Diverticulitis occurs when one or more diverticula in your digestive

tract become inflamed or infected. Diverticula are small, bulging

pouches that can form anywhere in your digestive system, including
your esophagus, stomach and small intestine. However, they're most
commonly found in the large intestine.

Diverticula are common, especially after age 40. When you have
diverticula, the condition is known as diverticulosis. You may never
even know you have these pouches because they seldom cause any
problems, such as diverticulitis.

Sometimes, however, diverticulitis occurs, causing severe abdominal

pain, fever, nausea and a marked change in your bowel habits. Mild
cases of diverticulitis can be treated with rest, changes in your diet
and antibiotics. But serious cases of diverticulitis may require surgery.

Common signs and symptoms of diverticulitis include:

• Pain that's often sudden, severe, and located in the lower left side of
the abdomen. Less commonly, abdominal pain may be mild at first,
and become worse over several days, possibly fluctuating in intensity

• Change in bowel habits

• Abdominal tenderness

• Fever

• Nausea and vomiting

• Constipation

• Diarrhea

Less common signs and symptoms of diverticulitis may include:

• Bloating

Bleeding from your rectum

 Diverticula usually develop when naturally weak places in your colon
give way under pressure. This causes marble-sized pouches to
protrude through the colon wall.

Exactly how diverticula become inflamed or infected isn't clear. One

theory is that the increased pressure in the colon can lead to
breakdown of the wall of the diverticula leading to infection. Another is
that the narrow openings of diverticula may trap fecal matter, which
can lead to infection. Or, an obstruction in the narrow opening of a
diverticulum may reduce blood supply to the area, which leads to
inflammation.

In the past, doctors thought that nuts, seeds, popcorn and corn played
a role in causing diverticulitis by getting trapped in the diverticula.
However, recent research has found that these foods weren't
associated with an increased risk of diverticulitis.

These factors may increase your chances of getting diverticulitis:

• Aging. You're more likely to get diverticulitis if you're over 40,

although it's not known why. It may be that age-related changes, such
as a decrease in strength and elasticity of your bowel wall, could
contribute to diverticulitis.

• Too little fiber. Diverticulitis is rare in countries where people eat a

high-fiber diet that helps keep stools soft. But it's common in
industrialized nations, such as the United States, where the average
diet is high in refined carbohydrates and low in fiber. In fact,
diverticular disease emerged after the introduction of steel-rolling
mills, which greatly reduced the fiber content of flour and other grains.

• Lack of exercise. Lack of exercise has been associated with a greater

risk of formation of diverticula putting a person at risk of diverticulitis.
The reasons for this aren't understood.

Obesity. Being seriously overweight increases your odds of developing

diverticulitis and diverticular bleeding.

Complications of diverticulitis may include:

• Peritonitis, which can occur if the infected or inflamed pouch ruptures,
spilling intestinal contents into your abdominal cavity. This can cause
an inflammation of the lining of your abdominal cavity (peritoneum).
Peritonitis is a medical emergency and requires immediate care.

• Rectal bleeding

• A blockage in your colon or small intestine caused by scarring

• An abscess, which occurs when pus collects in the pouch

A fistula, which is an abnormal passageway that occurs between

different parts of your intestine, between your intestine and your
bladder or vagina, or between your intestine and abdominal wall.

• Examine your abdomen for tenderness.

• Obtain a blood sample to check your white blood cell count to look for
signs of infection.

Have you undergo an imaging test, such as a CT scan, to help visualize

the pouches that are inflamed or infected. A CT scan uses a series of
computer-directed X-rays to provide a comprehensive view of your
internal organs.

Surgery If you have a perforation, abscess, fistula or recurring

diverticulitis, your doctor may recommend surgery to remove the
diseased part of your colon. There are two types of surgery:

• Primary bowel resection. In this procedure, your surgeon removes

the diseased part of your intestine and then reconnects the healthy
segments of your colon (anastomosis). This allows you to have normal
bowel movements. Depending on the amount of inflammation, you
may have open (traditional) surgery or laparoscopic surgery. In open
surgery, your surgeon makes one long incision in your abdomen, while
laparoscopic surgery is performed through three or four small
incisions. Recovery is generally faster and quicker with laparoscopic
surgery.

• Bowel resection with colostomy. This surgery may be necessary if

you have so much inflammation in your colon that it's not possible to
rejoin your colon and rectum. During a colostomy, your surgeon
 makes an opening (stoma) in your abdominal wall. The unaffected part
of your colon is then connected to the stoma, and waste passes
through the opening into a bag. A colostomy may be temporary or
permanent. Several months later — once the inflammation has healed
— your surgeon may be able to perform a second operation to
reconnect your colon and rectum.

Abscess drainage. Diverticulitis may be complicated by the formation

of an abscess, which may need to be drained. This can be done by
inserting a needle through the skin which is guided by ultrasound or
CT. A catheter is then placed to drain the abscess. This catheter may
need to remain in place while you're being treated with antibiotics.
Once you have recovered, a bowel resection may be needed.

Here are things you can do to help prevent or slow the progression of
diverticular disease:

• Eat more fiber. High-fiber foods, such as fresh fruits and vegetables
and whole grains, soften waste material and help it pass more quickly
through your colon. This reduces pressure inside your digestive tract.
Aim for 20 to 35 grams of fiber each day. An apple or 1/2 cup (236
milliliters) of spinach each contains more than 3 grams of fiber, and
1/2 cup of kidney beans contains about 8 grams. Try to substitute
fruits, vegetables and grain products for foods high in fat. Be sure to
add fiber gradually to avoid bloating, abdominal discomfort and gas. If
it's difficult for you to consume 20 or more grams of fiber every day,
consider using a fiber supplement, such as psyllium (Metamucil) or
methylcellulose (Citrucel). Avoiding seeds or nuts won't prevent
recurrent attacks of diverticulitis.

• 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.

• Respond to bowel urges. When you need to use the bathroom, don't
delay. Delaying bowel movements leads to harder stools that require
more force to pass and increased pressure within your colon.

Exercise regularly. Exercise promotes normal bowel function and

reduces pressure inside your colon. Try to exercise at least 30 minutes
on most days.