor may consider a surgery called proctocolectomy.

In this procedure, your entire colon and rectum are removed. Most surgeries also involve a procedure in which your doctor will attach a pouch at the end of the small intestine or outside your body to pass poop directly into it.

Diverticulitis treatments may include:

Antibiotics. If your case is mild, your doctor may prescribe oral antibiotics to bring the symptoms under control. If you have multiple bouts of diverticulitis episodes, you’ll need to go to the hospital for intravenous (IV) antibiotics and fluids. At this point, your doctor may consider surgery as an option, too.

Surgery. Your doctor may recommend you have surgery for diverticulitis because of issues in your colon such as:

• Abscess (a type of walled-off infection)
• Obstruction
• Tears that cause pus or poop to leak into your stomach cavity
• Tunnel-like opening in the colon that connects with other organs (fistula)
• Continuous bleeding (if your diverticulitis is recurring)

In some cases, you may need a colostomy bag after surgery. It’s a pouch that’s attached outside of your body to pass poop into if your colon needs time to heal. Once your colon is healthy, your doctor might remove the colostomy bag.

UC is a lifelong condition, and your symptoms may come and go. About 30% of people with UC have severe symptoms, and flare-ups might happen more frequently. While medications often help, surgery may also be needed.

In contrast, most cases of diverticulitis, even though it’s also considered a lifelong condition, clear up with a 7- to 10-day course of antibiotics and plenty of rest. If you have severe symptoms, talk to your doctor about other treatment options.

Managing your diet and stress and making time for regular physical exercise are key to lowering your risks for both conditions. However, because some of the symptoms are specific, there are steps you can take to avoid your condition flaring up or getting worse.

To prevent diverticulitis, you should:

• Eat more fiber. This helps your poop move better in your digestive tract and reduces any pressure on the colon walls
• Drink lots of water, this prevents constipation.

If you’re not sure what to eat, talk to your doctor.

To lower your odds for UC or manage flare-ups, you should:

• Get plenty of sleep. This can ease emotional stress and keep your immune system in check.
• Avoid using too many nonsteroidal anti-inflammatory drugs (NSAIDs). For pain relief and fever, switch to alternatives like acetaminophen (Tylenol).
• Be careful when you take antibiotics. These drugs can trigger UC flare-ups. Let your doctor know if it does.

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Onco Wiki – What diseases occur in the intestines?

Diseases of the large intestine

Diseases of the large intestine are infectious, inflammatory, acute, chronic.

Their symptoms can be similar, so you should always consult a doctor to find out what kind of disease it is and how to treat it.

Colitis (colitis, from the Greek kolon – large intestine, itis – inflammation) – inflammation of the large intestine. Infectious colitis is caused by:

• bacteria,
• viruses,
• helminths.

Ulcerative colitis is a chronic condition in which the lining of the large intestine becomes inflamed and ulcerated, leading to bleeding and diarrhea. In ulcerative colitis, only the large intestine is affected.

Crohn’s disease is a chronic inflammatory disease that can affect the gastrointestinal tract from the mouth to the anus. Ulcerative colitis and Crohn’s disease are similar in mechanism of occurrence. This is a condition in which the body’s immune system attacks healthy tissues, resulting in ulcers on the mucous membranes.

Infectious and inflammatory diseases of the large intestine are manifested by diarrhea, possibly with an admixture of blood, pain in the abdomen, in the rectum, and also with fever.

Ulcers can lead to loss of blood, protein and electrolytes, so it is very important to control exacerbations and see a gastroenterologist.

Diverticula – sac-like protrusions of the colon wall. The condition when present is called diverticulosis. It usually does not manifest itself in any way, but at 4% of cases develop diverticulitis – inflammation of the diverticulum. Main symptoms:

• abdominal pain,
• fever,
• constipation or diarrhoea.

Surgery may be required due to complications of diverticulitis:

• intestinal obstruction,
• bleeding.

benign colon neoplasms include polyps . They grow from the wall into the intestinal lumen and usually do not manifest themselves clinically. You can read more about them in the article “What are intestinal polyps? Why are they dangerous? For larger sizes polyp occur:

• abdominal pain,
• constipation,
• diarrhea,
• nausea.

Rectal mass may be palpable on digital rectal examination. For a complete diagnosis, a colonoscopy is necessary.

Polyps found during colonoscopy are removed by the doctor and sent for histological examination.

Multiple colonic polyps (usually more than 100) may be a symptom familial adenomatous polyposis intestine. Read more in the article.

Diagnosis of diseases of the large intestine is carried out using:

• laboratory tests,
• Colonoscopy,
• biopsies.

What diseases can occur in the rectum?

Hemorrhoids – varicose veins in the lower part of the rectum. In , 40% of cases are asymptomatic. Manifested by bleeding from the nodes, pain, itching, constipation and anemia (anemia, decreased hemoglobin in the blood). Hemorrhoids may be visible from the outside or hidden in the rectum. They are not life-threatening, but cause significant discomfort. It is necessary to visit a doctor to rule out other diseases of the rectum and colon. A doctor may relieve symptoms with medication or remove the nodes with surgery.

