Diverticulosis and Diverticulitis: Causes and Treatment

Diverticulosis and diverticulitis are technically two different digestive ailments that occur in the large intestine, your colon.

You may not even realize you have diverticulitis. It’s pain free and usually only spotted during a colonoscopy or an imaging study like a CT scan.

Diverticulitis, on the other hand, makes itself known typically with lower abdominal pain and discomfort, fever, and a sudden change in bowel habits.

What is Diverticulosis

Diverticulosis is the development of pouches, sacs or pocket-like openings (diverticula) in the colon wall. Diverticula develop when outward pressure in the colon causes weak spots in the colon wall.

In most cases, you won’t experience any symptoms from having diverticulosis. Most people are unaware that they have it. When symptoms occur, they include abdominal pain or cramps; bloating; diarrhea; constipation; and rectal bleeding.

What is Diverticulitis

You cannot have diverticulitis unless you have diverticulosis. Diverticulitis results from complications within the diverticular sacs.

If the sacs become thinned out and infected with bacteria, then they may burst open. Diverticulitis is the rupturing of the sacs. Once the sac has ruptured, the fluid that was in the sacs leaks through the colon walls and that leads to an infection. Rupture of the sacs and ensuing infections are far worse than just having them.

Diverticulitis can become a life-threatening ailment. Warning signs of diverticulitis include: tenderness in the abdomen, fever, chills, vomiting, nausea, bloating, constipation, and cramping.

Complications from Diverticulitis

It’s important to understand the symptoms and complications that you might experience if you’re suffering from diverticulitis. Depending on how severe your infection is, complications can vary from diverticulitis. 

Complications include bleeding, perforation, abscesses, peritonitis, fistulas and intestinal obstructions. Review below to get a more complete understanding of these complications.

1. Bleeding

Diverticular bleeding is a rare complication of diverticulitis. Bleeding may be due to a weakened blood vessel breaking open. Bleeding usually stops by itself but sometimes it can get worse than expected.

If you experience severe bleeding, you might require surgery or a procedure to prevent further blood loss. If you see any blood in your stools or in the toilet, contact your doctor right away.

2. Perforations

In most cases, an infection caused by diverticulitis will usually respond to antibiotic treatment. In some cases, however, if it doesn’t work, you might develop tiny holes in the colon known as perforations.

3. Abscesses

A perforation filled with pus can lead to an infection called an abscess. If abscesses do not respond to antibiotic treatment, then you might need surgery or a procedure to drain the pus before it spreads to your abdominal cavity. 

4. Peritonitis

If an extremely large abscess has ruptured from its original location and caused a spreading of infection throughout your abdomen, then you may be suffering from peritonitis. This situation requires immediate surgery to clean the infection in the abdominal cavity and remove any damaged parts of the colon.

5. Fistulas

If an infection spreads from inside your colon out into other parts of your body, it could cause your colon tissue to stick to other tissues, organs, or even your skin. This connection of tissue is known as a fistula. The organs that are most affected are the bladder, small intestine, and skin.

This type of fistula can be severe and can cause long-lasting health issues like urinary tract infections. Surgery may be necessary to remove the fistula and the affected part of the colon.

6. Intestinal Obstructions

When the body heals from an infection, scar tissue can be left behind from the healing process. Diverticulitis is an infection and it can result in scarring. This scarring may lead to a total or partial obstruction in either the large intestine or nearby small intestine.

If your intestines become obstructed, even partially, then having bowel movements may be difficult for you. Sometimes if there’s a partial obstruction, they’ll clear up by themselves. If there’s no way for you to pass stool, then bowel surgery might be necessary because moving your bowels would be impossible.

Diverticulosis and Diverticulitis Diagnosis

One of the most important parts of your treatment is actually making sure that you get diagnosed correctly. There are many different methods for diagnosing diverticulosis or diverticular disease.

It is important to first understand that a diagnosis of diverticulosis is rare because most people don’t experience any symptoms. Most times, diverticulosis is accidentally discovered while performing exams for other reasons, like a screening colonoscopy.

