Who has diverticulosis?
More than half of Americans over the age of 60 have diverticulosis. This term refers to the presence of small balloon-like pouches, known as diverticula, in the walls of the large intestine (colon), but without the presence of complications. Having these pouches in the intestine can sometimes lead to diverticulitis.
What is diverticulitis?
Most people with diverticulosis don’t have symptoms, but the pouches can become inflamed or infected. Health experts say that about 20% of those with diverticulosis will develop complications like diverticulitis.
The most common symptom of diverticulitis is sharp abdominal pain on the lower left side. There may also be constipation or diarrhea as well as an increased need to urinate. Some people may have fever and chills. However, these are common symptoms of many other diseases, so a diagnostic test is needed to determine if it's diverticulitis. Some of these tests include a computerized tomography (CT) scan and colonoscopy.
The exact cause of diverticulitis isn’t known, but some experts believe that a diet that’s low in fiber is one cause. Dietary fiber is a type of complex carbohydrate that helps make you feel full faster, helps digestion, and prevents constipation.
You are at higher risk for diverticulitis if you:
- Don’t exercise
- Are obese
- Use non-steroidal anti-inflammatory drugs, opioids, or corticosteroids
- Have a family history of diverticulosis
A low-fiber diet can cause constipation and hard stools. Straining to pass the stools puts more pressure on the colon or intestines, which may result in these pouches. Diverticulitis happens when one of the pouches develops a hole which allows bacteria from the intestine to leak out. Some experts believe diverticulitis can occur without such a hole.
There are several complications from diverticulitis.
A fistula is an abnormal connection that forms between two body parts, which could happen if inflamed diverticula touches another organ and the bacteria slowly moves into that organ.
Another complication is an abscess, a collection of pus, which can form around an inflamed pouch.Peritonitis is the inflammation of the tissues that line your abdomen (peritoneum) and can result from diverticulitis.
Remedies for diverticulitis
What foods should you avoid?
In the past, doctors would recommend avoiding certain foods like nuts, seeds, and popcorn, believing that these foods are harder to digest. But doctors now say you don’t need to avoid these foods.
However, every person is different and certain foods may make your symptoms worse. Some experts recommend that you limit certain foods only if you have problems with diarrhea, gas, bloating, and cramping during a diverticulitis flare-up. These include:
- Foods that are greasy, fried, and sugary
- High-lactose dairy products such as ice-cream and buttermilk
- Drinks with sugar and caffeine such as smoothies and sodas
- Foods sweetened with artificial sweeteners such as isomalt and xylitol
What foods are recommended?
If you have a diverticulitis flare-up, your healthcare provider may recommend a liquid diet. This means no solid foods, not even pulp in juices. You can have broth, jell-o, popsicles, and clear juices such as apple and grape. Talk to your healthcare provider about when to progress to solid foods.
When you're able to have solids, start with low-fiber foods as you’re still healing. A low-fiber diet means lower frequency of stools and less discomfort. Healthcare providers recommend about 10 to 15 grams of fiber each day. Gradually add high fiber foods back one by one, with the goal of 30 to 35 grams of fiber per day.
What treatments can help?
Severe diverticulitis is usually treated with antibiotics, especially if there are complications like abscess or perforation. Large abscesses may be drained via a tube placed in the abdomen.
Surgery may be needed if abscesses have formed and antibiotics aren’t working. The most common surgery is a colon resection, which is the removal of the affected part of the intestine. Usually this is a minimally invasive procedure (laparoscopy) in which small cuts are made in the abdominal wall and surgical instruments are inserted.
Risks and outlook
How long will it last?
About 80% of diverticulitis cases are mild. In almost all of the mild cases, the diverticulitis goes away on its own within a week. About 5% of mild cases require treatment as the symptoms remain.
Some people may have chronic diverticulitis or repeated attacks. For many years, it was thought that with every diverticulitis flare-up, the risk of complications increases. That's why surgery was usually recommended. However, studies have now shown that the risk is highest during the first diverticulitis occurrence. So doctors are now urged to try out medications and dietary changes before surgery.
Moving forward and recovering
If your diverticulitis is mild, you should still see a doctor regularly so that any complications can be detected early. Serious complications are rare but it’s important to be aware of the symptoms.
If you had to have surgery, you should be able to return to your regular activities in about one to two weeks, and you should see your doctor for a follow-up after two weeks.
Diverticulosis is a lifelong condition. Once the diverticula have formed, they won't disappear unless the affected section is surgically removed. However, it can be managed by making diet changes, which may lessen your chances of having a diverticulitis flare-up.
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American Society of Colon & Rectal Surgeons: "Diverticular Disease Expanded Version."
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Institute for Quality and Efficiency in Health Care: "Diverticular disease and diverticulitis: Treating acute diverticulitis."
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