Diverticulosis and Diverticulitis

What are diverticulosis and diverticulitis?

Many people have small pouches in the lin­ing of the colon, or large intestine, that bulge outward through weak spots. Each pouch is called a diverticulum. Multiple pouches are called diverticula. The condition of having diverticula is called diverticulosis. About 10 percent of Americans older than 40 havediverticulosis. The condition becomes morecommon as people age. About half of all people older than 60 have diverticulosis. Diverticula are most common in the lower portion of the large intestine, called the sigmoid colon. When the pouches become inflamed, the condition is called diverticulitis. Ten to 25 percent of people with diverticulosis get diverticulitis. Diverticulosis and divertic­ulitis together are called diverticular disease.

What are the symptoms of diverticulosis and diverticulitis?
Diverticulosis Most people with diverticulosis do not have any discomfort or symptoms. However, some people may experience crampy pain or discomfort in the lower abdomen, bloating, and constipation. Other conditions such as irritable bowel syndrome and stomach ulcerscause similar problems, so the symptoms do

Many people have small pouches in their colon that bulge outward through weak spots. Each pouch is called a diverticulum. Multiple pouches are called diverticula. The condition of having diverticula is called diverticulosis.

not always mean a person has diverticulosis. People with chronic symptoms should visit their doctor or health care provider.

Diverticulitis
The most common symptom of diverticulitis is abdominal pain. The most common sign on examination is tenderness in the lower left side of the abdomen. Usually, the pain is severe and comes on suddenly, but it can also be mild and become worse over several days. The intensity of the pain can fluctuate. A per­son may experience cramping, nausea, vomit­ing, fever, chills, or a change in bowel habits.

What are the complications of diverticulitis?
Diverticulitis can lead to bleeding; infections small tears, called perforations; or blockagesin the colon. These complications always require treatment to prevent them from pro­gressing and causing serious illness.

Bleeding
Rectal bleeding from diverticula is a rare complication. Doctors believe the bleeding is caused by a small blood vessel in a diver­ticulum that weakens and then bursts. When diverticula bleed, blood may appear in the toilet or in the stool. Bleeding can be severe,but it may stop by itself and not require treatment. A person who has bleeding from the
rectum—even a small amount—should see a doctor right away. Often, colonoscopy is used to identify the site of bleeding and stop the bleeding. Sometimes the doctor injects dye into an artery—a procedure called angiography—to identify and treat diver­ticular bleeding. If the bleeding does not stop, surgery may be necessary to remove the involved portion of the colon.

Abscess, Perforation, and Peritonitis
Diverticulitis may lead to infection, which often clears up after a few days of treatment with antibiotics. If the infection gets worse, an abscess may form in the wall of the colon

An abscess is a localized collection of pus that may cause swelling and destroy tissue. If the abscess is small and remains in the wall of the colon, it may clear up after treatment with antibiotics. If the abscess does not clear up with antibiotics, the doctor may need to drain it using a catheter—a small tube— placed into the abscess through the skin. After giving the patient numbing medicine, the doctor inserts the needle through the skin until reaching the abscess and then drains the fluid through the catheter. This process may be guided by sonography or x ray.

Infected diverticula may develop perfora­ tions. Sometimes the perforations leak pus out of the colon and form a large abscess in the abdominal cavity, a condition called peritonitis. A person with peritonitis may be extremely ill with nausea, vomiting, fever, and severe abdominal tenderness. The condi­tion requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without prompt treatment, peritonitis can be fatal.