Diverticulosis and Diverticulitis: What’s the Difference?

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Chances are, you don’t think much about your digestive tract — unless it’s giving you trouble.

A condition called diverticulosis, which is not uncommon for women over 50 (though men are at greater risk), can lead to trouble. With this condition, small pouches — diverticula — form in the colon (or intestinal) wall. And this can increase your risk of a painful bout of diverticulitis — an infection or inflammation of the pouches.

The good news? “Only a small number of people with diverticulosis have diverticulitis,” says Fayez Abboud, MD, gastroenterologist with Premier Gastroenterology Specialists.

Dr. Fayez Abboud talks about diverticulitis. Click play to watch the video or read the transcript.

What is diverticulitis?

Diverticulitis is when some of the people with diverticulosis develop infections or an inflammation in these little sacs that protrude out. Only a small number of people with diverticulosis have diverticulitis.

The symptoms of diverticulitis are usually abdominal pain. Usually in the left, lower part of the abdomen. Pain, sometimes you can have fever, and tenderness; which means if you push on the abdomen you have pain with the pushing on it. These are the most common symptoms.

If it becomes very severe then it requires putting the patient in the hospital for treatment. The diverticulitis can become perforated, which is ... Only a small number of people with diverticulitis have perforation, which is a serious condition where there's a small little hole or a tear in one of these little sacs that leaks the contents of the bowel into the abdomen. That is a serious condition that usually requires surgery.

Diverticulitis, most cases of diverticulitis are acute. It's a sudden attack, the patients know about it. But a small number of patients have recurrent, acute diverticulitis. They have recurrent episodes of these attacks. A small number of them can develop chronic diverticular disease, which is kind of a low grade degree of diverticulitis with some mild and chronic low grade discomfort. So it is possible for diverticulitis to become chronic to some extent.


Learn more about the link between the two, and what you can do when symptoms signal that something is wrong.

What Causes Diverticulitis and Diverticulosis?

Experts don’t know for sure what causes these conditions, but several factors may play a role:

  • High pressure in the colon: Muscle spasms in the colon or straining to have a bowel movement may cause bulges to form at weak spots.
  • Family history: The genes you inherit may make you more likely to develop diverticulosis and diverticulitis.
  • Medications: Studies have uncovered connections between these digestive conditions and some medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin.
  • Lifestyle: Lack of exercise, obesity and smoking may also contribute.

Dr. Fayez Abboud talks about what causes diverticulitis. Click play to watch the video or read the transcript.

What causes diverticulitis?

What causes diverticulitis? It's not completely clear, but it is an infection and/or inflammation in one of the pockets. It is a common misconception that people are told to avoid seeds, or that people are told to avoid seeds, nuts, popcorn. Really the studies show that there is no clear evidence that avoiding these lead to diverticulitis.


What Are the Symptoms?

Diverticulosis: Most people with diverticulosis don’t even know they have it. But if you do have symptoms, they may include:

  • Bloating
  • Constipation
    Cramping or pain in your lower abdomen

Diverticulitis: With diverticulitis, the inflamed pouches typically trigger pain in the lower left side of your abdomen. The pain is often severe and comes on suddenly. Other symptoms include:

  • Constipation or diarrhea
  • Fevers and chills
  • Nausea or vomiting

See your doctor right away if you are troubled by any of these symptoms.

With diverticulitis, the inflamed pouches typically trigger pain in the lower left side of your abdomen. The pain is often severe and comes on suddenly.

How Are Diverticulitis and Diverticulosis Diagnosed?

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If your health care provider believes you have one or both conditions, based on your symptoms, she may make her diagnosis using the following:

  • Medical history: Your doctor will ask about your bowel movement frequency, diet, overall health, what medicines you take and what symptoms you are experiencing.
  • Physical exam: Your doctor will perform an exam, which may include a digital rectal exam, when she slides a gloved, lubricated finger into your anus to check for pain, bleeding, hemorrhoids or other problems.

Your doctor may also use one of these tests:

  • CT scan: This uses computer technology to combine multiple X-rays into a detailed image of your gastrointestinal (GI) tract.
  • Barium enema: A chalky, liquid solution of barium sulfate, introduced by enema, coats the large intestine to help provide clear X-ray images of your large intestine. This procedure is also called a lower GI series.
  • Colonoscopy: Using a thin, flexible tube with a tiny camera on the end, this test provides a look inside your rectum and colon.

Dr. Fayez Abboud talks about diagnosing and treating diverticulitis. Click play to watch the video or read the transcript.

How is diverticulitis diagnosed and treated?

Diverticulitis is usually diagnosed by, initially, the clinical picture. People presenting with symptoms to suggest it. The examination, when we feel the abdomen and it's tender where the diverticulosis is usually present. A CT scan of the abdomen usually confirms this diagnosis.

If somebody gets an acute diverticulitis every two or three years it can be treated with antibiotics. Having frequent attacks of diverticulitis can lead to complications, adhesions. Things stick together in the abdomen and then you can have something called "fistula," when you develop an abnormal connection between the colon and the bladder or other organs.


How Are Diverticulitis and Diverticulosis Treated?

Diverticulosis: With the goal of preventing bothersome symptoms or more serious problems like diverticulitis, these can help:

  • High-fiber diet: Foods rich in fiber can help you avoid symptoms if you already have the condition. Increase fiber in your diet slowly to decrease the chances of abdominal gas and pain. 
  • Medicines: Mesalazine (Asacol) and the antibiotic rifaximin (Xifaxan) may help reduce symptoms.
  • Probiotics: Probiotics are healthy bacteria, like those that naturally live in your stomach and intestines. You can find them in dietary supplements and in foods like yogurt. Talk with your doctor or health care provider first about using these or any alternative medicines.

Diverticulitis: Treatment will depend on your symptoms.

  • Mild symptoms: You may be put on a liquid diet for a short time. Antibiotics are often prescribed. If these help, your doctor may put you on a high-fiber diet.
  • Severe symptoms: You may be admitted to the hospital, where you can be given intravenous (IV) antibiotics and fluids. You will also be put on a low-fiber or liquid diet. In rare cases, surgery may be needed. 
Small Steps: Prevent Hemorrhoids
Drinking more water and adding fiber to your diet are two key ways to reduce your risk of developing hemorrhoids.