To understand diverticulosis, it is first necessary to know a bit about the anatomy and function of the intestine. Food is digested and nutrition absorbed in the 20 feet of small intestine. This is the long, thin segment of bowel that begins at the stomach and ends in the right lower abdomen. After the digestive process is complete, the liquid waste enters the 5 feet of large intestine, or colon, which ends in the rectum. Just above the rectum is the sigmoid (s-shaped) part of the colon where diverticulosis usually occurs. About two gallons of liquid stool enters the right colon each day where excess water is purified and recycled back into the blood stream. The remaining solid waste, or stool, eventually enters the rectum where the waste is stored until it is convenient to have a bowel movement.

What is Diverticulosis?

Diverticulosis is a condition, rather than a disease. It affects the large intestine, or colon. A normal colon is strong and relatively smooth. A colon affected by diverticulosis has weak spots in the walls. These defects allow the development of balloon-like sacs or outpouches - much like a bubble forming on a worn inner tube. These hollow pouches, - about the size of a large pea - called diverticulae, occur when the inner intestinal lining has pushed through weakened areas of the colon wall. A single pouch is called a diverticula. Although diverticulosis can occur anywhere in the colon, 80% are found in the lower left side - called the sigmoid colon - because that is where the colon is the narrowest and the inner pressure the highest. The presence of these pouches on the colon is called diverticulosis. When the pouches are inflamed or infected, it is called diverticulitis.

Who Gets Diverticulosis?

Diverticulosis is a common condition affecting both men and women. Since diverticulosis takes so long to develop, it usually appears later in life. It affects over 50 percent of those over age 60. Occasionally it occurs in much younger individuals where it is usually a more aggressive problem. This disorder is mostly one of Western society. It is very rare in rural Africa or India where the diet consists of grains very high in dietary fiber. Many researchers feel that our typical low fiber American diet is responsible for the high incidence of diverticulosis in this country. A diet low in fiber promotes constipation and straining at bowel movements that may worsen diverticulosis.

Complications of Diverticulosis

Considering how many millions of Americans have diverticulosis, it is remarkable that so few people are affected by complications. Diverticula usually don't cause any symptoms unless they become inflamed or infected. In fact, most people with diverticulosis experience no symptoms at all. However, complications do occur and can be serious. These may include abdominal pain, rectal bleeding, and diverticulitis.

• Abdominal Pain
  Most diverticular pouches are painless. But, if you have enough of them, they can cause thickening and narrowing of the sigmoid colon. This results in painful spams in the lower left part of the abdomen. When diverticulosis is far advanced, the lower colon may become narrowed and distorted. When this occurs, there may be thin or pellet-shaped stools, persistent bouts of constipation, and an occasional rush of diarrhea.
• Rectal Bleeding
  Bleeding occurs from a ruptured blood vessel in one of the pouches. This may produce a gush of red blood from the rectum or maroon-colored stools. The bleeding is usually self-limited and stops on its own, but requires careful evaluation and usually a brief hospitalization. Occasionally, emergency surgery is necessary to stop the loss of blood.
• Diverticulitis
  Diverticulitis is a complication of diverticulosis. The colon is home to many beneficial bacteria - helpful as long as they stay within the colon. Sometimes, one of the diverticular pouches becomes thin and ruptures allowing bacteria normally contained inside the colon to seep out through the wall and cause infection on the outside of the colon. When this occurs, it is called diverticulitis. Diverticulitis can be mild with only slight discomfort in the left lower abdomen - or it can be extreme with abscess formation, severe tenderness and fever. Nobody knows why "osis" becomes "itis," but is probably because bacteria normally present in the colon penetrate the thin walled pouches.

Because diverticulosis usually causes no symptoms, it is usually discovered during an intestinal examination performed for other reasons. This may include tests such as a barium enema X-ray, flexible sigmoidoscopy, or colonoscopy examination. The later two tests are performed through the rectum with a lighted flexible "scope" and can directly view the colon from the inside providing additional information about the problem. Sometimes, diverticulosis is an incidental finding at surgery or autopsy. Click here to see what diverticulosis looks like during an autopsy.

Does Diverticulosis Require Treatment?

Treatment of diverticulosis varies. If there are no symptoms, treatment is usually not necessary, but a fiber-rich diet is advisable. When diverticulitis occurs, simple bowel rest and antibiotics can usually abort a mild attack. In severe cases, patients may need hospitalization and intravenous antibiotics. While most people recover from diverticulitis without surgery, sometimes it is necessary to remove the affected portion of the colon - the healthy ends are then rejoined. The most common reason for surgery is to stop repeated episodes of pain, bleeding, or diverticulitis.

High Fiber Diet

As mentioned earlier, an inadequate diet is considered the leading cause of diverticulosis. Most health experts agree that the lack of fiber and bulk in the diet is the major cause of chronic constipation and diverticular disease. As our foods are becoming more highly refined, more of us are suffering from symptoms of diverticular disease. Once diverticula have formed there is no way to reverse the process. The pouches are there for the rest of your life.

Chances are you are not getting enough fiber in your diet. In fact, most people in the United States average only 10 to 15 grams of dietary fiber a day. Most dietitians, however, use 35 grams of fiber a day as the minimum benchmark for a high-fiber diet.

Adding fiber and bulk to your diet helps promote regular bowel function and is very important in controlling and minimizing this disease. Foods rich in fiber, such as bran cereals, whole wheat breads, a variety of beans, and fresh fruits and vegetables help keep the stools soft and bulky. We all should make an effort to include more fiber, or roughage, in our diet. But, don't be too enthusiastic. That is, do not add too much fiber too soon. Otherwise, troublesome side effects, such as increased gas and bloating, may occur. The golden rule regarding fiber is to go slow. Start with small amounts and gradually increase the extra fiber in your diet.

Many patients ask about seeds. For many years it has been suspected that large seeds (apple seeds, orange pits, watermelon seeds, grape pits, etc.) may become trapped in the pouches and can occasionally cause problems. There is no medical evidence to support this theory, but is has not been studied in a scientific fashion. We tell paients that these fruits may be still enjoyed, but we suggest that they remove the seeds. Smaller soft seeds seem to be harmless. Foods such as nuts and popcorn should be chewed very well to avoid problems.

The following list shows various categories of foods that are high in dietary fiber. The examples given for each category are not all inclusive and similar foods may be substituted. You should try to include foods from each group in your daily diet:

Grains
• Bran cereals
• Shredded Wheat
• Grape Nuts
• Ry-Krisp
• Whole wheat
• Whole rye bread
• Graham crackers
• Oatmeal
• Puffed Wheat
• Wheatina

  Vegetables

• Green peas
• Carrots
• Winter squash
• Broccoli
• Brussel sprouts
• String beans
• Sweet potatoes
• Artichokes
• Lima beans

  Fruits

• Pears
• Apples
• Tangerines
• Prunes