But of course this fate isn’t inevitable. By knowing the basics behind the causes, risk factors, and symptoms of diverticulitis, you can get the treatment you need to prevent progression and lower your risk of complications. First, though, it’s crucial to read up on the fundamentals, including what diverticulitis is — then you’ll need to understand the potential for comorbidities.
Know the Basics of Diverticulitis to Lower Your Risk for Future Health Issues
Diverticulitis is a condition that affects the digestive tract. It’s a complication caused when tiny pockets, called diverticula, along the large intestine become inflamed. The condition starts as diverticular disease, or diverticulosis, which develops slowly over time. Pockets within the lining of the colon pop up through the muscle layers of the colon. Because there aren’t any symptoms when the pockets are forming, people don’t find out they have diverticulosis until it’s seen during testing — like a colonoscopy or CT scan — or it progresses to a point where it produces symptoms. (1) People with symptomless diverticulosis don’t need treatment unless it develops into diverticulitis. Earlier research found that about 10 to 25 percent of people with diverticulosis will develop diverticulitis in their lifetime. (2) But newer findings suggest that number is much smaller and may be even as low as 1 percent over 11 years. (3) Once you notice diverticulitis symptoms, like abdominal pain, fever, tenderness, or diarrhea, treatment is required to prevent more serious complications. “Most patients with diverticulosis are not going to develop complications,” says William Stassen, MD, an Austin, Texas–based gastroenterologist. But for those who do experience a single episode of diverticulitis, he recommends being seen by a gastroenterologist as soon as possible. Doctors aren’t sure what exactly causes diverticulosis to develop into diverticulitis. The symptoms usually begin when bacteria or stool get stuck in one of the colon pouches, leading to infection and inflammation. It’s likely a result of several different risk factors. (6,7) Here are some of those possible risk factors:
Age: As people age, they’re more likely to develop diverticulosis, which can then turn into diverticulitis. In Western societies, about 10 percent of people over age 40 and 50 percent of people over age 60 have diverticulosis. Just about everyone over age 80 has it. (8)Genetics: Like many chronic conditions, if you have a family history of diverticulitis, you may be more likely to develop it. (9)Constipation: Ongoing constipation (straining while passing hard stool) can increase pressure in the colon, which can create weak spots in the colon lining over time. (10)A low-fiber diet: A diet that’s low in fiber and high in animal fat is more likely to cause constipation. (10) Eating more fruit, vegetables, and whole grains as well as drinking more water is recommended to soften stool and help it move more easily.Obesity: Weight plays a role in the likelihood of developing diverticulitis. Those who are severely overweight or obese have a higher risk for the disease. (6)Smoking: Smokers are more likely to have diverticulitis than nonsmokers. (6)Lack of exercise: Regular physical activity can also help to get your bowels moving. (6)Medication: Some medication, like steroids and certain pain relievers, including opiates and nonsteroidal anti-inflammatory drugs, can increase your risk of developing diverticulitis. (6)
But if the disease isn’t treated quickly enough or is resistant to treatment, serious complications can develop. About 85 percent of people will respond to medical treatment of uncomplicated diverticulosis, while about 15 percent will require surgery. (1) In fact, diverticulitis accounts for about 4 percent of emergency room visits for abdominal pain. (2) It’s also the third most common gastrointestinal illness that requires hospitalization in the United States. (1) The following symptoms are signs of diverticulitis and should be taken seriously: (11)
Pain in the lower left side of the abdomenFeverBleeding from the rectumNauseaVomitingCrampsConstipation or diarrhea
Often, people will try to ride out the abdominal pain, thinking it will go away, says Rudy Bedford, MD, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California. This is dangerous because untreated diverticulitis can be life-threatening. “It’s a disease of older people,” says Dr. Stassen, who explains that the older someone gets, the more likely they are to have a complication, like bleeding. Severe complications can come on quickly, resulting in sudden pain. These include the following, which require immediate medical attention, like hospitalization or surgery: (2, 7, 13, 14)
Perforation
Diverticulitis causes tiny tears, called perforations, in the bowel walls. These weaken the colon walls and, if they grow larger, can spill bowel contents into the abdominal cavity. This can lead to infection and inflammation in the abdomen, called peritonitis. (2) Peritonitis is a medical emergency that requires immediate surgery to clear the abdominal cavity. Part of the damaged colon may need to be removed. If peritonitis isn’t treated, it can be fatal. In addition, about 1 to 2 percent of larger perforations can lead to abscesses and fistulas.