Tests for diagnosing diverticulosis may include imaging tests such as computed tomography (CT) scans or barium enemas, or endoscopic evaluations such as flexible sigmoidoscopies or colonoscopies.

You’re given an enema filled with barium during a barium x-ray. An x-ray is then taken after the barium has been injected into the patient’s body. With the use of barium, we get better visualization of the gastrointestinal system and the diverticula can be seen.

Both sigmoidoscopy and colonoscopy procedures involve inserting a flexible, lighted probe into the anus for inspection of the lower bowel. It lets you see directly into the colon, which may reveal any diverticula (pouches) present there.

You’ll need to provide additional details if you want us to diagnose your condition as diverticulitis. A physician will ask for a full medical history and physical exam. If there’s something wrong, they may need to perform additional testing.

Be prepared to give the doctor your entire medical history. The information your doctor will need consists of your bowel habits, diet, symptoms, and medications.

Once your medical history is complete, the doctor will then do a physical exam. 

To determine if you have any signs of infection, your doctor will do a blood test and may check the stool for any signs of blood. If your doctor feels it’s necessary, he or she will order more tests such as a CT scan or a colonoscopy.

Doctors will use these tests for a clearer image of your colon and what is going on in. They will help rule out more serious issues, such as colon cancer.

Dietary Recommendations

You’ve been diagnosed with diverticulosis or diverticulitis. What’s next?

One of the best ways to manage these conditions is by following a multipronged approach that includes a healthy eating plan and adding extra fiber into your daily routine.

How to feel your best

Below are ways to manage your diet and exercise routines, so you will feel your best.

Modify Your Diet

The key to managing diverticulosis and diverticulitis is early diagnosis and intervention. The earlier that changes are made, the less opportunity there is for pressure to build up on the colon walls.

To get started, consume enough fiber and drink plenty of water. It sounds “old school” but it really works!

You may want to increase your fiber intake by consuming more foods rich in fiber and/or take a dietary fiber supplement. Increasing fiber intake will also help with other conditions like IBS (Irritable Bowel Syndrome). 

Consume at least 25–30 grams of fiber per day. Fiber has been shown to help people lose weight and provide other health benefits.

Psyllium husk powder is one type of dietary fiber found in some fiber supplements. Plus, it produces less flatulence (gas) than high-fiber fruits and vegetables.

Increasing your intake of dietary fiber makes your stool soft and bulky so they’re easier for your body to move through the digestive system. It lowers the amount of pressure in the colon which is responsible for developing diverticulosis and diverticulitis.

Drinking plenty of water is important for good health. A general guideline is to drink half your bodyweight in ounces every day. A 150-pound woman should consume approximately 75 ounces of high-quality water each day. Herbs, broths, and fresh juices can be used to count towards her daily intake. Liquids help keep the pouches clean, prevent them from becoming inflamed.

There is a misconception that if you suffer from diverticulosis or diverticulitis, you should avoid small seeds, certain grains, lettuce and high-fiber foods because the particles may lodge in the sacs and cause discomfort or inflammation.

This theory was based on a small study and has not been replicated. There is no reason to avoid these foods. Everyone’s body is different. You must find your own comfort level in the amounts and types of foods you can eat.

Trial and error is the only way to find out which strategy works best for you.

Some tips for modifying your diet:

  • When scanning food labels look for whole grains or whole wheat as the first ingredients.
  • Raw fruits and veggies are better for digestion because they’re easier to break down into nutrients. They contain more fiber than their cooked counterparts too! They’ll also help with bowel regularity.
  • Improve meat dishes by adding fiber with lentils, baked beans, kidney beans, black-eyed peas, lima beans, bran or oatmeal.
  • Add unprocessed wheat bran to some of your favorite meat and carbohydrate meals. Meatloaf, pot pies, breads, muffins, casseroles and other baked goods can easily include wheat bran in the recipe without distorting the flavor.
  • Increase the fiber in your dairy products by adding fresh fruit, whole grain or bran cereals to yogurt or cottage cheese.
  • Replacing all-purpose flour with oats in your baking recipes makes them healthier without sacrificing taste.
  • Increase your fiber intake by eating a variety of high-fiber food. Add a psyllium-based supplement if you need additional fiber.
  • Increase your daily fiber intake gradually. If you increase your daily fiber intake rapidly, you may experience some discomfort such as gas, bloating, constipation, or diarrhea.

