Many people, especially in their later years, have diverticular disease and don’t even know it. However, when symptoms do occur, they may be painful and require further medical attention.
A diverticulum is a pouch that bulges out from a layer of the colon’s wall. Twenty percent of people under age 40 have one or more, as do 30 to 60 percent of people over 60. When diverticula do not cause any symptoms or problems – which is the case 70 percent of the time – the condition is called diverticulosis. It occurs equally in men and women. Your doctor may discover diverticulosis during a routine colonoscopy for colorectal cancer screening. No treatment is needed unless symptoms develop.
About 15 to 25 percent of individuals with diverticulosis will develop diverticulitis, which is an infection in the pouch. This is usually caused when feces become trapped in the pouch or from increased pressure in the colon, which results in decreased blood flow to the pouch. Symptoms include pain in the lower left abdomen, fever, constipation or diarrhea, nausea and vomiting.
If these symptoms occur, it’s time to see your doctor. A CT scan is the common method of diagnosis. Usually antibiotics and a clear liquid diet will resolve the problem. Sometimes, hospitalization may be required. Diverticulitis can cause an abscess, fistula, or other complications that require surgery.
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Another problem that can occur with diverticulosis is rectal bleeding, which happens when an artery in the diverticula ruptures. The bleeding is painless and may appear maroon or bright red in color. The bleeding is often heavy and may occur with bowel movements. Seventy-five percent of the time, the bleeding stops spontaneously. About 5 percent of the time the bleeding is severe and may require surgery.
Rectal bleeding is not normal. If you have rectal bleeding – whether it is caused by diverticulosis or another condition – you should see your doctor for a diagnosis and treatment. About 30 to 50 percent of massive rectal bleeding is caused by diverticulosis. The bleeding associated with colon cancer is usually not obvious compared to diverticular bleeding. There are also benign causes of rectal bleeding, such as hemorrhoids.
If you have been diagnosed with diverticulosis in the past, your doctor may have told you to avoid eating nuts, seeds, and other small, hard foods such as popcorn. Recent studies show that avoiding these foods is not necessary. However, a high-fiber diet can help prevent diverticulosis by making the stools bulkier. The recommended amount of fiber is 20 to 35 grams per day. Fiber can be found in fruit, oats, beans, peas, and green leafy vegetables. Other ways to help prevent diverticulosis include maintaining an optimal weight and getting appropriate exercise.