Many of us know when something is wrong with our gut. For instance, we may have cramps, feel pain, or have a change in our bowel habits. But there is a common gastrointestinal (GI) problem — called diverticular disease — that many people don’t know they have until it is either discovered during a test or they develop symptoms.
There are two types of diverticular disease: diverticulosis and diverticulitis. They have similar names, so they can be confusing to patients who have diverticular disease. But they're two separate diagnoses that differ in seriousness and treatment.
As a gastroenterologist, it's important to me for patients to understand the difference. While diverticulosis and diverticulitis can't always be prevented, understanding the conditions and being aware of red-flag symptoms can help you get the treatment you need. And in some cases, it could even save your life.
How they differ
Diverticulosis and diverticulitis both occur in the colon. Diverticulosis is common and often goes unnoticed while diverticulitis is less common, causes pain, and can lead to complications.
- Diverticulosis happens when small pouches or sacs, called diverticula, develop in the colon wall. It doesn't typically cause symptoms and may go undetected until a person undergoes routine imaging tests or a procedure like a colonoscopy.
- Diverticulitis occurs when diverticula become inflamed or infected. Diverticulitis typically causes sudden, severe abdominal symptoms.
I tell my patients that diverticulosis can be a normal part of aging. It affects more than 30% of people ages 50 to 59 and more than 70% of people over 80. But less than 15% of people with diverticulosis develop diverticulitis.
Experts don't fully understand the cause of diverticulosis. It might develop from intestinal muscle spasms or straining during bowel movements, which could weaken the walls of the colon. Low-fiber diets, sedentary lifestyles, frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, smoking, and carrying excess body fat may increase diverticulitis risk. But there's no way to predict which people with diverticulosis will develop diverticulitis and which won't.
Spotting the symptoms
As I said before, diverticulosis doesn't often cause symptoms. But sometimes it can cause chronic problems like bloating, constipation, diarrhea, or abdominal pain (even when there aren't signs of diverticulitis).
Diverticulosis that turns into diverticulitis is more likely to cause severe symptoms, such as sudden abdominal pain. This pain more commonly occurs in the lower left side of their abdomen. The pain typically intensifies over several days and may be accompanied by fever, chills, nausea, vomiting, constipation, or diarrhea.
Sometimes diverticula — those small pouches or sacs — can bleed, even in the absence of diverticulitis. This happens when a small blood vessel in the wall of an individual pouch bursts. Diverticular bleeding isn't always painful, but it does cause a person to experience rectal bleeding or bloody stool. This bleeding can be severe or even life-threatening and warrants immediate medical attention.
Understanding the risks
Many patients with diverticulosis never go on to experience symptoms or problems like diverticulitis. But diverticulosis has the potential to cause diverticular bleeding.
Among those who do develop diverticulitis, about a quarter will experience serious complications. These can include:
- An abscess, where the infected pouch becomes swollen and filled with pus
- A fistula, where an abnormal passageway forms between the bowel and other organs
- Intestinal obstruction, or a blockage that prevents food, fluid, air, and stool from moving through the intestines
- A perforation, or hole in the colon
- Peritonitis, a life-threatening emergency that can occur if an infected pouch ruptures, causing the infection to spread to the abdominal cavity
Treating symptomatic diverticulosis and diverticulitis
There's no need for treatment if a patient's diverticulosis isn't causing symptoms. If their diverticulosis is causing mild abdominal symptoms, I'll encourage them to eat more high-fiber and probiotic-rich foods.
Diverticulitis typically requires treatment. Patients with mild symptoms often take antibiotics to clear the infection. I'll also usually recommend sticking with a liquid diet initially and reintroducing solid foods slowly while the bowel heals.
Diverticulitis that causes severe pain or complications may require hospitalization. At the hospital, patients will receive IV antibiotics and may need to have abscesses drained with a tube placed in the abdomen. In some cases, surgery or a temporary colostomy is the best treatment choice.
Diverticular bleeding needs immediate medical attention. It's possible that a patient's bleeding may stop on its own. But often procedures such as colonoscopy, angiogram, or surgery are used to stop the bleeding.
Preventing diverticular problems
Diverticulosis and diverticulitis can't always be prevented. It's possible that healthy habits could make diverticula less likely to form. Lifestyle changes may also play a role in helping people with diverticulosis avoid diverticulitis. Some of the strategies I recommend to patients include:
- Working toward a healthy weight. Excess body fat may increase the risk of diverticulosis and diverticulitis.
- Quitting smoking if you smoke. Smoking is tied to a higher risk of diverticulosis and diverticulitis.
- Eating a high-fiber diet and reducing red meat intake. Eating fiber-rich foods (like fruits, vegetables, and whole grains) doesn't seem to stop diverticula from forming. But it may help prevent diverticulitis. Cutting back on how much red meat you eat can lower your diverticulitis risk, too. People with diverticulosis don't need to avoid foods like nuts, seeds, and popcorn.
- Exercising regularly. Regular physical activity promotes healthy bowel function. Aim for at least 30 minutes most days of the week.
- Minimizing NSAID use. Avoid taking ibuprofen and aspirin when you can, since they may increase the risk of diverticulitis. If you take aspirin for your heart or blood vessels, don't stop without talking to your doctor first.
Finally, I always encourage my patients with diverticulosis to be aware of the symptoms of diverticulitis or diverticular bleeding. Knowing what to look for means you'll be able to get the treatment you need more quickly and reduce the chance of serious complications.
Get help for your GI problems
It's important to seek medical attention for unexplained abdominal pain that doesn't go away or is accompanied by fever, constipation, or diarrhea. These could be signs of diverticular problems — or other gut conditions — that require treatment.
The gastroenterologists at the Temple Digestive Disease Center are highly experienced at diagnosing and treating GI problems and can offer the most up-to-date treatment options. Schedule an appointment with a Temple GI doctor today to discuss your symptoms and decide on the best course of action.
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