Diverticular Disease- Diverticulosis
Diverticular Disease- Diverticulosis is a very common condition often identified during colonoscopy or on CT scan / imaging of the intestinal tract. For lack of a better word, diverticulosis could be described as small sac-like “pockets” within the colon wall. In most cases, these pockets are not causing noticeable symptoms. If you have undergone a colonoscopy and told that you have diverticulosis, this is a quick review.
Background
Diverticular pockets in the colon seem to occur as we age. It has been estimated that 20 % of the population will have diverticulosis by age 40. The rate rises dramatically to 60 % by age 60.
Studies have shown a few things
- diverticulosis is more common in western countries – most likely due to our low fiber diet
- usually occurs on our sigmoid colon which corresponds to the left lower abdomen
- more common in men than women
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Risk Factors as for Diverticulosis – reports vary
- Age > 40
- Obesity
- Diet low in fiber
- Chronic constipation
- Family history
Diverticulitis – infection
Approximately 4 percent of patients with diverticulosis will have an attack of infection and inflammation in the colon. Diverticular pockets can become infected and result in abdominal pain as well as fever or constipation. Patients with an attack of diverticulitis need to see their doctor asap or go to a local ER/ Urgent care for treatment. Typically, a CT scan of the abdomen will identify and confirm the condition. Broad spectrum antibiotics are recommended 10-14 days to stop the infection. Rarely, diverticulitis can lead to hospitalization, surgery and procedures to drain the infection. Abscess formation
Risk Factors for Diverticulitis
- Sedentary Lifestyle
- Obesity
- Immunosuppression – steroid use
- Smoking
- Medications – NSAIDs, Menopausal Hormone therapy, opiate pain medications
- Anticoagulants – Plavix, Xarelto are examples
- Genetic predisposition
Diverticular Bleeding
Diverticular pockets can also bleed. Bleeding from diverticulosis is actually one of the top causes of bleeding when patients present to the emergency room. The bleeding often presents as sudden, painless and is very obvious. The bleeding may occur with or without stool present and can be of large volume. Bleeding can be dramatic and quite serious, causing dizziness, low blood pressure and even passing out. Patients usually wind up in their local ER to have this condition treated. In many centers, non- surgical treatment is very effective in stopping the bleeding. In fact, a radiology procedure known as an angiogram is often performed to identify the bleeding site which is then treated with embolization. Of course, other causes of bleeding must be ruled out prior to any interventional treatments.
What are other common causes of sudden onset rectal bleeding?
- Inflammation in the colon – colitis
- Colon growths or cancers
- AVM or leaking blood vessel anywhere in the Gi tract
- Varices in patients with cirrhosis and liver disease
- Peptic ulcer in the upper Gi tract
Recommendations for Patients with Diverticulosis
- Avoid straining and constipation
- Increase fiber in the diet
- Consider starting a fiber supplement – Citrucel or Metamucil daily
- Avoid NSAID medications if possible
- Exercise
- Lose weight if obese
- Notify your doctor for any symptoms of abdominal pain, tenderness with fever
- Start antibiotics early if diverticulitis suspected
- Go to a local ER/ Urgent care for any sudden rectal bleeding – let them know you have diverticulosis