When going to the doctor for a test or regular screening, it’s possible that your doctor could find something that’s unrelated to the reason you went there in the first place. In the U.S., there’s a 40-60% chance of developing diverticulosis by age 60. While some people never experience symptoms, it’s possible that diverticulosis can progress to diverticulitis, causing severe symptoms.

Fortunately, diverticulosis and diverticulitis (also called diverticular disease) can be managed, and there are ways to reduce your risks. Keep reading to learn more about diverticular disease symptoms, risk factors, diagnosis and treatment.

What is diverticulosis? It occurs when little “pockets” form in the colon

Diverticulosis is a condition that develops when pouches or pockets (called diverticula) form in the wall of the lower part of the colon, the large intestine. These pouches are usually very small, only 5-10 millimeters in diameter, but they can be larger.

The cause of diverticulosis could be from pressure inside the colon

So what causes these pockets to form? While a cause isn’t entirely known, it’s possible that high pressure from inside the colon pushes against weak spots in the colon. This could happen for a couple of reasons:

  • Straining too much during bowel movements, especially if you experience frequent constipation and pass hard stools
  • Spending long periods of time on the toilet while browsing your phone or reading
  • A diet low in fiber can cause constipation or stool to remain in your bowels for longer, contributing to increased pressure on the walls of the colon

Diverticulosis symptoms usually aren’t painful

Many people with diverticulosis don’t experience painful and serious symptoms. You may not even know you have the condition until it is discovered during a test.

It’s still possible to experience symptoms such as bloating, abdominal cramping in the lower abdomen, or constipation and diarrhea. However, diverticulosis might not be the only cause of these symptoms.

Diverticular bleeding is also possible but not common. It happens when a blood vessel in the wall of a pocket bursts. This type of bleeding does not cause pain, but you could see blood in your stool or have rectal bleeding. This type of bleeding is different than a hemorrhoid or anal fissure bleed – these conditions usually produce smaller amounts of bright red blood that you’d find occasionally on toilet paper or in the toilet. This bleeding also usually happens intermittently.

What is diverticulitis? It’s inflammation of the pockets in your colon

Diverticulosis can turn into diverticulitis, which occurs when the pouches in the colon become inflamed or infected – usually causing more noticeable and painful symptoms.

Diverticulitis symptoms often include pain

You may notice a change in bowel movements for a couple of days, including constipation or diarrhea. Then the most common symptom, severe abdominal pain, will usually start suddenly. The pain most often occurs in the lower left side of the abdomen and sometimes feels worse when you move. It’s also possible to experience fevers, chills, nausea or vomiting.

If you experience any of these symptoms, especially if you pass out or feel dizzy, weak or less alert, call 911 or head to an emergency room for immediate medical care.

Diverticulitis can lead to serious complications

When left untreated, it’s possible for diverticulitis to cause more severe complications, including:

  • Abscess: An infected pocket can become swollen and filled with pus
  • Fistula: They are an abnormal passageway between the bowel and another organ
  • Intestinal block: Scarring in your bowel can lead to an intestinal block
  • Perforation in the colon: A hole in the colon, called a perforation, can occur
  • Peritonitis: This can occur if an infected pouch ruptures, spreading infection to the abdominal cavity, and can be life threatening

How diverticulitis is different from irritable bowel syndrome

Like diverticulitis, irritable bowel syndrome (IBS) can cause abdominal pain and changes in bowel patterns. However, there are a few ways you can tell the difference between IBS and diverticulitis symptoms.

IBS symptoms usually begin suddenly and can be very painful. Symptoms of IBS also occur on a more intermittent basis, worsening with stress or trigger foods. With diverticulitis, symptoms aren’t as severe and it’s not worsened by triggers.

Risk factors of diverticulosis and diverticulitis

Genetics and age are common risk factors of diverticulosis and diverticulitis. By age 60, people in the U.S. have a 40-60% chance of developing diverticular disease

Rates of diverticular disease are lower in other countries, such as in Asian countries where there is a 20% risk. This could be the result of differing diets – in the U.S., a diet low in fiber and high in fat is more common. This type of diet is a contributing factor to diverticular disease.

Smoking, obesity, and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin for several years can also contribute to the disease.

Diagnosing diverticulosis and diverticulitis: Types of tests

If you don’t have symptoms, it’s possible that your doctor may find diverticulosis when doing a test for a different reason, such as during a routine colonoscopy screening.

Otherwise, if you are experiencing symptoms, your doctor will review your medical history, conduct a physical exam and suggest tests. There are multiple types of tests to diagnose diverticulosis and diverticulitis, including:

  • Imaging tests such as a CT scan or MRI. These can show inflammation or abscesses in the pockets of the colon to indicate diverticulitis.
  • Blood tests can spot signs of an infection.
  • A colonoscopy may be done if you have rectal bleeding. This allows doctors to see the inside of your large intestine and look for narrow spots or growths in the bowel.

Treatment for diverticulosis is focused on diet and lifestyle changes

There isn’t a medical treatment to improve diverticulosis. The main focus is to make lifestyle changes so you can reduce your risk of diverticulosis from developing into diverticulitis.

  • Diet: Eating a diet that’s high in fiber (whole grains, vegetables, fruits and beans), reducing consumption of red meat and drinking plenty of fluids promote regular and healthy bowel movements. Here are more tips to eating a colon-healthy diet.
  • Staying active: Regular exercise and movement also promote healthy bowel movements. The general recommendation is to exercise for 30 minutes, five days per week. Not sure where to start? Here are some of the best exercises for your health.
  • Maintaining a healthy lifestyle: Because factors like smoking and obesity contribute to diverticular disease, as well as other health conditions, it’s recommended to quit smoking and work toward a healthy weight.

Treatment for diverticulitis often includes antibiotics

The treatment for diverticulitis depends on the severity and frequency of your symptoms. In some cases, no treatments are needed, but it’s still recommended to follow the diet and lifestyle changes listed above. A high-fiber diet can help reduce irritation to the inflamed pockets of the colon.

In many cases, oral antibiotics are prescribed to reduce the inflammation. Doctors may also recommend a clear liquid diet to help rest the bowel until the inflammation subsides. A low-fiber diet may also be recommended for a couple of weeks to reduce any stomach discomfort until symptoms resolve.

Once someone has diverticulitis, it’s easier to spot the symptoms and get treatment as soon as possible. The sooner you start antibiotics, the sooner you can reduce the risk of more inflammation or infection.

When surgery may be needed for diverticulitis

Surgery for diverticulitis is rare. However, it might be an option for people with severe and frequent cases of diverticulitis.

The surgery for diverticulitis may be open or a laparoscopic-assisted surgery, which involves one or more small incisions below the belly button where a laparoscope enters. Doctors use results from a CT scan or colonoscopy to identify the areas of the intestines with the most inflamed pockets to remove during surgery.

You can expect to stay in the hospital for a couple of days. Depending on the severity of the diverticulitis, not all areas may be able to be removed, but surgery generally reduces the risk of diverticulitis from occurring again.

Get a gut check

Any time you’re experiencing changes in your bowel habits or abdominal pain, don’t ignore your symptoms. You can start by making an appointment with a primary care doctor. If necessary, your primary care doctor can refer you to a specialist like a gastroenterologist.