Just the other day, a patient, let’s call him Mr. Davies, came into my clinic. He’d recently had a routine colonoscopy, and he looked a bit puzzled. “Doc,” he said, “they told me I have something called… diverticulosis? Sounds a bit scary.” I smiled, because it’s a conversation I have quite often. The first thing to know about diverticulosis is that it’s actually pretty common, especially as we get a bit older.
So, What is This Diverticulosis Thing?
Alright, let’s break down what diverticulosis really is. Imagine your intestines, particularly your large intestine (we call it the colon), as a long, winding road. Sometimes, little side-pockets or pouches can form along the walls of this road. These are called diverticula (that’s plural; one is a diverticulum). When you have these pouches, that’s diverticulosis.
How do they get there? Well, over time, as food waste moves through your intestines, it puts pressure on the intestinal walls. If there are any naturally weaker spots, the inner lining can push through, creating these little outpouchings. It usually happens gradually. These diverticula are most common in the last part of your colon, the sigmoid colon, because the waste is more solid there and can push a bit harder.
Now, it’s super important to know the difference between diverticulosis and its more troublesome cousin, diverticulitis.
- Diverticulosis: This just means the pouches are there. Most of the time, they’re quiet and don’t cause any fuss.
- Diverticulitis: This is when one or more of those pouches get inflamed or infected. Think of a little pocket getting clogged with bacteria and becoming sore and angry. That’s when you’d typically feel unwell.
Having diverticulosis by itself isn’t usually a big deal. Most folks live their whole lives with it and never even know. It can become serious, but that’s rare. For instance, if an infection (diverticulitis) isn’t treated, it could lead to bigger problems like sepsis. And, in a very small number of people, these pouches might bleed, which could, if it happens a lot, lead to significant blood loss.
You might be surprised how common it is here in the Western world. About 30% of folks over 50 have it, jumping to 50% over 60, and even up to 75% of people over 80! It’s not something we see much in folks under 40, or in parts of the world where diets are generally higher in fiber and less processed, like in many parts of Africa and Asia.
What Might I Notice? Symptoms of Diverticulosis
Here’s the thing about diverticulosis itself: most people have absolutely no symptoms. Zip. Nada. You’re likely to never know it’s there unless it’s found during a check-up for something else.
If you do start feeling unwell, with things like:
- Lower abdominal pain (often on the left side)
- Fever
- Chills
…that might mean you’ve developed diverticulitis (the inflammation or infection I mentioned).
Sometimes, if you already have something else going on in your gut, like irritable bowel syndrome (IBS), the pressure from food passing by the diverticula might cause a bit of tenderness or bloating. And if you’re often constipated, hard stool can get stuck in these pockets, which isn’t very comfortable.
About 10% of people with diverticulosis might experience some diverticular bleeding. This can happen if a hard piece of stool scrapes a blood vessel in one of the pouches. It’s usually painless, and you might see bright red blood in your poop. If this happens, or if you have ongoing symptoms, we then call it “diverticular disease.”
What’s Behind Diverticulosis?
We doctors think a big player in causing diverticulosis is the typical Western diet – often low in dietary fiber from plants and high in processed foods. This kind of diet can lead to denser, slower-moving stool that doesn’t quite sweep the colon clean. As this waste gets more solid towards the end of the colon, it puts more pressure on those weak spots.
Are there other factors? Possibly. Genetics might play a small part. We’ve also noticed that in Asian countries, when people do get diverticulosis, it often shows up in a different part of the colon – the beginning rather than the end. Interesting, right?
Figuring It Out: Diagnosis and Tests for Diverticulosis
So, how do we find out if you have diverticulosis? Often, it’s an accidental discovery. You might be having a routine colonoscopy (where a tiny camera looks inside your colon) or a special X-ray of your gut, and there they are – little pouches.
If you are having symptoms, we’ll want to get to the bottom of it. I’d start by chatting with you about:
- Your medical history
- Any medications you’re taking
- Your usual diet
- Your bowel habits – what’s normal for you?
Then, we might do a few things to investigate:
- Physical exam: I’ll check your temperature, blood pressure, gently feel your abdomen, and listen to your bowel sounds. Sometimes a quick digital rectal exam (a gloved finger exam) is helpful.
