GI Conditions
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      Diverticulosis

      Brief Overview: Diverticulosis is characterized by the presence of diverticula (small, sac-like protrusions) in the lining of the intestines. Diverticula are most often located in the colon.

      Prevalence: According to UpToDate, “The prevalence of diverticulosis increases with age from less than 20% at age 40 to 60% by age 60. The number and size of diverticula also increase with age, suggesting that diverticulosis is a progressive process.”

      Etiology: The etiology is unknown.

      Risk Factors:

      • Age > 60
      • Smoking
      • Male
      • Elevated BMI

      Commonly Associated Conditions:

      • Diverticulitis
      • IBS
      • Constipation

      Common Medications:

      • Typically, treatment is not necessary. Fiber supplements, antispasmodics, or stool softeners may be recommended.

      Common Labs, Imaging, and Tests:

      • CBC
      • Colonoscopy
      • Flexible sigmoidoscopy
      • CT scan or ultrasound of the abdomen
      • X-ray following a barium enema
      • Stool test

      Common Symptoms:

      • Can be asymptomatic
      • Bloating
      • Constipation
      • Abdominal cramps
      • Painless rectal bleeding

       

      Common Treatments:

      • Treatment may not be needed
      • Increased dietary fiber

      Physical Findings:

      • Diverticulosis is found on colonoscopy or other imaging studies
      • Abdominal pain/tenderness may be present

      Potential Complications and Contraindications:

      • Diverticulitis
      • GI bleeding
      • Bowel perforation
      • Bowel stricture
      • Abscess
      • NSAIDs can increase the risk of bleeding and diverticulitis. Talk with your healthcare provider about if you should avoid NSAIDs

      General Health and Lifestyle Guidance:

      • Go to the restroom as soon as you feel the urge to have a bowel movement. Do not “hold it”
      • Maintain adequate hydration (discuss hydration needs with your healthcare provider)
      • Exercise as tolerated. Make sure to discuss exercise with your healthcare provider first.
      • Consume adequate fiber in your diet. Foods that are high in fiber include fruits, vegetables, and some grains. Talk to your healthcare provider about any fiber supplementation recommendations.
      • Ask your healthcare provider if a probiotic is recommended
      • Regular colon screenings as recommended by your healthcare provider

      Suggested Questions to Ask Patients:

      • Have you ever been told you have diverticulosis or diverticulitis?
      • Have you been told to follow a high-fiber diet?
      • Do you have frequent constipation or bloating?
      • Have you had a recent colonoscopy?
      • Are you experiencing any abdominal pain or changes in bowel habits?

      Suggested Talking Points:

      • Educate re: symptoms of diverticulitis: fever, pain (typically lower abdominal), change in bowel habits, nausea, vomiting
      • Diverticulosis is typically asymptomatic
      • Notify your healthcare provider of any new or worsening symptoms

       

      Brief Description of Diverticular Diseases:

      • Diverticulitis – inflammation of one or more diverticula. This is an acute process and typically painful. Can be treated inpatient or outpatient based on the specific findings.
      • Diverticular Bleeding – painless bleeding in the stool. Typically requires hospitalization
      • Symptomatic Uncomplicated Diverticular Disease (SUDD) – persistent abdominal pain related to diverticula, but without overt colitis or diverticulitis
      • Segmental Colitis associated with diverticulosis (SCAD) – also called diverticular colitis, chronic inflammation of areas of the left colon with diverticulosis. This is a rare manifestation of diverticulosis and overlaps with IBD

      Sources: