Which One Do I Have, Doc?
I talk about diverticulosis almost every day. Whether in the office or after doing a colonoscopy, patients always have questions. That’s because diverticulosis is a very common condition. Close to 70% of people will have diverticulosis once they reach age 70, making this one of the most common medical conditions in the US. There are a lot of falsehoods regarding how we get diverticulosis, such as what you can and cannot eat, so I will try to answer some of those questions for you.
What is diverticulosis?
Diverticulosis is a condition where small pockets or pouches form anywhere in the intestinal tract, but are most frequently in the colon. In the U.S., the left colon is most often affected.
How did I get diverticulosis?
There is a natural area of weakness in the wall of the colon. It is hypothesized that if there is too much pressure in the colon, diverticulosis can form. Pressure can build up in the colon from pushing or straining to have a bowel movement or not having enough fiber in the diet.
My parents and grandparents have diverticulosis. Is it hereditary?
No, it is just extremely common.
Do I have diverticulosis or diverticulitis?
You have diverticulosis when the pockets form in the colon. Typically, this does not cause symptoms. Diverticulitis occurs when inflammation and/or infection occur in one of the pockets. It is estimated that only 5-15% of people with diverticulosis will develop diverticulitis.
What are the symptoms of diverticulitis? How is it diagnosed?
Acute onset of abdominal pain, often in the left lower quadrant, is the most common symptom, but fevers and changes in bowel habits could occur. The diagnosis can be made based on clinical suspicion, especially in those with previous episodes of diverticulitis, but confirmation requires a CT scan of the abdomen.
How is diverticulitis treated?
Antibiotics have been the mainstay of therapy for years, but several recent studies have called this practice into question. Some select patients with uncomplicated diverticulitis can be treated without antibiotics.
What is the difference between complicated and uncomplicated diverticulitis?
Symptoms of uncomplicated diverticulitis are often mild and can be treated in the outpatient setting.
Complicated diverticulitis occurs when either a perforation, abscess, stricture, obstruction, or fistula form.
Hospitalization for these complications is often needed.
Will I eventually need surgery if I get diverticulitis?
No. Historically, medical teaching stated that those who had three or more episodes of diverticulitis required surgery. This is no longer the case. No specific number exists. Even some patients with complicated diseases, such as a small abscess, may not need surgery.
If I get diverticulitis, do I need a colonoscopy?
It depends. If you had a colonoscopy in the past 3-5 years, then probably not, although this is up to your doctor’s discretion. If you never had a colonoscopy, then you need to have one performed 4-8 weeks after the resolution of diverticulitis, just to make sure there are no other abnormalities, such as cancer or polyps, that may have triggered the diverticulitis.
What can I do to prevent diverticulitis?
Dietary and lifestyle modifications are most beneficial. A healthy, well-rounded diet, exercise and weight loss can help. Limiting highly processed foods and meats is also recommended. The mainstay of prevention is a high-fiber diet. The goal for fiber intake is 25 to 30 grams per day. Fiber can be found in fruits, vegetables, grains and legumes. Adding a fiber supplement to your daily regimen can help reach the goal. Following these diet and lifestyle recommendations has been shown to reduce the risk of developing diverticulitis by as much as 75%.
Can I eat nuts, seeds and popcorn?
Yes. This is a misconception that nuts, seeds and popcorn get stuck in the pockets and lead to diverticulitis. These are excellent sources of additional fiber. I hope you find this information helpful and educational.