- Blood tests: A small blood sample can tell us if there are signs of infection or significant bleeding.
- Stool test: A sample of your poop can also be checked for infection or hidden blood.
- Imaging tests: To actually see the diverticula and check for any complications, we might suggest:
- A CT scan (a detailed X-ray)
- A barium enema (an X-ray after a special contrast liquid)
- A flexible sigmoidoscopy (like a mini-colonoscopy, looking at the lower part of the colon)
- A full colonoscopy
What’s the Plan? Managing Diverticulosis
The good news? For most people with just diverticulosis (the pouches, no inflammation), no specific medical treatment is needed for the pouches themselves. Phew!
Our main advice? We’ll likely talk a lot about dietary fiber. Upping your fiber intake is key because it helps address what probably caused the diverticulosis in the first place. More fiber makes your stool softer and bulkier, helping it pass more smoothly and keeping your colon cleaner. Think of it as giving your gut a gentle sweep!
In those rare cases where there’s persistent bleeding from a diverticulum (about 3% of people), we do have ways to help. Usually, a gastroenterologist (a specialist in digestive diseases) can stop the bleeding during a colonoscopy by sealing the tiny blood vessel. Sometimes, an angiogram (a special X-ray of blood vessels) is used to find the bleeding, and then medication can be injected to stop it.
What to Expect and Can It Go Away?
If you have diverticulosis but no symptoms, chances are you’ll stay that way. If you have other conditions like constipation or IBS, you might be a bit more prone to ongoing discomfort. A very small number of people have repeated bleeding episodes and might need treatment for those.
One common question I get is, “Can diverticulosis be reversed?” Unfortunately, once those little pouches have formed, we don’t have a way to make them disappear. But don’t let that discourage you! If they’re not causing trouble, they’re just… there. If they do cause issues, we focus on managing those with lifestyle adjustments.
Can We Prevent Diverticulosis?
This is where you have some real power! Eating plenty of plant-based foods (fruits, veggies, whole grains), getting regular exercise, and drinking enough water are all fantastic for keeping your bowel movements healthy and regular. This kind of lifestyle may help prevent diverticulosis from developing in the first place. And if you already have it, these habits can help prevent more pouches from forming and reduce the risk of complications. While it’s not a 100% guarantee, it’s a great strategy for overall bowel health.
Living Well with Diverticulosis
Whether you have symptoms or not, if you know you have diverticulosis, it’s a good sign you could benefit from more dietary fiber.
- Aim for more whole grains, fruits, and vegetables.
- Some people find fiber supplements, like psyllium, helpful. Just be sure to drink plenty of water with them, or they can actually make constipation worse! Weird, right?
If you have “diverticular disease” (meaning you get symptoms or bleeding), you’ll want to pay a bit more attention.
- Notice if certain foods seem to cause more discomfort.
- Be aware of how any medications you take might affect your symptoms.
- And importantly, if you see any rectal bleeding, always let your doctor know, even if it stops on its own. We’ll want to make sure everything’s okay.
A Little Extra Note: Pouches Elsewhere?
Just so you know, these diverticula can technically pop up elsewhere in your digestive tract – like your small intestine, stomach, or even your esophagus (the tube from your mouth to your stomach). But these are much rarer and usually linked to other specific conditions. The vast majority of the time, when we talk about diverticulosis, we’re talking about those pockets in the colon.
Take-Home Message: Understanding Your Diverticulosis
So, if you’ve been told you have diverticulosis, here are the key things to remember:
- It’s Common: You’re not alone; many people develop these small pouches (diverticula) in their colon, especially as they age.
- Often Silent: Most people with diverticulosis have no symptoms at all.
- Diet Matters: A diet low in dietary fiber is a likely contributor. Increasing fiber can help manage it and prevent complications.
- Diverticulitis is Different: If a pouch gets inflamed or infected, that’s diverticulitis, and it does cause symptoms like abdominal pain and fever.
- Usually Not Serious: While complications can occur, they are not common.
- Talk to Us: If you have concerns, new symptoms, or notice bleeding, please chat with your doctor.
You’re not alone in this. We’re here to help you navigate it and keep you feeling your best.