Understanding Colonic Diverticula: Causes, Symptoms, and Gut Health

Treating and preventing diverticulitis

As we age there are specific anatomic and physiologic changes we go through. First, there’s puberty, then there’s the mid-life crisis, then there’s menopause. In some people, getting older means growing colonic diverticula.

A colonic diverticulum is an outpouching of the colon wall. These can actually occur in any lumen in the body such as the esophagus, stomach, small bowel, and even blood vessels. Today’s topic is the large bowel.

Diverticulosis itself is not an issue. When these pouches sit there in the colon and do nothing, it’s no harm no foul. Most people experience absolutely no symptoms. They are most common in the sigmoid colon (the last part of the small bowel) but can be anywhere. You can have a lot, or you can have very few. Some people get none.

Interestingly, diverticulosis is more common on the right side of the bowel in Asian countries and on the left side in the west.

Some people with diverticulosis experience cramping, bloating, or flatulence. In rare cases, these diverticula can bleed. This is usually very mild and self-limiting. If you have anemia or other bleeding risks it may be of greater concern.

When diverticula become inflamed you are at risk of acute diverticulitis. As the “itis” suggests, this means inflammation. Acute diverticulitis is an unpleasant condition. Diverticulosis affects somewhere between 5% and 40% of people. Of those with diverticulosis, 5-15% of people will develop diverticulitis in their lifetime.

Diverticulitis starts with low-grade abdominal pain, usually in the left lower quadrant, and symptoms of an infection. The pain gets worse over time and you develop fever, chills, etc. This is usually when people go to the emergency department.

In some cases, people’s natural immune response gets ahold of the infection and walls it off. This is known as an abscess or phlegmon. This can be a good thing because it limits the infection. If your body can’t fight it off, it works against you, leaving you with a chronic low-grade infection.

As the diverticula become inflamed and infected they swell, fluid accumulates, and the typical infectious process occurs. In some cases the colon wall cannot withstand the pressure and pops a hole, releasing bowel contents into your abdomen. This is known as perforated diverticulitis and it’s the worst-case scenario.

The mainstream treatment for diverticulitis is antibiotics. If you knock out all the bacteria in the colon, there’s nothing to cause infection. When the infection is particularly bad it may require surgery. This can be surgery to fix a small segment of the bowel, a longer segment can be removed (colectomy), or anything in between.

In severe cases, the surgeon may need to create a colostomy. This is called a Hartmann’s procedure. The surgeon removes the infected bowel and pulls the end of the bowel through the abdominal wall. They put a bag on the abdomen and you drain your feces through that bag. The other end of the bowel (attached to your rectum) is closed and left in the abdomen. After a few months, they go back in and remove the colostomy and reconnect the bowel.

Surgery is never ideal. Anytime you’re cut open you risk damage to surrounding and underlying structures, formation of adhesions (risks bowel obstruction and future surgery), and other complications from surgery such as anesthesia.

Treatment with antibiotics also isn’t ideal. When you have diverticulitis they give you hardcore antibiotics. This annihilates all bacteria in your gastrointestinal tract. Bad ones and good ones alike are killed. That’s a problem.