Diverticulitis is a gastrointestinal disorder involving diverticula, pouches or pockets that can begin to form in the walls of the colon. When these pouches aren’t inflamed, the condition is known as diverticulosis. It becomes diverticulitis after the diverticula become infected or inflamed. Inflammation is what caused diverticulitis pain. Inflamed diverticula can be very painful, beyond causing flu-like symptoms and affecting your ability to eat.
Diverticulosis is extremely common in the United States, especially in older patients. Around one half of all Americans over the age of 60 have pouches in the colon wall, according to the National Institutes of Health, although only a portion of these patients will ever experience the symptoms of diverticulitis.
What Is Diverticulitis Caused By?
Mechanically, we know that diverticula form when naturally-weak portions of the intestinal wall give way, caving under the force of some pressure. High pressures inside the colon can push against these weak spots, eventually creating a small depression or pouch. The points where blood vessels pass through the colon’s muscular wall are especially weak, according to WebMD, and thus likely to become diverticula.
Once enough pressure builds, the pouches themselves can tear, creating inflammation or allowing bacteria to enter. Infection and inflammation are what cause the symptoms of diverticulitis. The infection can also spread, invading the abdominal wall to become peritonitis, an infection that can be life-threatening if left untreated.
1. Abnormal Colon Contractions
Some studies suggest that uncoordinated bowel movements, likely caused by neurological problems, can lead to the formation of pouches in the colon wall. On this theory, inefficient contractions of the large intestine, like those seen in people with irritable bowel syndrome, contribute to diverticulitis.
2. Low-Fiber Diets
The high pressures associated with diverticulitis have also been linked to low-fiber diets. Surprisingly, the condition is almost unheard of outside of the developed world. Scientists believe that diverticulitis is so rare in the developing world because people in less-developed countries eat relatively high-fiber diets, while people in richer countries eat less fiber on average.
With sufficient fiber in the diet, a person’s stool should be large and relatively soft, making it easy to pass through the intestinal canal. Too little fiber, however, and your stool becomes hard and small. The intestines have to work more strenuously – and for longer periods of time – to pass the stool, increasing pressure inside the colon. This pressure, researchers think, pushes against the intestinal wall, ultimately creating pouches.
Symptoms Of Diverticulitis
Beyond these mechanical details, researchers are still struggling to understand why people develop diverticulitis. Only around 20% of people who develop pouches in the colon wall will ultimately develop diverticulitis and experience symptoms. Doctors don’t yet understand why some people experience symptoms and others do not.
- Belly pain (most prevalent in the lower left abdomen; pain usually increases with movement)
- Abdominal bloating and gas
- Diarrhea or constipation
- Nausea and vomiting
- Difficulty eating
- Fever and chills
The symptoms of diverticulitis can last for weeks, or persist only for a matter of hours. Again, most patients won’t experience any symptoms.
How Do Doctors Diagnose Diverticulitis?
In order to diagnose diverticulitis, physicians will take a patient’s symptoms, lifestyle, diet and medical history into account, along with the results of medical tests:
- digital rectal examination – a doctor inserts a gloved finger into the rectum to check for blockages or abnormalities
- x-rays and CT scans – these diagnostic tests help physicians visualize the organs inside the abdomen and identify potential problems
- blood tests – these tests allow doctors to monitor for signs of infection and evaluate liver and kidney function, potentially ruling-out other diagnoses
- colonoscopy – using a flexible tube with a camera at one end, doctors can inspect the inside of the colon
- sigmoidoscopy – signoidocopes are similar to endoscopes, the instruments used during a colonoscopy, but don’t go as far into the colon, making procedures shorter
The presence of diverticula is often diagnosed during examinations for completely different diseases, like colon cancer. Diagnosing diverticulitis can be difficult, since the condition’s most notable symptoms “mimic” the effects of other disorders. Colon cancer and diverticulitis are often mistaken for one another, especially given the latter condition’s most severe side effect: rectal bleeding.
How Is Diverticulitis Treated?
The proper treatment for diverticulitis is highly dependent on the severity of a patient’s symptoms. Mild cases are often treated with oral antibiotics, to eliminate any infection, and liquid diets that can help soothe the intestine and reduce inflammation. Some healthcare professionals will recommend switching to a high-fiber diet or beginning to include fiber supplements in your daily routine. Mild pain medications are also usually suggested.
Severe cases, along with ones that don’t resolve after other treatments, may indicate surgery. Generally, this procedure involves surgically removing an infected portion of the colon. Surgery is usually reserved for patients with associated complications, like a fistula, or people who have experienced repeated attacks of diverticulitis.