Diverticulosis; is it anything to worry about?
Dr. Jesse P. Houghton is a board-certified gastroenterologist. He was born and raised in New Jersey and has been practicing in Southern Ohio since 2012. He has been in practice for over 13 years. He treats both gastrointestinal as well as liver diseases. He prides himself in carefully listening to his patients and their... more
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Diverticulosis is a condition in which small pockets (diverticula) form in the wall of the colon or large intestine. The condition is more common as we age, and affects the majority of people in their 70s and 80s. However, we sometimes find diverticulosis in patients as young as their early 30s. It most often occurs in the sigmoid colon, which would be located in the left lower abdomen. In the majority of patients, diverticulosis does NOT cause any symptoms. Classic symptoms, when they do occur, include crampy left lower abdominal pain and bloating.
As it gets worse, diverticulosis (or ‘tics’ for short) can be associated with diarrhea and constipation. Two rare complications from diverticulosis, are bleeding (diverticular bleed) and infection (diverticulitis). We do not know why some people have diverticulosis and others do not. Likewise, we are not sure why some people get diverticulitis and diverticular bleeding. Some studies show an association between NSAIDs (ibuprofen, aspirin), obesity, lack of exercise, and smoking. I personally believe genetic factors play a big role, as in most medical conditions.
Diverticular bleeding is usually acute (all of a sudden) and a lot of bleeding. Unlike classic hemorrhoidal bleeding, diverticular bleeding is bright to dark red, large volume, and associated with lower abdominal cramping. Fortunately, most of the time, it resolves on its own. However, most patients will seek medical treatment for these symptoms, and end up being admitted to the hospital. Often times, a colonoscopy is performed in hopes of finding and stopping the bleed, however, most of the time, all we find is old or fresh blood, with no clear source. Sometimes we get lucky and can localize the diverticular bleed, at which time we can clip, band, or cauterize the spot.
Diverticulitis is when one of the diverticular pockets becomes infected. Typical symptoms are lower (usually left lower) abdominal pain, nausea/vomiting, and fevers/chills. Sometimes bowel habit changes occur as well (usual constipation from the swelling in the area). Antibiotics are usually required in true cases of diverticulitis. There is NO good evidence to suggest that nuts, seeds, or popcorn cause diverticulitis or diverticular bleeding. I have found from experience, that this is so ingrained in some of my patients’ beliefs, that I let them do as they choose in terms of avoiding these foods. I simply provide them with the best available evidence. We do generally recommend a high fiber diet when someone has diverticulosis, although admittedly the data for this is not great either.
Be well!
