Diverticulosis – What You Need to Know
By William W. Lunt, MD, Associates in Gastroenterology, Colorado Springs LIVING WELL Magazine
Diverticulosis is an extremely common disorder with an increased prevalence as a person ages. At age 40 only 10% of Americans have diverticula, which increases to 40% by age 60 and finally up to 70% as people reach their 80s. Most individuals remain completely asymptomatic, never knowing they have diverticula. Of those with diverticula, only 25-30% will experience any complication, which manifests as either an infection or bleeding.
What is and what causes diverticulosis?
The large bowel, or colon, comprises the last five feet of the total 25-30 feet of human intestines. The colon wall is intrinsically weak and over time small pouches may begin to bulge outward through weak spots in the wall. These small pouches in the colon wall are termed diverticula, or diverticulosis. When complications occur from these pouches it is termed diverticular disease. These pouches can become quite numerous (up to hundreds) and vary in size, at times becoming quite large. They usually occur in the lower colon, called the sigmoid, but infrequently extend throughout the colon.
The exact cause of diverticulosis is unknown, but is thought to be due to increased pressure within the colon lumen and affects men and women equally. These pouches occur more often in patients who are constipated or have diets that are low in fiber. Diverticulosis is also seen more commonly in obese or sedentary individuals. Diverticulosis is uncommon in countries that consume high fiber foods such as Asia and Africa.
What problems occur with diverticulosis?
Most people with diverticulosis have no symptoms at all, but few may experience such complaints as left lower abdominal crampy pain, nausea, bloating and rarely bowel changes such as constipation or diarrhea. It is difficult to tell whether these problems are due to diverticulosis or underlying irritable bowel syndrome or other chronic conditions.
In 15-25% of individuals with diverticulosis inflammation can occur in the pouches. The exact reason for this is unknown, but may cause more severe diffuse lower abdominal pain, nausea, fever and chills. If this continues, infection can set in possibly leading to a pus pocket or abscess, which weakens the colon wall further and if untreated, perforation of the colon wall may occur. These symptoms may occur suddenly or over several days. If caught early, oral antibiotics usually correct the infection. If it progresses, however, hospitalization with intravenous antibiotics and possibly surgical resection of the infected colon segment may be required.
Another complication that may occur in a small percentage of people is bleeding from a single diverticulum. These individuals present with profuse, painless rectal bleeding. Most of the time the bleeding stops spontaneously, but a colonoscopy may be needed to stop the bleeding and, if unsuccessful, surgical resection would be required.
To diagnose diverticulosis your physician may order a barium enema, CT scan or colonoscopy. If your physician suspects worsening symptoms or complications due to diverticulosis, you may be prescribed a course of antibiotics.
What is needed to treat diverticulosis?
The cornerstone of therapy when diverticulosis is diagnosed is a high fiber diet. Most Americans consume only 10-14 grams of fiber per day, however the FDA recommends at least 25-35 grams of dietary fiber per day. Adding a daily fiber supplement such as psyllium husk, Fibercon or Citrucel can certainly help. Fiber softens and bulks the stool making it easier to pass, thus decreasing the pressure within the colon and preventing further diverticulum from forming. A diet high in fiber reduces the risk of diverticular complications.
In the past, doctors have often recommended avoiding certain foods that contain seeds and nuts that could theoretically get stuck in these colon pockets. No scientific study has ever shown that these foods worsen diverticulosis or cause diverticular disease. Elimination of foods containing seeds and nuts is not needed…so enjoy!
William W. Lunt is a physician with Associates in Gastroenterology and can be reached at 719-635-7321. For more information visit www.agcosprings.com.
