by Jon Avery Go, MD

Diverticulosis is a condition where small, bulging pouches or sacs, called diverticula, form in the lining of the large intestine, or the colon. When one or more of these diverticula become inflamed or infected, the condition is known as diverticulitis.

Diverticula are common in people over the age of 40, and it is estimated that about 50% of people over the age of 60 have diverticula. It is most common in the left colon.

Most people with diverticulosis do not experience any symptoms, and the condition is often only discovered during a routine colonoscopy or other medical test.

But when a diverticulum becomes inflamed or infected, it can cause a range of symptoms, including abdominal pain (usually on the left side), fever, nausea, vomiting, and change in bowel habits of either constipation or diarrhea. In some cases, people with diverticulitis may also experience rectal bleeding or bloody stools.

The exact cause of diverticulosis is unknown, but it is believed to be related to a combination of factors like a high-fat, low-fiber diet, constipation, and aging. When there is not enough fiber in the diet, the colon has to work harder to move stool through it, which can cause pressure to build up and create the small pouches.

If a stool gets trapped in the pouches, it can lead to inflammation or infection. Other risk factors for diverticulitis include obesity, smoking, lack of exercise, and some medications.

To diagnose diverticulitis, your healthcare provider will obtain a history, do a physical exam, blood tests, and order tests such as a CT scan. Treatment for diverticulitis depends on the severity of the condition. Mild cases may be treated with antibiotics and a liquid diet to give the colon time to heal.

In more severe cases, hospitalization may be necessary, and surgery may be required to remove the affected part of the colon. Patients may be admitted to the hospital if they have severe diverticulitis (showing systemic signs of infection or peritonitis), inability to tolerate oral fluids, failure of outpatient antibiotic therapy, immunocompromised, and severe pain.

Complications can include abscess formation, intestinal fistula formation, perforation, and spread of the infection leading to sepsis. Of those who have had an episode of diverticulitis, about 20% have one or more recurrent episodes within 10 years.

To prevent diverticulitis, eat a high-fiber diet, drink plenty of water, exercise regularly, lower stress, and avoid certain foods that may get trapped in the diverticula and increase the risk of inflammation or infection such as nuts and seeds.

With proper treatment and lifestyle modifications, most people with the condition are able to manage their symptoms and prevent future episodes. Talk to your healthcare provider if you feel you are at risk for diverticulosis, and if you experience similar symptoms, immediately seek care from your healthcare provider.

JON AVERY GO, MD, ABIM is a board-certified Internal Medicine primary care physician.  He is currently practicing at the Primary Care Clinic of Hawaii.  

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