Diverticulosis is a very common condition of the colon that affects millions of people as they grow older. It has been estimated that close to half of Americans 60 years of age or older have this condition. In diverticulosis, part of the colon bulges outward through weak spots in the colon wall. Imagine a rubber inner tube that has weak spots. These spots can give rise to bulges if the pressure inside becomes too high. This is similar to diverticulosis. Weak spots in the colon wall bulge out and form little pouches, called diverticula. The mere presence of this condition is called diverticulosis. This is different than diverticulitis, which implies that these pouches (diverticula) have become inflamed or infected. Diverticular disease is simply the presence of diverticulosis, with or without diverticulitis.

What is the cause of diverticular disease?

Many believe a low-fiber diet is the main culprit behind diverticular disease. This disease was initially noticed in America in the early 1900s, around the same time that processed foods were introduced into our diet. Of further support for the low-fiber diet theory is the fact that diverticular disease is common in developed countries where low-fiber diets are consumed. However, it is rare in countries where citizens eat a diet high in fiber.

Fiber is the part of grains, fruits, and vegetables that the body cannot digest. While some fiber does dissolve in water (soluble fiber) the other form of fiber does not (insoluble fiber). Nevertheless, both types of fiber remain undigested by the body?s digestive enzymes and pass out of the body by way of the stools. Both types of fiber help make stools soft.

When stool is soft, you do not have to strain as hard to have a bowel movement. On the other hand, when the stool is hard, you often have to strain to pass it. This straining increases the pressure within the colon, which is felt to play a major role in causing weak spots in the colon wall to bulge out and form pouches, or diverticula.

What causes diverticulitis?

This complication of diverticulosis occurs when the diverticula become inflamed or infected. This may occur when stool (which is full of bacteria) becomes trapped in the diverticular pouches and sets up an infection. Therefore, people with diverticulosis are cautioned not to eat foods that can get stuck in the opening of the pouches and trap the stool behind it. Such foods include foods with seeds, nuts, and other small, but firm foods that are not readily broken down in the digestive process.

What are the symptoms of diverticular disease?

Diverticulosis generally does not cause any significant symptoms, though on occasion people with this condition may experience mild cramps or bloating. While rare, the diverticular pouches can bleed and on occasion the bleeding can be severe.

On the other end of the spectrum is diverticulitis which is far more likely to cause symptoms, which can include severe abdominal pain, usually in the lower left abdominal region. Fevers, chills, nausea, and vomiting are other common symptoms.

How is diverticular disease treated?

As mentioned above, a high-fiber diet is important. It may reduce the likelihood of developing symptoms from diverticulosis and may even reduce the risk of developing diverticulitis.

Diverticulitis requires antibiotics. If mild, it is often treated as an outpatient. If the symptoms are moderate to severe, a short hospitalization is usually warranted.
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