Diverticulosis and Diverticulitis

  • Basics

    Diverticula are small pouches of tissue that bulge out through weak spots in the colon. People with diverticula are said to have diverticulosis. Figure 01 Diverticulosis is very common in the U.S. and other Western countries. An estimated half of all Americans between the ages of 60 and 80, and almost everyone older than age 80, has diverticulosis.

    Diverticulitis is a serious, unpredictable, and potentially dangerous complication of diverticulosis that occurs when the diverticula become inflamed or infected.

    An estimated 10% to 25% of people with diverticulosis develop diverticulitis. Diverticulitis can be treated with antibiotics, pain medications, and/or surgery.

    Frequently, food residue gets lodged in diverticula, providing a good environment for bacteria to grow and multiply. In severe cases, bacterial infection may spread outside the colon into the abdominal space—a serious and potentially fatal condition called peritonitis.

    With diverticulitis, the inflammation may be limited, or may be accompanied by abscesses, blockages, or tears in the wall of the colon.

    Diverticulosis and diverticulitis are known together as diverticular disease. Diverticular disease most often occurs in those over 50 years of age, but is becoming more common in younger people.

    An estimated 2% to 4% of younger people had diverticular disease in the late 1960s. In the early 1990s the incidence was estimated to have risen to between 12% and 30%. Diverticular disease in younger people is generally more aggressive, and often requires surgical treatment.

    Click to enlarge: Diverticula in the colon

    Figure 01. Diverticula in the colon

  • Causes

    The underlying cause of diverticular disease is thought to be a low-fiber diet. Fiber is the undigestable part of the foods we eat. Fiber helps to soften stools and make them easier to pass through the colon. Fiber also helps prevent constipation.

    Diverticular disease is common in industrialized countries where the diet consists predominantly of processed foods with relatively little fiber. Diverticular disease is rare in countries where people eat high-fiber diets with large amounts of fruits and vegetables.

    Diverticula are thought to form when there is too much pressure in the colon. The stools of people who eat low-fiber diets are often hard and compact. To force these stools through the colon, the abdominal muscles must put additional pressure on the colon. This excess pressure causes weak spots in the wall of the colon to bulge out, much like an inner tube poking out of the weak spot in a bicycle tire as it is pumped up.

    In rare cases, diverticular disease may be caused by a puncture of the colon with a foreign body, such as a fish bone.

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