Crohn's Disease

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What is Diverticular Disease?

Diverticular disease or diverticulosis of the colon can be described as pressure within the colon which causes bulging pockets or outpouchings of colonic mucosa (inner tissue lining) to push through the walls of the colon. These outpouchings are referred to as diverticula and they can affect only a segment of colon (usually in the sigmoid or left colon) or may involve the entire colon. Diverticulosis is a common condition that afflicts about 50 percent of Americans by age 60 and nearly all by age 80. Only a small percentage of those with diverticulosis have symptoms and even fewer will ever require surgery.

What are the symptoms of diverticular disease?

The protruding nature of diverticula may cause very small to large perforations in the colon resulting in diverticulitis which is an infection of the diverticula. As a result symptoms can range from minor discomfort to severe abdominal pain accompanied by fevers and chills.

What causes diverticular disease?

Diverticulosis and any resulting diverticulitis are associated with a low fiber diet. It takes more pressure in the colon to pass low volume (low fiber) contents, which eventually results in pockets (outpouchings or diverticula). In Africa, where high fiber diet is predominant, diverticular disease is very rare.

What treatments are available?

Increasing the amount of dietary fiber (grains, legumes, vegetables, etc.) can help. At least 20gm of fiber a day will stabilize or slow the progression of the disease by reducing the pressure created by the diverticula.

Diverticulitis requires different management. Mild cases of diverticulitis are managed with oral antibiotics with more severe cases requiring bowel rest (dietary restrictions) and hospitalization with intravenous antibiotics.

Is there surgery available for diverticular disease?

Surgery is available but as a treatment of last resort. The criteria for having surgery have been changing over the last 2-3 years with the trend heavily leaning towards a more conservative and individualized approach. Surgery is mostly advised for those patients with recurrent episodes of diverticulitis, complications, or refractory disease that is not responding to medical therapy.

What are the possible complications resulting from diverticular disease?

Bleeding, abscess, stricture, fistula (connection of the large bowel with adjacent organs such as the bladder or skin), and/or perforation resulting in a spillage of feces into the abdominal cavity.

Will I ever need a colostomy?

During an elective (planned) procedure a diseased part of the colon is removed and the bowel ends are reconnected. Bowel function resumes in several days and normalizes in three to four weeks meaning a permanent colostomy pouch is unlikely. In emergency situations, chances are that you may require a temporary colostomy pouch.