Digestive health centre

Diverticulitis and diverticulosis symptoms, treatment and prevention

Diverticular disease is the result of the development of small sacs or pockets (diverticula) in the wall of the colon. Often these are present without causing any symptoms, a condition called diverticulosis. When they cause symptoms - such as pain, constipation or diarrhoea - the condition is known as diverticular disease, and if they become inflamed it is known as diverticulitis.

What are the symptoms?

Symptoms of diverticulitis are:

• Severe, cramping abdominal pain that is usually worse on the left side
• Nausea
• Chills or fever
• Constipation, thin stools, or diarrhoea
• Pain in the lower left quadrant of the abdomen that increases when the area is touched
• Rectal bleeding (rare)

Seek medical advice if:

• You have a fever, chills, and abdominal pain or swelling, or are vomiting, or your abdomen becomes rigid and you experience pain when you move; you could have peritonitis, an infection of the membrane that lines the abdominal cavity. Get medical help immediately.
• Blood appears in stools; this indicates internal bleeding.
• You have a fever; you may have an infection that requires medication.
• Severe pain continues despite treatment; you may have another abdominal disorder.

How can I prevent diverticulitis?

The best preventive action you can take against diverticulitis, of course, is to keep from developing the small sacs called diverticula. You have a good chance of doing that simply by modifying your diet and lifestyle:

• Eat wholegrain breads, oatmeal, bran cereals, fibrous fresh fruits and vegetables to increase the bulk in your diet.
• Keep refined foods such as white flour, white rice, and other processed foods to a minimum.
• Regular exercise can help the muscles in your intestine retain their tone, which encourages regular bowel movements.
• Don't use suppositories for constipation on a long-term basis without seeking medical advice.
• Prunes, prune juice and psyllium seed may all help to keep the bowels functioning.

Risk factors for diverticulitis and making the diagnosis

Ageing and heredity are primary factors in the development of diverticulosis and diverticulitis, but diet also plays a role; eating a lot of low-fibre, refined foods can greatly increase the risk. Indeed, in Western societies, an estimated 10% of people over 40 eventually develop diverticulosis; the figure reaches 50% in people over 60. Diverticulitis will occur in about 10%-25% of those with diverticulosis.

Although it has not been proven, it is thought that if you are often constipated and usually strain at bowel movements, you may create enough pressure in the intestinal walls to weaken them and begin the development of diverticular pouches. If the diverticula then become filled with faecal material or with undigested food, they are vulnerable to bacterial infection, leading to the inflammation of diverticulitis.

If you think you have either diverticulosis or diverticulitis, your doctor will probably have tests done on both your blood and stool to help diagnose possible infection. Because cancer, stomach ulcers, irritable bowel syndrome, and diverticulitis can share the same symptoms, your doctor will need to thoroughly examine your intestines.

A barium enema, which fills the colon with barium and allows an X-ray to show an outline of the inside of the intestines, can help confirm a diagnosis of diverticulosis. You may also have the insides of your intestines examined with a flexible lighted tube in a procedure called a colonoscopy. If you have an acute case of diverticulitis, both barium enemas and colonoscopies can injure your intestine, so your doctor may choose instead a CT scan, which can help confirm the diagnosis of diverticulitis.