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OVERVIEW

What is diverticular disease?

Diverticular (say: die-ver-tick-yoo-ler) disease affects the lining of your large intestine. It is caused by small pouches (called diverticula) that can form anywhere in your digestive tract, but usually form in the last part of the large intestine (called the colon). The most common types of diverticular disease are:

• People who have diverticulosis have pouches in the large intestine. Most people who have diverticulosis don’t have any symptoms and may not even know they have it.
• This occurs when the pouches become infected and inflamed. Symptoms of diverticulitis can include severe abdominal pain, fever, nausea, constipation or diarrhea. Less common symptoms include vomiting and frequent and painful urination. Pain is most often located on the lower left side of the abdomen. Complications of diverticulitis can include intestinal blockages and openings in the bowel wall.
• Diverticular bleeding. Diverticular bleeding occurs when a blood vessel next to the pouches bursts. You may find blood in a bowel movement or in the toilet. If you notice blood coming from your rectum, you should contact your healthcare provider immediately.

CAUSES & RISK FACTORS

Who gets this disease and why?

Diverticular disease affects both men and women and is most common in people older than 40 years of age. Diverticular disease may be caused by not eating enough fibre. When you don’t eat enough fibre, you may get constipated and your stools may not be as soft. Constipation and hard stools increase the pressure in the bowel walls. This pressure may cause the diverticular pouches to form.

DIAGNOSIS & TESTS

How can my healthcare provider tell if I have diverticular disease?

Your healthcare provider may check your abdomen for tenderness and ask you about your bowel habits, diet and medications. Your healthcare provider may also want to do some tests to screen for diverticular disease:

• Barium enema. For this test, you are given an enema (injection of fluid into the rectum) with a liquid that makes your colon show up on an X-ray.
• Flexible sigmoidoscopy. In this test, your healthcare provider puts a thin, flexible, hollow tube with a light on the end into your rectum. The tube is connected to a tiny video camera, which allows your healthcare provider to see the rectum and the last part of your colon.
• Before you have this test, you are given a medicine to make you relaxed and sleepy. A thin, flexible tube connected to a video camera is put into your rectum, which allows your healthcare provider to see your whole colon. A colonoscopy may be uncomfortable, but it is usually not painful.
• CT Scan. This test is a type of X-ray that allows your healthcare provider to see the pouches in your digestive tract that are inflamed or infected.

Sometimes, diverticular disease is found when tests are ordered for a different reason, such as routine screening that checks for colorectal cancer or other digestive problems.

TREATMENT

How is diverticular disease treated?

For diverticulosis, your healthcare provider may suggest that you eat more fibre, drink plenty of fluids and exercise regularly to help prevent the pouches from becoming infected or inflamed. For mild cases of diverticulitis, your healthcare provider may prescribe antibiotics. He or she may also suggest that you eat more fibre, drink plenty of fluids and exercise regularly to help prevent future problems. For severe cases of diverticulitis or diverticular bleeding, you may need surgery to remove the pouches and the diseased parts of your colon.

PREVENTION

How can I prevent diverticular disease?

A high-fibre diet is the best way to prevent diverticular disease. You can increase the amount of fibre you eat by including more fruits, vegetables and whole-grain foods in your diet. Also be sure to drink plenty of fluids and exercise regularly.

QUESTIONS TO ASK YOUR HEALTHCARE PROVIDER

• What lifestyle changes can I make to prevent diverticular disease from getting worse?
• Is diverticular disease a sign of colon cancer or another health condition?
• Does having diverticular disease put me at an increased risk of colorectal cancer?
• Are there medicines that treat diverticular disease?
• Will I need surgery to treat diverticular disease? Are there other options?

Sources

Diverticular Disease: Diagnosis and Treatment by H Salzman, M.D., and D Lillie, M.D. (10/01/05, http://www.aafp.org/afp/20051001/1229.html )