Who’s heard of diverticulosis? And who can remember whether they have it or not!? It must be one of the most common, yet one of the most poorly understood diagnoses out there. Considering all the harm it can cause, it’s worth getting into the details of what these colon outpouchings are all about!
What is a diverticulum? A pouch-like protrusion or pocket of the colon wall at points of weakness in the colon wall.
What is diverticulosis? The presence of diverticula, from one to many! It could be a diagnosis you receive after a routine screening colonoscopy causing no symptoms or it could be causing an infection or bleed. Most of them are found on the left lower side of your colon.
What complications are associated with diverticulosis? The two big ones are infection (“diverticulitis”) in up to 25% and bleeding (“diverticular bleed”) in up to 15%.
- Diverticular bleeding is painless rectal bleeding (maroon or bright red blood) due to small arteries (blood vessles) in the wall diverticulum that get injured as the wall gets thinner.
- Diverticulitis is abdominal pain (usually left lower abdomen) and fever due to an inflamed diverticulum. This can be caused by increased pressure in the colon or hard pieces of stool, that can become lodged in the diverticulum. This can cause infection, abscesses, colon perforation and other not-so-nice things.
Is it common? Yes, with increasing age. Less than 20% of people age 40 have it but up 60% of people age 60. There is more diverticulosis in countries with a Western lifestyle.
Most importantly-- how does one prevent diverticulosis???
- High fiber diet- Dietary fiber can bulk the stools and possibly prevent development of new diverticula, diverticulitis, or diverticular bleeding. In a cohort study that included over 47,000 men total dietary fiber intake was inversely associated with risk of symptomatic diverticular disease.
- Avoid fat & red meat- same study as above showed that risk of diverticular disease significantly increased with diets high in total fat or red meat.
- Run & jog! Vigorous physical activity appears to reduce risk of diverticulitis and diverticular bleeding. In a prospective study of 48,000 men without colonic disease at baseline, risk of developing symptomatic diverticular disease was inversely related to overall physical activity.
- Maintain a healthy weight! Obesity has been associated with an increase in risk of diverticulitis and diverticular bleeding. One study showed the risk of both diverticulitis and diverticular bleeding was higher with larger waist size.
- Quit smoking! Current smokers are at increased risk for perforated diverticulitis and a diverticular abscess.
- Avoid certain drugs such as anti-inflammatory drugs (“NSAIDS” Motrin, Aleve, Ibuprofen, etc), steroids, and opiates that are associated with an increased risk of diverticulitis and diverticular bleeding.
- Check your Vitamin D level! Higher levels of vitamin D associated with a reduced risk of hospitalization for diverticulitis.
*ALERT!* Dispelling the Myth: Nuts, corn, seeds and popcorn are not associated with an increased risk of diverticulosis, diverticulitis or diverticular bleeding. In a study of 47,228 men there was an inverse association between the amount of nut and popcorn consumption and the risk of diverticulitis.
CANCER PREVENTION: One of the most IMPORTANT take-aways from this post is that if you develop diverticulitis, you absolutely must get a colonoscopy 6 weeks after symptoms resolve. This is to rule out colon cancer. An analysis of registry data showed that patients hospitalized for diverticulitis were 2x as likely to develop colon cancer in the next 18 years than those without diverticulitis, and over 50% of colon cancers were diagnosed within 1 year of diagnosis of diverticulitis.