Diverticulosis or Diverticulitis
“I don’t know, diverticulosis or diverticulitis… what’s the difference?”
The meaning of those two words never meant that much to me until my first colonoscopy 14 years ago.
The very first conversation I had after I woke up from the test, enjoying my orange juice and cookie, was with my husband who had already spoken to the doctor.
“He said you have diverticulitis and you should take fiber.”
I thought “well, ok. I can do something about this.” I headed home and did some research on my computer.
“Hmm.” I discovered that if I had “diverticulitis”, that meant that I had an infection or inflammation and should probably be taking an antibiotic or something.
“Did the doctor say diverticulitis or diverticulosis?” I asked my husband the next day. He looked at me like I had two heads.
“I don’t know, diverticulitis, diverticulosis… What’s the difference?”
Good question. The difference was big, I discovered.
After finally speaking with my doctor several days later, I discovered that I had diverticulosis. No infection, no inflammation, no antibiotics needed…it was just these “pockets” that had developed in the intestinal wall. “Just add fiber and keep things moving.” That was his advice. So I did that. (And I also changed doctors and made sure to get one who stayed long enough after my next test to talk to me directly.)
So what exactly is the difference between the two?
Diverticulosis and diverticulitis are both part of the same disease often referred to as diverticular disease. The difference is all about those darn pockets!
Diverticulosis is a condition that develops in the colon over a long period of time causing the wall to weaken. Where the wall is weak, the inner layer of the bowel is able to bulge out from the intestine creating a pocket that protrudes into the abdominal cavity. They can be up to an inch both in width and depth. Think of an inner tube bulging out through a break or hole in a bicycle tire.
The condition of diverticulosis can develop anywhere in the large intestine, but they seem to be most numerous in the sigmoid colon. It is pretty much common thought that they develop due to a lack of a healthy diet and lifestyle that causes constipation. Genetics may or may not play a part, but both my parents had it as well as did my older brother…
And that’s what I learned I had that day. Some people have just a few of them that develop, others have many. Most of the time I didn’t even realize I had those pockets. I would have some bloating, mild abdominal cramps, and constipation and then I would make some dietary changes, drink lots of water and I would feel better.
Diverticulitis on the other hand is what occurs when those pockets become infected or inflamed from the intestinal waste that sometimes becomes trapped in these pockets. These places become a breeding ground for bacteria. There’s not much self help once it gets to this point.
That’s when, if the infection is not treated, this disease can become serious.
The most common sign that diverticulosis has turned into diverticulitis is abdominal pain in the lower left side with extreme tenderness and pain when that area is pressed. (They call that rebound pain.) In addition, you may also have a fever, nausea, chills, or cramping with constipation and even vomiting.
A word of caution here: everyone’s response to this disease is unique and different. You may or may not have all of those symptoms. I have what my doctor calls complex diverticulosis and yet, I never had a fever when I had an “attack”. I would get chills, lose my appetite and have abdominal pain with altered bowel function but no rebound pain or tenderness. I had inflammation in the area, but not always a full-blown infection, so sometimes it was difficult to isolate when I was at risk.
A CT scan with IV contrast appears to be the most accurate and convenient method of confirming an infection. Some doctors will also do blood work (a high white blood count is also a sign of an infection.)
If the “attack” is mild, then rest. A mostly liquid or low fiber diet for a few days and antibiotics are the usual treatment. If you are relatively healthy, you usually start to feel better even before the end of the antibiotic treatment.
In severe cases, hospitalization is required. This is where antibiotics and fluids can be given intravenously and you have nothing to eat for a few days to achieve a complete bowel rest. However, sometimes surgery is required to remove the affected part of the colon if a complication occurs.
Some of the most serious complications include peritonitis (when the thin wall of the pocket ruptures and leaks bacteria into the abdomen) which is a life-threatening event. There is also abdominal obstruction from repeated bouts of diverticulitis that can result in scarring and thickening of the intestine. This narrows the inside causing either partial or total blockage. That’s what happened to me.
How do you avoid complications? I’m still working on that, but I try to remain acutely aware of what my body is doing and telling me. At the first sign of any intestinal stress, I immediately slow down my diet. This is to a low fiber diet or almost just to liquids if need be. I also drink lots of water. The trick is to keep things moving, breathe deeply, take long walks and keep your fingers crossed!
If you suffer from a diverticular disease, what are your symptoms? I would love to hear from you.