Alan Frischer, MD, MPH
This may surprise you: Diverticulosis is seen in some 30%-50% of adults over the age of 60. It is usually found in the lining of the sigmoid colon, on the left side of the abdomen, near the entrance to the rectum. It’s important to know that treatment for this condition has recently changed.
Diverticulosis means that diverticula are present. Diverticula are pockets of mucous membrane which have been pushed out through weak points in the muscle. Diverticulitis is when one or more of these pouches become inflamed, and in some cases infected. Diverticulitis can lead to bleeding, abscesses, perforation of the colon, strictures, and fistulas. It can cause severe abdominal pain, fever, nausea and change in the stool. However, most of those with diverticulosis do not have symptoms.
The old traditional method of managing diverticulitis was to prescribe routine antibiotics for everybody. This practice is on the way out. The American College of Physicians has developed new guidelines which are based on evidence that diverticulitis is indeed a disease of inflammation, but does not always include infection. Therefore, some patients can forgo antibiotics, recover just as well, and have less antibiotic exposure. (Of course, it’s not always easy for a doctor to send a patient home without an antibiotic, when the longtime rule has been to prescribe one.)
We now look at diverticular disease on a spectrum, beginning with asymptomatic diverticulosis. Diverticula without inflammation are common. Next on the spectrum is mild diverticulitis, which involves inflammation of a small area of the intestine. More severe diverticulitis carries with it more intense inflammation and possible abscess formation, and comes with a risk of perforation and death.
Antibiotics should be used, per these new guidelines, when the patient has complicated diverticulitis, other chronic conditions, is immunosuppressed, or has signs of a more systemic disease process. Antibiotics may also be used if symptoms last for more than five days, or if the patient cannot eat without making the symptoms worse.
Diverticulosis is usually a result of consuming a low-fiber diet, and from straining when having a bowel movement. Lifestyle changes that may help prevent future attacks are highly effective and very straightforward:
Cut down on red meat
Consume more dietary fiber
Increase physical activity
Work towards a normal body mass index (BMI)
Do not smoke.
As always, I urge you to discuss prevention and treatment with your physician.