Exercise: Your Colon’s Best Friend

Though there may not be any scientific link between exercise and regularity in bowel movements, the connection between people who exercise on a regular basis and regularity does exist. All of your intestines are surrounded by inside muscles. Abdominal and intestinal muscle strength are important for proper bowel function and fast transit time.

Intestinal muscle tone helps remove the correct amount of water from feces before they leave the body. When intestinal muscles aren’t strong enough, they slow down the elimination process. This leads to an unhealthy amount of liquid that gets removed from the stool. That leads to waste impaction, expansion of the colon walls and hardened, dry stools.

If you don’t exercise them regularly, they’ll weaken and become less effective at pushing waste through your system.

Some situations that can lead to a loss of muscle tone are:

  • A diet low in fiber
  • Sedentary life style, lack of exercise and/or excess time spent lying down
  • Long-term use of stimulant laxatives, chronic diarrhea and loosely formed stools
  • Neural interference (drugs/medications or damage to nerves)
  • Diseases affecting the bowel lining or nerve input to the bowel

Most often, loss of muscle tone due to lack of activity can be reversed by exercising regularly and eating plenty of whole grains.

Discontinue use of stimulant laxatives, diuretics and drugs that could disrupt normal bowel functions (with proper guidance from your healthcare professional).

Before starting an exercise program, consult with a qualified healthcare professional who has experience working with people like yourself. Minor changes like walking, taking the stairs or parking in the farthest spot from the store can improve your muscle tone.

You should implement dietary changes slowly so they don’t cause any discomfort. If you increase your intake of dietary fibers too rapidly, you might get uncomfortable bloating and intestinal pain. Don’t let that stop you…A high-fiber diet is crucial for healthy digestion and a healthy colon.

Diverticulosis and Diverticulitis Treatment

If these dietary modifications and exercise methods don’t help alleviate your symptoms, then something else might be going on. There may be an infection from diverticulitis, consult your doctor because medical intervention is needed.

Once diverticulitis is diagnosed, your doctor will most likely concentrate on clearing up the infection, reducing inflammation, resting the colon, and preventing complications.

An antibiotic is used to treat an infection, and a liquid diet helps the body heal itself by resting the digestive tract.

In some cases, if your pain becomes too severe, your doctor might recommend taking prescription medications for pain relief, along with an anti-inflammatory medication to reduce uncomfortable cramping and pain.

Combining these treatments will help prevent further complications from occurring. Most respond to treatments within 2-3 days, but the antibiotics will most likely be continued for a 10-14 day period.

In some cases, when a diverticulitis attack doesn’t respond to antibiotic treatment, occurs frequently or severely, or develops into complications, surgery might be necessary. The surgery, called a colon resection, involves removing the affected colon part and reattaching the two healthy pieces. Your surgeon will remove any collected pus from the wound during the operation.

Diverticulosis and Diverticulitis Prevention

After you’ve been diagnosed with diverticulosis, there is nothing you can do to reverse the condition. The best way to manage diverticulosis and diverticulitis pains is to keep the pressure at low and constant levels in your colon.

When impacted waste builds up in the colon, pressure increases and becomes unstable. By reducing the amount of waste in your colon, you’ll speed up its transit time. To do this you must:

  • Consume at least 25-30 grams of fiber daily
  • Never put off the urge to have a bowel movement
  • Drink ½ your body weight in ounces of water daily
  • Do not use chemical laxatives or enemas regularly to assist in bowel movements
  • Exercise

Prevention is always better than treatment. It’s especially important if you suffer from diverticulosis and diverticulitis. Implementing preventive measures means less risk of developing serious health issues later in life. That makes prevention the cheapest insurance you’ll ever “buy.”