Diverticulosis (the anatomical condition) and diverticulitis (active inflammation) are very common, particularly here in the United States. The American Society of Colon and Rectal Surgeons estimates that up to half of all Americans have diverticulosis by the age of 60, and it is nearly a universal condition after the age of 80.
While mostly an asymptomatic condition, those affected by diverticular disease can have uncomfortable symptoms when the condition is acute, and potentially life-threatening complications can occur without adequate treatment.
Diverticula are sac-like formations in the mucosa of the colon that protrude out from the muscular layer. They are most commonly found on the left side in the sigmoid colon, but can appear virtually anywhere in the colon.
The term diverticulosis describes the existence of these pockets and diverticulitis is the inflammation or complications within the diverticula.
The increasing lack of fiber in the commercially available diets of today has been implicated in diverticular development, because the pressure to move small, hard stool through the colon causes the muscular wall of the colon to work harder.
As mentioned previously, most people with diverticular disease do not have symptoms. Diverticulosis is often found incidentally when running tests for abdominal pain or other gastrointestinal disease. Most often it is discovered during routine colonoscopy for cancer screening. Symptoms can be related to complications including infection and bleeding—diverticular disease is the most common cause of significant colonic bleeding.
An inflammation in one or more of the pockets is most commonly associated with acute abdominal pain, fever, chills and change in bowel habits. While nausea, vomiting, low-grade fever and abdominal discomfort are common, more intense symptoms develop when the wall of the pocket ruptures and an abscess or fistula forms. A fistula is an abnormal connection between the colon and the skin or another organ and serves as an escalating area of infection.
In diverticula without symptoms, increasing dietary fiber such as grains, vegetables and legumes reduces pressure within the colon and helps transit waste material through the gastrointestinal system. Such high fiber diets or use of fiber supplements such as bran powder decrease the likelihood of future complications. While diverticula are permanent anatomic conditions, they can remain without problem virtually forever.
When diverticulitis occurs and is acute, most affected individuals are treated successfully through medical management with a clear liquid diet and antibiotics. At times diverticulitis can become acute and necessitate surgical management. A ruptured abscess or persistent fistula may require surgery and even resection of the affected part of the colon. In those cases hospitalization and intravenous fluids are mandatory.
Cases in which there is perforation of a pocket and rupture of contents into the body and abscess formation have the highest degree of life-threatening complications. Cancer is the number one “rule out” diagnosis and CT scanning and colonoscopy may be required once the infection is quieted.
While diverticulitis can recur in those who have been affected, thankfully the disease is usually well managed, and standard and preferred issues are likely when the process has subsided and is not recurrent. Permanent dietary changes significantly lessen subsequent attacks and symptoms.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1990. Goldstone can be reached by telephone at 949-420-8390. Email: firstname.lastname@example.org.