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Diverticulitis, Could it be Causing Your Chronic Gastrointestinal Issues?

UMass Memorial Medical Center’s Justin Maykel, M.D., chief, division of colon and rectal surgery, and Jennifer Davids, M.D., colorectal surgeon, explain how to know if you have diverticulitis and what you can do to treat it.

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When the Pope had surgery for “symptomatic stenotic diverticulitis” last summer, a collective “huh?” was heard around the world.

Though it sounds complicated, diverticulitis is a common condition that affects millions of people in the U.S. alone. The problem is many may not realize they even have it and wind up living in pain and discomfort for years without getting relief.

If you’ve been living with weird bowel habits or what you think is irritable bowel syndrome, diverticulitis might actually be to blame. Here’s what you should know about it, including a surgical solution that could significantly improve your quality of life.

What Is Diverticulitis, And What Causes It?

Diverticulitis is a condition affecting the digestive tract that’s largely attributed to a Western diet of low-fiber, highly processed foods. It begins as diverticulosis, which is the presence of pouches in the colon called diverticula thatusually appear in the sigmoid colon. These pouches cause the inside of the colon to look a lot like Swiss cheese, while making the outside look much like bubble wrap.

Diverticulitis occurs when these little pouches become inflamed or infected, resulting in a variety of symptoms. These generally include:

  • Abdominal pain, typically on the left lower abdomen
  • Fevers
  • Bowel changes (diarrhea or constipation)
  • Nausea and vomiting
  • Chills
What Are the Risk Factors?

Because diverticulitis is associated with processed foods, you’re more likely to develop it if you live in a Western country like the United States or Scotland versus an African country where foods are minimally processed.

While most people with diverticulosis don’t develop diverticulitis, the likelihood of developing diverticulosis increases with age. In addition, the condition is becoming increasingly more common in younger people. Diverticulitis can also be more aggressive in younger people, who may chalk their symptoms up to other conditions, such as irritable bowel syndrome or food sensitivities.

How Is Diverticulitis Diagnosed and Treated?

Diverticulitis falls into two major categories: uncomplicated diverticulitis and complicated diverticulitis.

Uncomplicated Diverticulitis

People with uncomplicated diverticulitis typically experience abdominal pain in their lower left side, a fever and sometimes even chills. It’s diagnosed through a blood test that detects an elevated white blood cell count and a CT scan to identify the characteristic findings of diverticulitis. Once diagnosed, patients with uncomplicated diverticulitis are typically treated with antibiotics and a liquid diet until the episode passes. Newer studies suggest that mild episodes of uncomplicated diverticulitis can be treated with a clear liquid diet alone, without the need for antibiotics—this option should be discussed with your doctor first.

The problem is, with each attack of diverticulitis, your chance of experiencing another one increases. After the first attack, there’s about a 20 percent chance you will have another one—and by your third, that likelihood jumps to 50 to 60 percent. If you develop recurrentuncomplicated diverticulitis, or if you have an attack so bad that it cannot be effectively treated with antibiotics, then you may be a candidate for surgery. 

Complicated Diverticulitis

Some patients present with complicated diverticulitis, which is more severe and might result in:

  • A colon perforation that requires emergency surgery
  • A localized perforation that creates an abscess, requiring a drain and antibiotics
  • Strictures where repeated diverticulitis attacks have caused scar tissue to form and create a blockage in the colon (which is why the Pope required surgery)
  • Fistulas, which result from the colon rupturing and connecting itself to adjacent structures, such as the bladder, skin, or other surrounding organs

As with recurrent uncomplicated diverticulitis, complicated diverticulitis is usually treated with surgery. However, as surgeons, we strive to help people manage their attacks to avoid the need for emergency surgery and instead operate on an elective basis.

What Are Diverticulitis Prevention Strategies?

Many candidates for surgery want to know what they can do to prevent a diverticulitis flare-up from happening again. While the course of treatment is fairly standard, less is known about prevention. Past guidance was to avoid seeds and nuts, but it has since been found that this doesn’t really have an impact on provoking attacks.

Unfortunately, we can’t simply advise patients to avoid certain foods, take a pill, or make lifestyle changes to prevent another attack because scientists don’t know what triggers attacks. Based on current research, it’s likely an interplay between your immune system, the diverticula, and the composition of bacteria (or microbiome) that live in your colon.

The good news is that diverticulitis is very treatable with surgery, which often can be performed using a minimally invasive laparoscopic approach. In fact, after two or three attacks, for most, surgery is the best option for prevention because nothing else is as reliable for halting future episodes. Outcomes after surgery are usually extremely positive and the chance of recurrence is exceedingly low.

It’s amazing how many people struggle with diverticulitis as a chronic disease, unaware that there’s often a life-changing surgical solution for it. After years of dealing with multiple attacks that reduce their quality of life—not only from pain, but also from having to limit foods and missing out on holidays and vacations—they can put it all behind them with a routine operation.

Even so, moving forward with surgery is an individual decision. If you’ve been living with recurrent diverticulitis or complicated diverticulitis, meet with a surgeon to discuss your options.

The question is: How are repeated or complicated attacks impacting your daily life—and are you willing to continue living with them indefinitely?

About The Author
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Jennifer is an associate professor of surgery and a colon and rectal surgeon at the University of Massachusetts Memorial Medical Center, where she has been in practice for nearly a decade. Double-boarded in general and colon and rectal surgery, her clinical interests are in minimally invasive surgery for colorectal cancer, inflammatory bowel disease (Crohn’s and ulcerative colitis), diverticulitis, and anorectal surgery. 

Jennifer is a 2005 graduate of Yale University School of Medicine. She completed her general surgery residency at Brigham and Women’s Hospital, followed by a fellowship in colon and rectal surgery at University of Massachusetts. She also has a research focus on building gender equity in surgery and has served as an invited lecturer and author on the topic. As program director of the UMASS Colon and Rectal Surgery Fellowship and as an associate examiner for the American Board of Colon and Rectal Surgery, she has a significant interest in curriculum design, ensuring quality in surgery, and training the next generation of surgical specialists.

Justin is a 1998 graduate of the Tufts University School of Medicine. He completed a general surgery residency and a clinical fellowship in surgical nutrition/metabolism at Beth Israel Deaconess Medical Center, Harvard Medical School. He also completed a colorectal surgery fellowship at the University of Minnesota, University of Minnesota Medical School.

Justin has served as the chief of the division of colon and rectal Surgery at UMass Memorial Medical Center in Worcester, MA, since 2007. His team started a colorectal surgery residency training program in 2012. He is a professor of surgery and holds the Joseph M. Streeter and Mary Streeter DeFeudis endowed chair in surgery at the University of Massachusetts Medical School.