What Is Diverticulitis? Symptoms, Complications, and Treatment
Diverticula are small pockets in the colon that are present in up to 10% of people over age 45. About 25% of those people experience an inflammation of those pockets (otherwise known as diverticulitis). Do nuts, seeds, corn, and popcorn really cause this potentially serious condition? The House Call Doctor explains the latest research.
I recently ran into a friend who shared his recent battles with recurrent diverticulitis.
Devin was so distraught over the illness that he had started to limit his food choices significantly – to the point that his quality of life was truly diminished and he had lost quite a bit of weight as a result.
I truly felt for him and his struggle reminded me of the new research findings on food restrictions that are advised for patients with this potentially serious condition. Doctors may recommend that sufferers avoid certain foods, like nuts and popcorn, but does this really cause diverticulitis? Let’s learn more about this medical condition in today’s episode.
What Is Diverticulitis?
Before we understand diverticulitis, it’s important to understand diverticulosis. Diverticulosis refers to small outpouchings (called “diverticula”) that are found in the inside lining of the colon – you can think of them as tiny pockets that are present in up to 10% of people over age 45. This incidence increases with age to about 80% of people over age 85.
These little pockets can sometimes get small bits of food stuck inside of them, which can then become inflamed and even potentially infected. When this happens, patients often feel pain and get what is referred to as “diverticulitis.” In medicine, anything that ends in “-itis” refers to inflammation. Therefore, diverticulitis is the inflammation of the diverticular pockets in the colon. But not everyone with diverticulosis develops diverticulitis – only about 25% of people with these colon pockets actually get them inflamed.
Symptoms of Diverticulitis
Those with acute diverticulitis (not –osis) often feel quite ill. There is what doctors call a “triad” of symptoms that include:
- Fever
- An elevated white blood cell count (which is found on a routine blood test called the “CBC” in more than half of those with diverticulitis; it’s often a reflection of an acute infection)
- Abdominal pain (this can be anywhere in the stomach, but is classically found in the lower left abdomen)
Other possible symptoms include:
- Decreased appetite
- Nausea
- Constipation
- Diarrhea
- Elevated heart rate
- Abdominal distention (or bloating)
Diagnosis of Diverticulitis
People who have a history of diverticulitis simply “know” when they are experiencing an acute attack. When symptoms are mild, imaging (meaning X-rays or CT scans) is not typically necessary. However, diverticulitis is most often diagnosed using an abdominal CT scan.
If you’re a regular listener or reader of the House Call Doctor show, you know that I’m not a big fan of CT scans due to excessive exposure to ionizing radiation. I think CT scans are over-utilized in the U.S. and really should be reserved for when it’s absolutely necessary. In a patient with severe abdominal pain, especially with a fever and an elevated white blood cell count, it may be necessary depending on the severity of the symptoms. But if you have a history of diverticulitis that’s been documented on a prior CT, and your symptoms are mild and similar, you don’t need a CT scan every time you have abdominal pain or an attack.
An ultrasound is a good alternative to the CT for diagnosing diverticulitis. However, it may not be the best choice if we suspect certain complications from diverticulitis. Also, a colonoscopy may be recommended after an acute attack has resolved, typically about 4-6 weeks after.
Complications of Diverticulitis
If left untreated, diverticulitis can be very serious and cause some potentially life-threatning complications, including:
- Abscess (a ball of pus surrounding the inflamed pocket)
- Perforation (a hole that is created in the colon wall as a result of a inflammation)
- Fistula (a “tunnel” that is created connecting the colon and the nearby organs, including the bladder or rectum)
- Bleeding
- Obstruction in the colon
Treatment of Diverticulitis
Most patients (over 90%) can be treated without hospitalization. Besides oral antibiotics, doctors recommend an initial clear liquid diet along with close monitoring by your doctor. Most patients see improvement in symptoms within 2-4 days of outpatient treatment.
Your doctor may decide to hospitalize you if your symptoms don’t improve with oral antibiotics (and in that case, would require IV antibiotics), if your fever doesn’t break, if your pain does not subside, or if you cannot tolerate any fluids or food.
Up to a third of those with one episode of acute diverticulitis have another attack sometime in their lifetime, and surgery is often recommended after the third attack that requires hospitalization (this varies depending on the patient, of course).
How to Prevent Diverticulitis
Unfortunately, we don’t know why some people are so prone to diverticulitis when there are so many others with diverticulosis who never get their diverticula inflamed. However, we do know that for some reason, patients who are obese and live rather sedentary lifestyles tend to have a higher risk of developing diverticulitis. There is evidence that the following recommendations are helpful in preventing diverticulitis attacks:
- Increase your fiber intake
- Exercise
- Lose weight if you’re obese
- Avoid anti-inflammatory drugs (like ibuprofen, naproxen, etc.)
- Quit smoking
- Take Lactobaccillus Casei (a probiotic)
Two prescription drugs that may also aid in preventing future attacks are:
- Mesalamine
- Xifaxan
What about avoiding nuts, seeds, corn, or popcorn as it was advised to my friend Devin, you may be wondering? Perhaps you were also given the same advice at some point along the way? Well, there was a large research study done in 2008 that refuted this theory. It seems that small food particles are not the culprits in causing diverticulitis.
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Disclaimer: Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
Colon image courtesy of Shutterstock.
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About the Author
Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women’s health and patient education.
