Diverticular disease usually consists of diverticulosis and diverticulitis. These two conditions are very similar; however there are key, distinct differences between them. These diseases affects the sigmoid and descending colon in over 90% of the population suffering from diverticular disease. The cause of such disease is not conclusive, however, many studies have shown a link between diverticulosis, which is described below as sometimes leading to diverticulitis, and diets that are low in dietary fiber as well as high in fined sugars and carbohydrates. This results in an increased intracolonic pressure and making evacuation of the bowels difficult. Other factors that contribute to diverticular disease include lack of physical exercise, obesity, smoking, and use of NSAIDs (non-steroidal anti-inflammatory drugs)(1).
Diverticulosis is considered a “benign disorder” of the mucosa lining of the colon. The lining tends to bulge out in areas of weakness in the colon wall. Experts say that 60% of individuals over the age of 65 have this type of bulging of the colon wall(2). Diverticulosis is said to be the most common cause of major bleeding into the lower intestines. Many episodes of intestinal bleeds are caused by the use of an accompanying NSAID drug such as Aspirin or Ibuprofen(3).
Diverticulitis is diagnosed when there is infection or inflammation that can occur when one of the sac-like protrusions, or diverticula mentioned above, become perforated. Only about 10-20% of individuals with diverticulosis have complications that lead to this type of infection or inflammation(3). Once a diagnosis has been made, treatment is based on whether the condition is a simple case or more complex. CT imaging is usually used first type of imaging used and has a high sensitivity and specificity for diagnosis(1). Simple cases tend to be treated in the hospital with 7-10 days of IV antibiotics and proper hydration(2). Complicated diverticulitis is diagnosed when there is an abscess, fistula, bowel obstruction, or peritontitis (inflammation of the peritoneum that lines the walls of the abdomen). Anaerobes, such as peptostreptococcus and clostridium, as well as gram-negative aerobes like E. Coli and gram-positive aerobes such as streptococci, are frequently cultured from the intestine(1).
Both forms of diverticular disease can to bacterial proliferation, toxin production, and gas production. Further testing should be conducted later to rule out other pathology such as irritable bowel syndrome or forms of malignancy(2).
Abdominal pain and tenderness in the left lower quadrant of the abdomen may be felt due to a diverticular disease when performing a physical exam. Only lab tests, fever, bloody stools, and other signs of infection and rule in diverticulitis(3). Sigmoid diverticulitis can mimic acute appendicitis. Other conditions such as inflammatory bowel disease, pelvic inflammatory disease, tubal pregnancy, cystitis, or cancer can produce similar symptoms to the above mentioned diverticular diseases(1). Please alert your physician or physical therapist if any of these symptoms are felt or noticed during your daily routine or upon a physical exam.