Colonic diverticulosis is a colon disease that commonly affects the elderly. In this disease diverticula, or outpouchings, develop in the lining of the large intestine because the muscular wall of the large bowels becomes weak. The most common areas involved are the descending colon and the sigmoid colon, found on the left side of the abdomen. In colonic diverticulosis, multiple diverticula are present but do not cause symptoms, while in diverticulitis, symptoms are present. Patients with colonic diverticulosis are asymptomatic or have minimal symptoms, thus no specific treatment is needed, but dietary modification and fiber supplementation are advised to prevent symptomatic disease and complications.
Age is one important risk factor for diverticulosis, and about half of all people older than 60 have this condition. Approximately 10 to 25% of people who have diverticulosis eventually get diverticulitis, a condition wherein the diverticula become inflamed, leading to symptoms of bleeding, abscess formation, colonic perforation, fistula formation, and bowel obstruction.
The development of mucosal herniations or diverticula depends on multiple risk factors. If a person has a family history of colonic diverticulosis, he or she is also at increased risk for this condition. Environmental factors include eating a low-fiber diet, being obese, and having a sedentary or non-active lifestyle. Regular intake of corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), caffeine, or alcohol is also a risk factor for developing colonic diverticulosis.
Most people who have this condition do not experience any symptom. Troubling symptoms, such as flatulence, changes in bowel habits, colicky abdominal pain, and bloating, are rarely reported. When these symptoms occur, they usually cease upon flatus passage or defecation. Bleeding may be the only sign that a person has diverticulosis.
When the diverticula become inflamed or infected, diverticulitis develops. Acute diverticulitis has symptoms of pain on the left lower quadrant of the abdomen, fever, chills, nausea and vomiting, constipation, diarrhea, and bowel obstruction. On laboratory examination of an affected person’s blood, leukocytosis or elevation of the number of white blood cells is observed. Right-sided pain may also occur in diverticulitis. The location of pain generally gives a clue on which segment of the colon is involved.
If colonic diverticulosis is not addressed and it progresses to diverticulitis, it can cause complications such as obstruction, fistula formation, or perforation. Delayed diagnosis and treatment may lead to sepsis and even death. Diagnosis should be made as soon as possible. Diagnostic tests used include blood tests, urinalysis, and abdominal X-ray. Other special tests include colonoscopy, ultrasound, and computed tomography (CT) scan.