Proctitis – inflammation of the rectum, occurs in many diseases, infectious (gonorrhea, chlamydia, shigellosis, salmonellosis …), inflammatory, as well as after radiation therapy to the pelvic area. Accompanied by a feeling of incomplete emptying, the release of blood and mucus from the rectum. To understand the cause of the disease, a doctor is needed.

Anal fissures is one of the most common causes of pain in the rectum, which usually appears or worsens during bowel movements. Cracked toilet paper leaves traces of blood. Causes can be diarrhea, constipation, childbirth, anal sex. In addition, fissures can be a symptom of other colon diseases, such as Crohn’s disease. It is necessary to visit a doctor for an accurate diagnosis and choice of treatment tactics.

Which bowel diseases can turn into cancer?

Ulcerative colitis and Crohn’s disease are risk factors for malignant neoplasms of the intestine. You can also read about this in the article “Who is at higher risk of getting colon cancer?”. The risk of developing colorectal cancer in these patients is higher than in the general population. To detect colorectal cancer as early as possible, most experts recommend starting colon cancer screening (colonoscopy) eight years after symptom onset , and be carried out regularly, annually or every other year.

Polyps do not always turn into cancer, this happens more often with hereditary diseases. For example, with familial adenomatous polyposis syndrome , the risk can be up to 100%. It is important to undergo a colonoscopy, then polyps can be detected and removed.

When should I contact an oncologist?

Consult an oncologist to rule out colon cancer and set a personalized screening schedule for any suspicious symptoms:

• constipation,
• diarrhea,
• blood,
• mucus in stool.

In addition, you should visit an oncologist if there are signs of malignancy based on the results of a colonoscopy.

Conclusions

• Inflammatory bowel diseases include ulcerative colitis and Crohn’s disease. These are cancer risk factors that require screening for colon cancer on a special schedule.
• Polyps – benign neoplasms of the colon, prone to malignant degeneration.
• The most common diseases of the colon are hemorrhoids, proctitis and anal fissure.
• The manifestations of diseases of the colon are very similar, therefore, with any symptoms, it is necessary to visit a doctor for an accurate diagnosis and choice of treatment tactics.

What else to read?

1. Osmosis resource about Crohn’s disease (in English).
2. Osmosis Video on Ulcerative Colitis (in English).
3. Osmosis video on diverticulitis (in English).
4. UpToDate Article for patients on Crohn’s disease (in English).
5. UpToDate Hemorrhoid Patient Article (in English).
6. Video about hemorrhoids (in English).
7. Osmosis Colon Polyp Video (in English).

Anastasia Kazantseva

Resident oncologist, chemotherapist, resident of the Higher School of Oncology

September 11, 2022

| Alone Clinic

Diverticula are small, bulging sacs that can form in the lining of the digestive system (esophagus or intestines). They are most often found in the lower part of the large intestine. Diverticula occur predominantly in people over 40 years of age.

The presence of diverticula in the colon is known as diverticulosis. When one or more sacs become inflamed and in some cases become infected, the condition is called diverticulitis. Diverticulitis can cause severe abdominal pain, fever, nausea, and marked changes in bowel function.

Mild diverticulitis can be treated with rest, dietary changes, and antibiotics. Severe or recurrent diverticulitis may require surgery.

Causes of diverticulitis

The reasons for the appearance of diverticula in the intestine are still the subject of controversy by most scientists and physicians. Some studies show that genetic predisposition plays a role.

The sacs in the intestine become inflamed or infected when they are torn or clogged with feces. If there are more bad microbes in the gut than good ones, this can also cause disease.

The chances of getting diverticulitis increase with age. The disease is more common in people over 40 years of age. Other risk factors include:

• overweight,
• smoking,
• insufficient physical activity,
• eating large amounts of fat and red meat,
• fiber deficiency,
• certain types of medications, including steroids, opioids, and non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen.

Symptoms of diverticulitis

Signs and symptoms of diverticulitis include:

• Pain that may be constant and persist for several days. The pain is usually felt in the left lower abdomen. In some patients, the right side of the abdomen may be more painful.
• Nausea and vomiting.
• Fever.
• Heaviness in the abdomen.
• Constipation or, less commonly, diarrhoea.

Diagnosis of diverticulitis

Colonic diverticulitis or diverticulosis can be diagnosed by endoscopy (colonoscopy), CT, MRI, or barium enema.

You can undergo a comprehensive examination by a proctologist and sign up for a colonoscopy procedure in the city of Kirov at the Naedine Clinic. Our doctors and endoscopists specialize in diagnosing and treating major diseases of the gastrointestinal tract. First-class equipment, strict requirements for disinfection, long-term qualification of specialists – all this guarantees a high level of medical services and a caring attitude to the health of each patient.

Treatment of intestinal diverticulosis

For patients with uncomplicated diverticulosis, doctors may recommend home treatment.