Irritable Bowel Syndrome and Diverticular Disease can cause similar symptoms, but they arise from completely different pathologies. While the medical treatments for the two disorders are quite disimilar, many of the lifestyle strategies for minimizing pain and bowel dysfunction are identical (particularly dietary changes and the use of gut-soothing herbs such as fennel and peppermint). Irritable Bowel Syndrome is defined as a functional gut disorder and is not actually a disease at all.
What is diverticular disease?
Many people have small pouches in their colons that bulge outward through weak spots, like an inner tube that pokes through weak places in a tire. Each pouch is called a diverticulum. Pouches (plural) are called diverticula. The condition of having diverticula is called diverticulosis. About half of all Americans age 60 to 80, and almost everyone over age 80, have diverticulosis.
When these pouches become infected or inflamed, the condition is called diverticulitis. This happens in 10 to 25 percent of people with diverticulosis. Diverticulosis and diverticulitis are also called diverticular disease.
- What causes diverticular disease?
- What are the symptoms of diverticular disease?
- Are there complications?
- How does the doctor diagnose diverticular disease?
- What is the treatment for diverticular disease?
- When is surgery necessary?
- Points to remember about diverticular disease
What causes diverticular disease?
Though not proven, the dominant theory is that a low-fiber diet is the main cause of diverticular disease. The disease was first noticed in the United States in the early 1900s. At about the same time, processed foods were introduced to the American diet. Many processed foods contain little to no fiber.
Diverticular disease is common in developed or industrialized countries–particularly the United States, England, and Australia–where low-fiber, high animal product diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber plant-based diets.
Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on a soft, jelly-like texture in the intestines. Some fiber passes almost unchanged through the intestines (insoluble fiber). Both kinds of fiber prevent constipation.
Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. The excess pressure might be the cause of the weak spots in the colon that bulge out and become diverticula.
Diverticulitis occurs when diverticula become infected or inflamed. Doctors are not certain what causes the infection. It may begin when stool or bacteria are caught in the diverticula. An attack of diverticulitis can develop suddenly and without warning.
What are the symptoms of diverticular disease?
Most people with diverticulosis do not have any discomfort or symptoms. However, symptoms may include mild cramps, bloating, and constipation. Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause similar problems, so it’s necessary to have a medical diagnosis before you assume you have diverticulosis.
The most common symptom of diverticulitis is abdominal pain. The most common sign is tenderness around the left side of the lower abdomen. If infection is the cause, fever, nausea, vomiting, chills, cramping, and constipation may occur as well. The severity of symptoms depends on the extent of the infection and complications.
Are there complications?
Diverticulitis can lead to complications such as infections, perforations or tears, blockages, or bleeding. These complications always require treatment to prevent them from progressing and causing serious illness.
Bleeding from diverticula is a rare complication. When diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can be severe, but it may stop by itself and not require treatment. Doctors believe bleeding diverticula are caused by a small blood vessel in a diverticulum that weakens and finally bursts. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary.
Abscess, Perforation, and Peritonitis
The infection causing diverticulitis often clears up after a few days of treatment with antibiotics. If the condition gets worse, an abscess may form in the colon.
An abscess is an infected area with pus that may cause swelling and destroy tissue. Sometimes the infected diverticula may develop small holes, called perforations. These perforations allow pus to leak out of the colon into the abdominal area. If the abscess is small and remains in 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.
To drain the abscess, the doctor uses a needle and a small tube called a catheter. The doctor inserts the needle through the skin and drains the fluid through the catheter. This procedure is called percutaneous catheter drainage. Sometimes surgery is needed to clean the abscess and, if necessary, remove part of the colon.
A large abscess can become a serious problem if the infection leaks out and contaminates areas outside the colon. Infection that spreads into the abdominal cavity is called peritonitis. Peritonitis requires immediate surgery to clean the abdominal cavity and remove the damaged part of the colon. Without surgery, peritonitis can be fatal.
