FAQs about Diverticulitis and Diverticulosis: What You Need to Know

Submitted by Stony Brook Surgery on Thu, 06/21/2012 - 07:41

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<img src="/sdmpubfiles/DenoyaPaula-150.jpg" width="150" height="225" alt="Paula I. Denoya, MD, a Stony Brook colorectal surgeon" title="Paula I. Denoya, MD" />
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Dr. Paula I. Denoya</div></div>

<p>Diverticulitis and diverticulosis are two big medical terms. They may sound alike, but they refer to different, albeit related, conditions of the digestive tract. Knowing the difference between them, and how to prevent the painful disease associated with them makes good sense — plus what the best treatment is, in case you ever need it.</p>

<p>Here, <a href="/surgery/people/faculty/dr-paula-i-denoya">Paula I. Denoya, MD</a>, assistant professor of surgery and a member of our <a href="/surgery/divisions/colorectal-surgery">Colon and Rectal Surgery Division</a>, answers a few of the frequently asked questions about diverticulitis and diverticulosis, and she clarifies the difference between them and their management.</p>

<p><strong>Q:</strong> What causes diverticulosis to turn into diverticulitis?</p>

<p><strong>A:</strong> Diverticulosis is a condition where small pockets occur in the wall of the colon, or large intestine. These pockets are believed to be caused by high pressure within the colon pushing out against weak spots in the colon wall. These pockets, called diverticula, become more common as people age, though they can be found in patients as young as 25. Diverticulosis can lead to bleeding or diverticulitis.</p>

<p>Diverticulitis is an infection that occurs when one of the diverticula becomes infected and perforates. Most patients with diverticulitis experience several episodes of abdominal pain requiring antibiotics. Some can be treated at home and others need to be hospitalized for several days, depending on the severity of the condition.</p>

<p>Few patients go on to develop complications such as abscess (a collection of infected fluid in the abdomen), fistula (an abnormal connection between the colon and another organ such as the bladder), stricture (a narrow area in the colon causing blockage), or perforation (a hole in the colon requiring emergency surgery).</p>

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The use of minimally invasive surgery leads to a shorter recovery time for patients.
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<p><strong>Q:</strong> Is diverticulosis, plus the susceptibility of diverticulitis, more prevalent in women or men?</p>

<p><strong>A:</strong> Diverticulosis and diverticulitis occur in both men and women equally. Diverticulosis becomes more common in older people. It afflicts about 50% of Americans by age 60 and nearly all by age 80, according to the <a href="http://www.fascrs.org&quot; target="_blank">American Society of Colon & Rectal Surgeons</a>. Only 15-20% of those with diverticulosis develop diverticulitis.</p>

<p><strong>Q:</strong> When does it make sense to surgically removing the part of the colon where diverticulosis is present?</p>

<p><strong>A:</strong> We recommend removing the affected part of the colon when the symptoms become frequent or if there are significant complications. We used to recommend surgery after only two episodes of diverticulitis, thinking that the severity would worsen over time. But newer studies show that severity does not necessarily worsen with the recurrence of disease, so we now reserve surgery for more severe disease presentations, rather than a clear-cut number of episodes. Another reason to remove the affected segment of colon is that a few patients with diverticulosis develop very severe bleeding.</p>

<p>Patients who have recurrent or chronic symptoms that interfere with quality of life, or patients who suffer complications of the disease should consider surgery to remove the section of colon affected.</p>

<p><strong>Q:</strong> What are the new advances in minimally invasive surgery that offer elderly and other compromised patients with chronic diverticulitis more options for treating diverticulitis? What research is being conducted to help people suffering from diverticulitis?</p>

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We are currently studying whether abdominal abscesses can be managed without surgery.
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<p><strong>A:</strong> The use of minimally invasive surgery (laparoscopic or "key hole" surgery) enables us to remove a piece of the colon with a smaller incision than with traditional surgery, which leads to a shorter recovery time for patients.</p>

<p>Another advance is the use of <a href="http://www.radiologyinfo.org/en/info.cfm?pg=PercAbscessDrn&quot; target="_blank">percutaneous drainage</a> techniques to treat abdominal abscess. By using this approach, doctors can treat a common complication of diverticulitis without emergent or urgent surgery. These patients may then be treated with elective surgery if needed at a future date. At Stony Brook, we are currently studying whether patients treated in this manner eventually need surgery or may continue to be managed without surgery in the long term.</p>

<p><strong>Q:</strong> There are recent studies refuting long-held notions that foods such as corn, nuts, and popcorn can trigger diverticulitis. What is your opinion about this, and is there such a thing as "trigger foods" with diverticulitis?</p>

<p><strong>A:</strong> In my opinion, there is no good evidence that foods such as corn and nuts trigger diverticulitis. Recent studies seem to indicate that a diet low in these items is actually associated with more flares, which is the opposite of the old conventional wisdom that has been advised for decades.</p>

<p>My advice to my patients is that they should eat healthy and in moderation. If they find a particular food that causes pain, they should avoid it. In general, we advise a high-fiber diet for general colon health.</p>

<p><strong>Q:</strong> What role does stress play in the development of diverticulitis?</p>

<strong>A:</strong> There is no direct link between stress and diverticulitis. However, stress may weaken the immune system, making patients more susceptible to infections in general.</p>

<span class="pointer"><p><strong> Please use our comments feature to submit your own questions to Dr. Denoya about diverticulitis and diverticulosis. <a href="http://www.fascrs.org/patients/conditions/diverticular_disease/&quot; target="_blank">Click here</a> to find out what the American Society of Colon & Rectal Surgeons says about them.</strong></p></span>