What You Need to Know About Diverticulosis and Diverticulitis
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Key Facts
- Diverticulosis involves small sacs in the colon lining, often without symptoms.
- Diverticulitis occurs when these sacs become inflamed or infected, causing pain and other symptoms.
- Diverticular disease is very common, especially in aging populations.
- Diet, lifestyle, genetics, and gut health are all factors that can contribute to the development of the disease.
- Treatment approaches for diverticulitis are evolving, with less emphasis on automatic antibiotic use and surgery.
Diverticular disease might sound like a fancy medical term but it’s surprisingly common – especially in aging populations across the Western world. It’s two related conditions: diverticulosis and diverticulitis. While the former is often symptom free, some people may have chronic symptoms that impact treatment. The latter can be painful and even complicated if not managed properly. Let’s break down what these conditions are, why they happen, who’s at risk and how treatment is evolving.
Table of Contents
- What is Diverticulosis and Diverticulitis?
- How Common Is It?
- What Causes It?
- Who’s at Risk?
- How is Diverticulitis Diagnosed?
- Diverticulitis Complications
- How is It Treated?
- Closing Thoughts
What is Diverticulosis and Diverticulitis?
At the heart of diverticular disease are small sacs – called diverticula – that form in the lining of the colon. This is called diverticulosis and often goes unnoticed until found during imaging or colonoscopy for other issues. These outpouchings occur where the colon wall is weak and pushes out due to pressure [1] [3].
On the other hand, when these sacs become inflamed or infected, it’s called diverticulitis. This can cause abdominal pain, fever and changes in bowel habits [1]. Complications can arise if a small blood vessel in the wall of a sac bursts and causes diverticular bleeding.
How Common Is It?
Very common, especially as we age. In fact up to 70% of adults in Western countries will develop diverticulosis by the age of 80 [8]. Among people 65 and older, two-thirds are affected. In the US, diverticular disease accounted for over 2.6 million outpatient visits in 2009 alone [1]. As lifespans increase, these numbers will rise.
What Causes It?
Diverticular disease is complex and influenced by multiple factors:
- Genetics: Family history plays a role in susceptibility.
- Lifestyle and Diet: Low fiber diet, sedentary habits and smoking all increase the risk [6].
- Gut Microbiome: Imbalances in gut bacteria may contribute to inflammation [7].
- Colonic Pressure and Motility: Chronic straining during bowel movements can cause excessive pressure in the colon.
- Structural Changes: As we age the colon wall may develop weak spots allowing diverticula to form more easily.
Interestingly newer research suggests the immune system plays a role in triggering diverticulitis, so inflammation isn’t just due to bacteria but also from the body’s own response mechanisms [2].
Who’s at Risk?
Several lifestyle and health factors make someone more prone to developing symptoms or complications:
- Obesity
- Smoking
- Certain Medications (like NSAIDs or steroids)
- Low-fiber diets
The good news? Eating more fiber – through fruits, vegetables and whole grains – may help prevent diverticula from forming or becoming inflamed [1].
A healthy diet rich in fiber is key to preventing diverticulitis and overall digestive health.
How is Diverticulitis Diagnosed?
Symptoms of diverticulitis typically include sudden lower abdominal pain often on the left side. Some patients also experience nausea, fever or constipation. But in older adults symptoms can be vague – sometimes just mild discomfort or confusion – which makes diagnosis tricky. [5]
Doctors often use a CT scan to confirm the presence of inflammation or complications. It’s the gold standard for diagnosing diverticulitis and guides treatment [6]. A physical exam is also done to assess the abdomen for tenderness and rule out other conditions.
Diverticulitis Complications
If left untreated or in more severe cases diverticulitis can lead to complications:
- Abscesses (pockets of pus)
- Fistulas (abnormal connections between organs)
- Bowel obstructions
- Peritonitis (a life-threatening infection if the bowel ruptures) [9]
A totally blocked large intestine is a medical emergency due to the risk of tissue decay and potential complications like peritonitis.
These are rare but serious so timely care is important.
How is It Treated?
Here’s the kicker. Traditional management involved antibiotics and even surgery for recurrent cases. But newer evidence is changing that:
Mild diverticulitis can often be managed at home with antibiotics and dietbut please note:
- Not Every Case Needs Antibiotics: Not every bout of diverticulitis needs antibiotics. For milder, uncomplicated cases, supportive care like fluids, rest and a modified diet might be enough [4].
- Surgery Isn’t Always the First Choice: Surgery (like a partial colectomy) used to be recommended after multiple episodes but many specialists now favor individualized decisions rather than automatic operations .
- Older Adults Need Tailored Care: In seniors multiple health conditions can complicate treatment. Managing diverticulitis in these patients means balancing quality of life, recovery risks and surgical outcomes. [10]
Closing Thoughts
Diverticulosis and diverticulitis are more than just digestive issues – they’re where aging, diet, lifestyle and even immune function intersect. With better awareness and more personalized care healthcare providers can help patients navigate these issues more safely and comfortably.
More research is ongoing to refine our understanding especially around non-surgical treatments and the gut microbiome. So while these pouches are common the way we treat them is far from one-size-fits-all.one-size-fits-all.
References
[1] Feuerstein, J. D., & Falchuk, K. R. (2016). Diverticulosis and Diverticulitis. Mayo Clinic proceedings, 91(8), 1094–1104. https://doi.org/10.1016/j.mayocp.2016.03.012
[2] Bassotti, G., Usai Satta, P., & Bellini, M. (2019). Prucalopride for the treatment of constipation: a view from 2015 and beyond. Expert review of gastroenterology & hepatology, 13(3), 257–262. https://doi.org/10.1080/17474124.2019.1568238
[3] Wan, D., & Krisko, T. (2021). Diverticulosis, Diverticulitis, and Diverticular Bleeding. Clinics in geriatric medicine, 37(1), 141–154. https://doi.org/10.1016/j.cger.2020.08.011
[4] Eckmann, J. D., & Shaukat, A. (2022). Updates in the understanding and management of diverticular disease. Current opinion in gastroenterology, 38(1), 48–54. https://doi.org/10.1097/MOG.0000000000000791
[5] West, A. B., & NDSG (2008). The pathology of diverticulitis. Journal of clinical gastroenterology, 42(10), 1137–1138. https://doi.org/10.1097/MCG.0b013e3181862a9f
[6] Bhatia, M., & Mattoo, A. (2023). Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends. Cureus, 15(8), e43158. https://doi.org/10.7759/cureus.43158
[7] Strate, L. L., & Morris, A. M. (2019). Epidemiology, Pathophysiology, and Treatment of Diverticulitis. Gastroenterology, 156(5), 1282–1298.e1. https://doi.org/10.1053/j.gastro.2018.12.033
[8] Williams, S., Bjarnason, I., Hayee, B., & Haji, A. (2023). Diverticular disease: update on pathophysiology, classification and management. Frontline gastroenterology, 15(1), 50–58. https://doi.org/10.1136/flgastro-2022-102361
[9] Hoffmann, R. M., & Kruis, W. (2005). Divertikulose und Divertikulitis [Diverticulosis and diverticulitis]. Der Internist, 46(6), 671–684. https://doi.org/10.1007/s00108-005-1403-z
[10] Piscopo, N., & Ellul, P. (2020). Diverticular Disease: A Review on Pathophysiology and Recent Evidence. The Ulster medical journal, 89(2), 83–88. https://pubmed.ncbi.nlm.nih.gov/33093692/
