Many people have small pouches in the lining of the colon (the large intestine) that bulge outward like weak spots in a tire. A single pouch is called a diverticulum; multiple pouches are called diverticula. When you have diverticula (multiple pouches), the condition is called diverticulosis. When the pouches become inflamed, the condition is called diverticulitis. Ten to 25 percent of people with diverticulosis get diverticulitis. As many as one American in 10 over the age of 40 has diverticulosis, and about half of all people over age 60 have it. Symptoms of Diverticular Disease Diverticulosis. Most people with diverticulosis don't have any symptoms. However, some people may sometimes experience cramping pain or discomfort in the lower abdomen, bloating, and constipation. Other gastrointestinal conditions, such as irritable bowel syndrome, can cause similar symptoms, so experiencing such symptoms doesn't always mean that a person has diverticulosis. However, gastroenterologist Steven R. Peikin, MD, who heads the Division of Gastroenterology & Liver Diseases at Cooper, noted that, "Diverticulosis is the number 1 cause of rectal bleeding if hemorrhoids are excluded." Diverticulitis. Diverticulitis most commonly causes abdominal pain and tenderness on the lower left side of the abdomen. Usually, the pain is sudden and severe, but it also can be mild and worsen over several days. Its intensity can change. A person may experience cramping, nausea, vomiting, fever, chills, or a change in bowel habits. Diverticulitis can lead to bleeding, infections, small tears (called perforations), or blockages in the colon. These complications always require treatment to prevent them from causing serious illness. Causes of Diverticular Disease The leading theory is that a low-fiber diet causes diverticular disease. The disease was first noticed in the United States in the early 1900s, around the time processed foods became part of the American diet, greatly reducing fiber intake. Fiber is the part of fruits, vegetables, and grains that the body can't digest. These indigestible foods, sometimes called roughage, help to promote healthy bowel movements. Some fiber, called soluble fiber, dissolves easily in water. It takes on a soft, jelly-like texture in the intestines. You get soluble fiber from oats, barley, and fruits such as oranges and apples. Other fiber, called insoluble fiber, passes almost unchanged through the intestines. Sources of insoluble fiber include whole-wheat flour, nuts, beans, and vegetables such as carrots. Both soluble and insoluble fiber help prevent constipation by making stools soft and easy to pass. Constipation, or hard stool, may cause people to strain during bowel movements. This may increase pressure in the colon, causing the colon lining to bulge out through weak spots in the colon wall. These bulges are the diverticula. Diagnosing Diverticular Disease There are many ways to test for diverticular disease. Because most people with diverticulosis don't experience symptoms, diverticulosis often is found through tests ordered for another problem. For example, diverticulosis frequently is found during a colonoscopy to screen for cancer or to evaluate complaints of pain or rectal bleeding. Diagnostic tests for diverticular disease include:

• Medical history. The gastroenterologist takes an inventory of your general health and symptoms regarding bowel habits, diet and medication use.
• Blood test. This test can help detect infections.
• Stool sample. This test may show bleeding in the digestive tract.
• Digital rectal exam. The gastroenterologist inserts a gloved finger in the rectum to check for pain, bleeding or a blockage.
• Imaging tests, including CT scan, X-ray, abdominal ultrasound or barium enema. These tests use a variety of machines and techniques to create pictures of the structures and activities inside the body.
• Colonoscopy. While a patient is sedated, the gastroenterologist inserts a thin tube through the anus to inspect the colon. A tiny video camera in the tube shows if there are any pouches, inflammation or infection.

Treating Diverticular Disease Treatment for diverticular disease depends on how serious the problem is and whether the condition is diverticulosis or diverticulitis. Diverticulosis symptoms can be relieved by eating high-fiber foods and, sometimes, mild pain medications can help. Diverticulitis treatment focuses on clearing up the inflammation and infection, resting the colon, and preventing or minimizing complications. Depending on the severity of symptoms, treatment may include bed rest, oral antibiotics, a pain reliever and a liquid diet. If symptoms ease after a few days, the gastroenterologist will recommend gradually increasing the amount of high-fiber foods in the diet. Severe cases of diverticulitis, with acute pain and complications, likely will require a hospital stay. Most cases of severe diverticulitis are treated with intravenous antibiotics and a few days without food or drink to help the colon rest. In some cases, surgery may be necessary. Summary

• Diverticular disease is more common in people as they grow older.
• A low-fiber diet is the most likely cause of the disease.
• Most people are treated with a high-fiber diet and pain medication.
• Add whole-grain foods, and high-fiber fruits and vegetables to your diet.
• Contact a doctor if you notice symptoms such as fever, chills, nausea, vomiting, abdominal pain, rectal bleeding, or change in bowel habits.

Related Links

• Cooper Digestive Health Institute
• Steven R. Peikin, MD