Abscess and Phlegmon
An abscess forms when a pocket in the bowel becomes infected and fills with pus. A phlegmon is the infected and inflamed area near the abscess. Both form along the wall of the colon as a result of diverticulitis. Abscess symptoms include sore abdomen, fever, nausea, and vomiting. (13) Up to 30 percent of people who develop acute diverticulitis (one or more temporary attacks marked by infection or inflammation) may also develop an abscess. (2) A small abscess might be able to be treated successfully with antibiotics. If it’s large or doesn’t respond to treatment, doctors will need to surgically drain the pus and may even need to remove some of the damaged bowel tissue.
Bowel Obstruction
A bowel obstruction is a blockage in the colon. You can have a partial block or complete block of the large intestine. It’s caused when scarring or inflammation makes the colon too narrow for stool to pass. This narrowing process is called stricture formation. A complete block requires emergency surgery to clear the path, while a partial block can be surgically corrected at a later date. Symptoms include severe constipation, bloating, vomiting, and abdominal pain.
Rectal Bleeding
Rectal bleeding caused by diverticulitis is not incredibly common, happening in about 17 percent of those with chronic diverticulitis, which is an ongoing form of the disease that never clears up entirely. When it happens, it can be severe. Diverticular pouches can damage the blood vessels in the colon wall, resulting in bleeding. (2) There are no symptoms of bleeding other than seeing red- or maroon-colored blood in the bowel movements. Sometimes bleeding stops on its own, if it’s mild. In severe cases, a hospital stay, blood transfusion, and surgery may be required. (14)
Fistula
A fistula is the formation of an abnormal pathway between two organs. In diverticulitis, a fistula typically connects the colon with either the bladder, the small intestine, or the vagina. Symptoms can include air or stool in the urine, pain while urinating, or abnormal vaginal discharge. After one sudden flare-up of diverticulitis, there’s about a 14 percent chance of developing a fistula. Fistulas usually require surgery to be repaired. (2) Outside of age, it’s hard to predict exactly who will develop complications stemming from the disease. Diverticulitis can present itself differently depending on a person’s genetics and lifestyle factors. But those who have experienced one flare-up of diverticulitis are at risk of having another. After about 5 to 10 years following the first flare-up, the risk of having a second is about 50 percent. (15) The best way to avoid severe diverticulitis symptoms from happening is to see a gastroenterologist immediately after noticing symptoms, follow treatment guidelines, and continue to have regular checkups, Stassen says. In a bowel resection, the surgeon goes in and removes the damaged part of the colon. Once that tissue is taken out, the bowel is reconnected using two healthier ends. A bowel resection with colostomy is done in two parts because the colon may be too inflamed at the time of surgery to perform the reconnection. After the damaged area is removed, a colostomy bag is connected to the healthy part of the colon. Waste will pass through the bag — which is on the outside of the body — giving the colon time to heal. Once the inflammation has gone down, the colostomy bag can be removed and the two healthy bowel ends reconnected.
Dementia
There’s a complex relationship between dementia and diverticulitis. Both conditions are more common in older people. A study suggests those with diverticular disease may be at an increased risk of dementia. (17) It’s also likely that complications of diverticulitis may go unnoticed in people with dementia because they’re unable to report symptoms.
High Blood Pressure and Heart Disease
Some evidence suggests people with heart disease or high blood pressure are more likely to require urgent surgery to correct diverticulitis complications. But this link may have to do with aspirin, which is considered an NSAID and a medication that may contribute to diverticulitis. (18)
Diabetes
Having diabetes might increase the chances of developing complications from diverticulitis. (18)
Colon Cancer
For many years, it was thought that colon cancer and diverticulitis were linked. However, new studies suggest this may not be the case. (9) And if you are currently managing diverticulitis, be sure to follow your treatment plan carefully, especially if you’re elderly and are at a greater risk for complications. Taking these preventative steps will help you live healthily for years to come.
