The vast majority of people with diverticulosis have no symptoms.
Abdominal pain is usually the first symptom of complications caused by diverticulitis. Because most cases of diverticulitis affect the left side of the colon, the pain or tenderness is usually located around the left side of the lower abdomen.
When an infection is present, diverticulitis may also appear with fever, nausea, vomiting, chills, cramping, and constipation.
Diverticulitis can have severe complications that cause bloody stools, persistent constipation, and severe abdominal pain or tenderness. You should seek immediate medical attention if these symptoms appear. Table 01 The complications that cause these symptoms include lower intestinal bleeding, abscesses, perforations in the colon wall, peritonitis, fistula formation, or intestinal obstructions.
- Intestinal bleeding can be caused by blood vessels that burst within diverticula. The bleeding usually stops by itself, but in some cases surgery is necessary.
- An abscess is an infected area that fills with pus. Abscesses can cause swelling, and can destroy healthy tissue. A perforation in the wall of the colon can lead to an abscess. The larger the abscess, the greater the need for it to be drained though the skin or by means of surgery.
- Peritonitis is an infection that spreads outside of the colon to the abdominal space. If left untreated, peritonitis can be fatal.
- Fistulas are abnormal connections between organs or tissues. When infected tissues come in contact with each other, they may stick together, creating abnormal passageways between the organs. The most common fistulas that occur with diverticulitis are between the bladder, the small intestine, and in women, the vagina. Fistulas to the skin are very rare in diverticular disease.
- Scarring caused by diverticulitis can block the intestinal tract, requiring surgery. In most cases, the blockage only partially obstructs the colon. When the colon is completely obstructed, emergency surgery is required to prevent potentially fatal complications.
Table 1. Symptoms of Diverticular Disease
Diverticulitis Lower left abdominal tenderness or pain Fever Nausea Vomiting Chills Cramping Constipation Symptoms requiring immediate medical attention Bloody stools Persistent, high fever Persistent constipation Severe abdominal pain or tenderness
A diet low in fiber is the primary risk factor for diverticulosis. The average American diet contains roughly half the recommended amount of fiber needed to avoid diverticulosis. In areas of the word where diverticulosis is rare, the average daily intake of fiber is 40 g to 45 g. The average American diet, in contrast, contains about 20 g to 25 g of fiber per day.
At one time, doctors thought that some ethnic groups had a higher risk of developing diverticular disease. The most recent research, however, suggests that any difference between ethnic groups is due to differences in diet. For example, diverticular disease is rare in Africa, and was relatively uncommon among African-Americans until the second half of the 20th century. However, the rate of diverticular disease among African-Americans has steadily increased, and is now equal to that of the white population. This suggests that environmental factors such as diet play a larger role in the disease than genetic differences related to ethnicity.
Asian populations have a higher incidence of right-sided diverticula and diverticulitis. However, right-sided diverticulitis can be mistaken for appendicitis.
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