The Do’s and Don’ts of Diverticulitis
If you’ve ever endured the pain of diverticulitis, our family practice doctors in Delray Beach want to offer some background on this common condition, which affects more than 200,000 people in the U.S. every year.
What is diverticulitis?
When small, bulging pouches or sacs (diverticula) develop in the colon, this is known as diverticulosis. When the diverticula become infected or inflamed, this is called diverticulitis (the “itis” suffix meaning inflammation). Collectively, these two conditions are known as diverticular disease.
Diverticulosis may never cause a problem, and many people don’t even know they have it unless it’s discovered during a colonoscopy. Diverticulitis, however, is not only painful, but can be life-threatening unless treated medically.
According to the National Institutes of Health (NIH), the U.S., Europe, and Australia have the highest prevalence of diverticular disease. Among these populations, approximately 50 percent of those aged 60 and older have diverticulosis. In the developing world, less than 0.5 percent of the population is afflicted.
While previously considered to be a disease that primarily affects older people, there is increasing incidence of diverticular disease found in individuals younger than 40, the NIH reports.
Symptoms of diverticulitis can include:
- severe, constant pain that comes on suddenly, usually in the left side of the abdomen, although the pain can also occur on the right
- nausea and vomiting
- abdominal tenderness
- constipation or, sometimes, diarrhea
- bright red blood in the stool
Diverticulitis can be either acute (a severe attack), or chronic, in which the most severe symptoms subside but never go away completely.
If the condition persists, it can lead to a bowel obstruction, which will require surgery. Other serious complications can include perforation of the intestinal wall, abscesses which can lead to peritonitis if they breach the intestinal wall, or fistulas, an abnormal passage between the intestines and other nearby organs.
Causes and risk factors
Experts are not sure what causes diverticular disease, but given its prevalence in developed nations as opposed to developing countries, several possibilities suggest themselves.
This includes diet, genes, or the frequent use of certain medications including opioids, nonsteriodal anti-inflammatory (NSAID) drugs like aspirin, ibuprofen, and naproxen, or steroids.
We do know, however, that such factors as obesity, smoking, and—especially—lack of exercise, are risk factors.
The role of diet has long factored into discussions regarding the causes of diverticulosis and diverticulitis, but new findings have challenged long-standing beliefs.
According to the NIH, “For more than 50 years, experts thought that following a low-fiber diet led to diverticulosis. However, recent research has found that a low-fiber diet may not play a role. This study also found that a high-fiber diet with more frequent bowel movements may be linked with a greater chance of having diverticulosis.”
Prevention and Treatment
The conflicting views among experts over whether to follow a high-fiber or low-fiber diet complicate the issue of prevention. However, it seems reasonable to believe that a healthy diet containing at least a moderate amount of fiber can help soften the stool and allow it to pass through the colon without straining, thus possibly reducing the risk of inflaming any diverticula present.
One persistent myth that seems to endure maintains that consuming such foods as nuts, seeds, corn, or popcorn can cause diverticulitis. This appears to stem from the belief that such hard, tiny bits can become lodged in the diverticula, causing inflammation. But a 2008 study published in the Journal of the American Medical Association (JAMA) found that such foods may actually lower the risk of the condition.
Other more concrete ways to prevent diverticulitis include avoiding practices that increase inflammation throughout the body: smoking, overweight, and lack of exercise.
Those with mild diverticulitis are treated with rest, a liquid diet, and sometimes oral antibiotics if warranted. More severe symptoms require hospitalization for treatment with intravenous antibiotics and, occasionally, surgery.
According to the NIH, the symptoms of diverticulitis can mimic other conditions, such as irritable bowel syndrome or peptic ulcers, so it’s important to see us if you have any of these symptoms so that we can rule out other causes and suggest appropriate treatment.