A fistula is an abnormal connection of tissue between two organs or between an organ and the skin. When damaged tissues come into contact with each other during infection, they sometimes stick together. If they heal that way, a fistula forms. When diverticulitis-related infection spreads outside the colon, the colon’s tissue may stick to nearby tissues. The organs usually involved are the bladder, small intestine, and skin.
The most common type of fistula occurs between the bladder and the colon. It affects men more than women. This type of fistula can result in a severe, long-lasting infection of the urinary tract. The problem can be corrected with surgery to remove the fistula and the affected part of the colon.
The scarring caused by infection may cause partial or total blockage of the large intestine. When this happens, the colon is unable to move bowel contents normally. When the obstruction totally blocks the intestine, emergency surgery is necessary. Partial blockage is not an emergency, so the surgery to correct it can be planned.
How does a doctor diagnose diverticular disease?
To diagnose diverticular disease, a doctor asks about medical history, does a physical exam, and may perform one or more diagnostic tests such as a colonoscopy. Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment.
When taking a medical history, the doctor may ask about bowel habits, symptoms, pain, diet, and medications. The physical exam usually involves a digital rectal exam. To perform this test, the doctor inserts a gloved, lubricated finger into the rectum to detect tenderness, blockage, or blood. The doctor may check stool for signs of bleeding and test blood for signs of infection. The doctor may also order x rays or other tests.
What is the treatment for diverticular disease?
Increasing the amount of fiber (and particularly soluble fiber) in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends a minimum of 20 to 35 grams of fiber each day.
You may also want to take a soluble fiber supplement such as Citrucel or Benefiber every day. These products are not laxatives – they simply help normalize bowel function and actually work as well to relieve and prevent diarrhea as constipation.
Patients with diverticulosis may find that insoluble fiber worsens their condition; it’s possible that small particles of insoluble fiber (which passes through the body undigested) can lodge in the diverticula and cause inflammation. For this reason it’s important to understand the difference between soluble and insoluble fiber foods.
If cramps, bloating, and constipation are problems, your doctor may prescribe a short course of pain medication. However, many medications affect emptying of the colon, an undesirable side effect for people with diverticulosis. You may wish to try a gut-soothing herb such as peppermint or fennel for these symptoms.
Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early.
To help the colon rest, the doctor may recommend bed rest and a liquid diet, along with a pain reliever.
An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein. In some cases, however, surgery may be necessary.
When is surgery necessary?
If attacks are severe or frequent, the doctor may advise surgery. The surgeon opens the abdomen and removes the affected part of the colon. The remaining sections of the colon are rejoined. This type of surgery, called colon resection, aims to keep attacks from coming back and to prevent complications. The doctor may also recommend surgery for complications of a fistula or intestinal obstruction.
If antibiotics do not correct the attack, emergency surgery may be required. Other reasons for emergency surgery include a large abscess, perforation, peritonitis, or continued bleeding.
Emergency surgery usually involves two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. Because of infection and sometimes obstruction, it is not safe to rejoin the colon during the first operation. The surgeon creates a temporary hole, or stoma, in the abdomen during the first operation. The end of the colon is connected to the hole, a procedure called a colostomy, to allow normal eating and bowel movement. The stool goes into a bag attached to the opening in the abdomen. In the second operation, the surgeon rejoins the ends of the colon.
* The pouches form when pressure inside the colon builds, usually because of constipation.
* Most people with diverticulosis never have any discomfort or symptoms.
* The most likely cause of diverticulosis is a low-fiber diet because it increases constipation and pressure inside the colon.
* For most people with diverticulosis, eating a high-fiber diet (with a particular emphasis on soluble fiber, and the careful incorporation of insoluble fiber) is the only treatment needed.
* Diverticulitis occurs when the pouches become infected or inflamed and cause pain and tenderness around the left side of the lower abdomen.
Diverticular disease information provided by the National Digestive Diseases Information Clearinghouse, NIH