Diverticular disease is an umbrella term that refers to a few related intestinal conditions.
A diverticulum is a pouch that forms in your large intestine (colon) that doesn’t usually cause symptoms. People may have one or many of these pouches in their colon, and this is referred to as having diverticulosis (die-vur-tik-yoo-LOE-sis). If these pockets or pouches get infected and inflamed, this is called diverticulitis (die-vur-tik-yoo-LIE-tis), which can put people at risk of these pouches rupturing and spilling intestinal waste into the abdomen. This could be a life-threatening condition!
Two additional associated conditions that could also be life-threatening are a diverticular bleed and segmental colitis associated with diverticulitis (SCAD). A diverticular bleed causes a large amount of typically painless blood loss in the bowel movements of someone who has known diverticulosis. A diverticular bleed is always a medical emergency and needs immediate medical attention. Trust me, I witnessed this a couple of months ago and it was shocking how much blood was lost! Calling 911 and the ER are the only interventions for a diverticular bleed. SCAD happens when diverticulitis is chronic and creates colon inflammation that can cause bleeding and severe abdominal pain.
If you have diverticulitis, you are also at risk of developing diverticulitis, SCAD or a dIverticular bleed.
The signs and symptoms of diverticulitis include:
• Abdominal pain or tenderness, which may be constant and persist for several days. The lower left side of the abdomen is the most common area of pain, but anywhere in the colon can have pain.
• Nausea and vomiting.
• Bowel changes — constipation or diarrhea.
Factors that can increase your risk of developing diverticulitis
Weakened intestinal wall. Diverticula usually develop when the colon wall has weak points that cause marble-sized pockets or pouches to form in the colon wall.
Aging. Higher risk in people over 40.
Smoking. Smokers are more likely than nonsmokers to have diverticulitis.
Lack of exercise. Exercise can lower your risk of diverticulitis.
Imbalanced microbiome. This can increase the amount of pro-inflammatory gut bugs and reduces your immune system’s health to be able to fight infections.
Certain medications. Several drugs are associated with an increased risk of diverticulitis, including steroids, opioids and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).
Diabetes. Can lead to blood vessel damage and microbiome imbalance
One in four people with acute diverticulitis develop complications, which may include:
• Abscesses, when pus collects in the pouch.
• Bowel blockage, caused by scarring and inflammation.
• Fistula, an abnormal tunnel between sections of bowel or the bowel and other organs.
• Peritonitis, when the infected or inflamed pouch ruptures, spilling intestinal contents into your abdominal cavity. Peritonitis is a medical emergency and requires immediate care.
What can you do to help prevent diverticulosis from turning into diverticulitis?
Improve microbiome health:
• Eat more fiber: Consume fruit and vegetables every day, if possible. Try having up to 40 individual servings of fruits and vegetables every week. Try different types of apples, onions, greens, and berries, and try not to eat the same varieties of produce all the time. Eating a wider variety of produce can help our gut health.
• Myth: Eating seeds and nuts isn’t associated with developing diverticulitis, despite this outdated information still being widely shared.
• Fermented Foods, such as sauerkraut, pickles, yogurt, kombucha and kimchi, have the ability to help improve our microbiome health.
• Stress reduction can help improve our microbiome health. Talk to someone about your stressors, create a relaxation practice, join a support group or other creative ways to help address stress.
Anti-inflammatory foods, such as ginger, turmeric, pomegranate, green tea and dark, leafy greens, can help to reduce inflammation.
Avoid overuse of antibiotics or the other medications listed above that increase the risk of diverticulitis.
Blood sugar control: Elevated blood sugars can lead to gut imbalances such as dysbiosis and leaky gut syndrome. Dysbiosis can fuel inflammation.
Therapeutic movement, for the health of our heart, lungs, blood vessels, mood, sleep and gut. pick some type of movement that you can do daily, even if it is just for 5-10 minutes.
Exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon. Try to exercise at least 30 minutes on most days.
Drink plenty of fluids. Fiber works by absorbing water and increasing the soft, bulky waste in your colon. But if you don’t drink enough liquid to replace what’s absorbed, fiber can be constipating.
How is diverticulosis/itis treated?
Treatment generally isn’t needed unless there is inflammation (diverticulitis). Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Antibiotics are being recommended less due to possibly not being as helpful in many cases of diverticulitis and possibly also because of the harm that they can create in the microbiome of the gut.
Severe or recurrent diverticulitis may require surgery. If you have a mild diverticulitis attack, do check in with your provider or specialist in addition to this important first step, consider not having any solid food. Liquid foods such as broth, filtered water, jello (I prefer homemade), and juice (diluted is best) could be consumed until you are able to be seen by a provider. This can give your gut some rest and may allow the mild case to self-resolve. Sometimes, if you are going to get a CT scan or other imaging exam, the doctor may want you to not have anything to eat or drink until they say it is OK. It is best to check with your provider for guidance.
SCAD: This condition is managed and treated like inflammatory bowel disease and typically it is diagnosed and followed by a gastroenterologist, sometimes in combination with seeking holistic and nutritional care from other providers like naturopathic doctors or nutritionists. This is diagnosed by colonoscopy.
Diverticular bleed: This is a medical emergency and you need to call 911. Blood loss like this can make people pass out. Please seek urgent care but know that with quick intervention, this can be addressed in an emergency situation.
When is it urgent? If you suspect you have diverticulitis, it is best to at least call a nurse on call, your doctor, or a specialist’s office. If you have severe, persistent, unexplained abdominal pain, fever, blood in your stool, vomiting or bowel changes, get immediate attention.
How are these conditions diagnosed? Diverticula (a pouch) and SCAD are most often identified on colonoscopy. They can be seen with a camera during this procedure. Diverticulitis is diagnosed based on your symptoms, physical exam, having a fever or elevated white blood cells and an abdominal CT scan.
If you are over 40, please get a screening colonoscopy, and if you have diverticulosis, consider following some of the prevention guidelines above. If you need help with diverticulosis, diverticulitis or SCAD, consider working with a naturopathic doctor who specializes in digestive health.
Dr. Christine Bowen of Everett is a licensed naturopathic doctor, keynote speaker and has been published in the Townsend Letter. In practice since 2005, Bowen specializes in holistic approaches for digestive health and autoimmunity. Go to www.bothellnaturalhealth.com for more information. Connect with her via Facebook drchristinebowen or Instagram @drchristinebowen.