Diverticular Disease

Diverticular disease is a condition that can develop in any portion of your gastrointestinal (GI) tract. However, it's most common in the sigmoid colon (the S-shaped part of the intestines), with about 95% of people with diverticulosis developing it here.

With diverticular disease, or diverticulosis, pouches called diverticula form at weak spots in the lining of the digestive tract.

Diet, genetics, and several other issues are linked to the formation of diverticula. The disease commonly affects those in industrialized and Western countries, perhaps due to Western diets.

This article discusses diverticular disease's symptoms, causes, diagnosis, treatment options, and how diverticulitis differs from diverticular disease.

Diverticulitis vs. Diverticulosis

Diverticulosis, or diverticular disease, is the name given to a group of problems that arise from the formation of diverticula pouches. Diverticulosis is a chronic condition that develops in most people over their lifetime, with the formation of diverticula increasing from age 40 and beyond.

Diverticulitis is the more acute form of diverticular disease, by which the pouches formed in your digestive tract become inflamed or infected. Less than 5% of people with diverticular disease develop diverticulitis; however, this form of diverticular disease leads to about 200,000 hospitalizations in the United States annually.

Diverticular Disease Symptoms

For many people, diverticular disease can develop over time with no symptoms. It occurs in less than 20% of people under age 40, with prevalence increasing to about 40–60% by age 60 and 75% by age 80. Diverticular disease isn't something you're typically aware of, so it's usually only diagnosed during routine colon screenings or when symptoms arise.

Diverticulosis Symptoms

Most people with diverticulosis never notice symptoms, and only about 25% develop them.

If symptoms develop, they can often be vague or common to other gastrointestinal issues. Examples include:

• Abdominal pain
• Cramping
• Constipation
• Difficulty passing stool

In more severe forms of diverticulosis, you may develop issues including:

• Gastrointestinal bleeding
• Blockages in the digestive tract

Diverticulitis Symptoms

Diverticulitis is a specific, acute form of diverticular disease that occurs when the diverticular pouches become irritated, inflamed, or infected.

The most common symptoms reported with diverticulitis include:

• Abdominal pain and/or tenderness (typically on the left side)
• Fever
• Nausea
• Vomiting
• Chills
• Cramping
• Constipation
• Changes in bowel habits
  

Segmental Colitis Associated With Diverticulosis (SCAD) Symptoms

Segmental colitis associated with diverticulosis (SCAD) is a rare form of inflammation that affects sections of the colon. SCAD symptoms can mimic IBD symptoms, which include abdominal pain, bleeding, diarrhea, and fever.

The exact cause of SCAD is not fully understood. However, some data suggests that the underlying cause of SCAD and IBD may have some overlap.

SCAD usually occurs without the symptoms of IBD or other similar symptoms like a fever and other signs of infection. There are some differences between the two conditions, including disease progression, complications, and the need for long-term treatment.

SCAD can also lead to a number of complications, such as:

• Bleeding
• Bowel perforation
• Inflammation
• Abscess formation

What Causes Diverticular Disease?

Several factors contribute to the formation of diverticula pouches, but the leading theory attributes their development to a low-fiber diet and the ongoing pressure from straining to make a bowel movement.

Additional factors may include genetic and connective tissue disorders that can cause the digestive lining to herniate (rupture), hormone changes, and neuromuscular diseases.

No specific bacteria has been found to cause the infection or irritation in diverticulitis, but diet and lifestyle choices are believed to have a big impact. Specifically, low-fiber diets, smoking, and a lack of exercise are some factors associated with a greater risk of developing diverticular disease and inflammation.

What Are the Risk Factors for Diverticular Disease?

Low-fiber diets, eating too much red meat, and other dietary choices associated with the Western diet are linked to an increased prevalence of diverticular disease. Beyond that, a lack of exercise and smoking can increase your risk.

Gender and hormones may also play a role. In general, men are more likely to develop diverticular disease, but the risk for women increases when undergoing hormonal therapies, such as those that help with menopause.

Additionally, diverticulosis is more common in people of White ethnic backgrounds, while people of African-American descent are more likely to develop complications like diverticular bleeding.

The use of certain medications may also increase your chances of developing either diverticulosis or diverticulitis. This includes the regular or ongoing use of medications like non-steroidal anti-inflammatory drugs (NSAIDs) and immunosuppressants.

Diagnosing Diverticular Disease

Diverticular disease diagnoses are often incidental, meaning healthcare providers aren't intentionally looking for the condition because of specific symptoms. Diagnosis often occurs during routine colonoscopies, although some of these colonoscopies are to help diagnose symptoms that might relate to diverticular disease, including bleeding.

Diverticula pouches are also sometimes visible on imaging studies, like a barium X-ray or computed tomography (CT) scan.

How Is Diverticular Disease Treated?

When diverticular disease develops with no symptoms, any need for treatment is unusual. Symptomatic cases of diverticulosis or diverticulitis that lead to other complications are usually treated with medication, lifestyle changes, and sometimes surgery.

Medication

The medications that most often treat diverticular disease include those that limit blockages, inflammation, and irritation of your intestinal lining.

Examples of medications that can treat this condition include:

• Laxatives
• Stool softeners
• Antibiotics (for diverticulitis)
• Antispasmodics
• Anti-inflammatory medications
• Pain relievers

Diet

A high-fiber diet is the main dietary recommendation for people with diverticular disease. Foods high in fiber help loosen your stools, making them easier to pass and reducing the strain on your intestinal walls.

Some high-fiber foods that can help improve diverticular disease include:

• Beans
• Brown rice
• Whole grains
• Fruit
• Vegetables

In the past, healthcare providers recommended that people with diverticular disease avoid certain foods that are prone to becoming stuck in diverticula, such as nuts, seeds, and popcorn. Recent research, however, suggests that these foods don't pose any risk to people with diverticulitis or diverticular disease.

Surgery

Surgery isn't usually indicated for most people with diverticular disease but may be necessary in more complicated cases. Examples of surgeries that may address complications of diverticulosis or diverticulitis include:

• Drainage of abscesses
• Repair of tears or perforations
• Fistula revisions
• Removal of obstructions
• Recurrent bleeding from diverticulosis

 What Are the Complications of Diverticular Disease?

Complications of diverticular disease are not common but can include:

• Perforation or tearing of the intestinal wall
• Bleeding
• Infection
• Abscess (pus-filled pockets) formation

Roughly 12% of people with diverticular disease develop complications like those mentioned above.

When to Seek Care for Diverticular Disease

Many people with diverticular disease develop the condition over many years with no obvious symptoms. There are several conditions that can cause you to develop problems within your gastrointestinal tract, so it's important to talk to your healthcare if you develop issues such as:

• Abdominal pain
• Cramping
• Changes/pain in your bowel habits
• Diarrhea
• Fever
• Blood in your stool

Tips for Managing Diverticular Disease

The key to managing diverticular disease is to maintain good bowel health. This means limiting or avoiding smoking and alcohol, eating a healthy diet rich in high-fiber foods, and getting regular exercise. If you are at risk of developing diverticular disease, your healthcare provider may recommend medications like laxatives to help prevent flare-ups and other complications.

Summary

Diverticular disease is a condition that develops when the walls of your intestines become weak, creating a bulge or pocket of tissue. These pockets don't cause symptoms often, but you may notice problems like cramping or abdominal pain when the tissue becomes inflamed or infected. When this happens, you will typically receive a diverticulitis diagnosis.