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Q: What's the difference between diverticulosis and diverticulitis?

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A: Collectively, these two conditions are called diverticular disease. Diverticula are pouches of bowel lining that bulge out through weak spots in the intestinal muscle layer anywhere along the gastrointestinal (GI) tract.


Diverticulosis is simply the condition of having diverticula. It's very common-up to half of adults over age 60 have it-and no wonder. Think of the constant wear and tear on the colon as the products of digestion pass through it.


Diverticulitis is the result of inflammation and infection arising within diverticula. It happens most often in the sigmoid colon and, no doubt about it, it can be dangerous. The inflammation and infection can impede drainage and lead to serious, even life-threatening complications, like abscesses, bowel perforation, hemorrhage, and peritonitis. A fistula can form too.


These complications arise because the inflammation of the herniated GI mucosa and submucosa that make up diverticula has a tendency to spread to the surrounding bowel wall, causing irritability and spasticity of the colon. It's under these conditions that abscesses are most likely to develop. If they perforate, peritonitis (infection of the peritoneal cavity), and erosion of the arterial vessels with bleeding can occur.


Most people with diverticulosis are asymptomatic. If symptoms are present, mild abdominal cramping, bloating, and constipation are the most common. With diverticulitis, abdominal pain is one of the most common symptoms, and abdominal tenderness in the lower left side is the most common sign. Infection will often produce additional signs and symptoms, including fever, chills, nausea, vomiting, cramping, and constipation.


Treat it right

In general, diverticulosis requires no treatment. The goal of treatment for diverticulitis is to halt the infection and inflammation and minimize complications. To achieve these goals, a 7- to 10-day course of antibiotics, typically ciprofloxacin (Cipro) or metronidazole (Flagyl), is ordered. A clear liquid diet (until the inflammation subsides), followed by a high-fiber, low-fat diet gives the colon a chance to rest. An analgesic given with an antispasmodic can effectively relieve symptoms.


Patients with acute diverticulitis with significant symptoms usually require hospitalization, as do those who are unable to tolerate oral hydration. In some cases, all oral intake is restricted and I.V. nutrition is given. The patient will be given a broad-spectrum antibiotic; an antispasmodic, like propantheline (Pro-Banthine) or oxyphencyclimine (Daricon); and an opioid for pain relief. Immediate surgery is usually indicated for diverticulitis associated with abscess, bowel perforation, peritonitis, hemorrhage, and, sometimes, fistula.


Preventive treatment for both types of diverticular disease involves increasing the amount of fiber in the diet. Dietary fiber helps keep stools soft and lowers the pressure in the colon, allowing stools to pass through more easily.


You know all those servings of fruits and veggies-both excellent sources of fiber-that you're supposed to be eating every day? You just learned some more good reasons to include them in your diet and recommend to your patients that they do the same.


Learn more about it


National Institute of Diabetes and Digestive and Kidney Diseases. National Digestive Diseases Information Clearinghouse. Diverticulosis and diverticulitis. Accessed April 8, 2006.