Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Diverticular Disease

Overview

Diverticular disease is a very common gastrointestinal problem in older people. It is characterized by 2 conditions in the colon.

Diverticulosis. Small pockets develop in the walls of parts of the colon. These pockets are called diverticula. In most people, they cause no symptoms.

Diverticulitis. Over time more pockets develop. In some people, these pockets can become:

  • Bigger and bulge outwards
  • Plugged with fecal matter
  • Infected

When one or more pockets are inflamed or infected the condition is called diverticulitis. Rarely, the pockets can bleed. This is called diverticular bleeding.  

About half of people over the age of 60 have diverticular disease. Most people over the age of 80 have the condition. We don’t know the exact cause, although a low-fiber diet appears be a risk factor. 

Treatments include:

  • Diet changes
  • Pain medication
  • Antibiotics 
  • Surgery

Pouches called diverticula form when increased pressure pushes the wall of the colon (large intestine) outward at certain weak points. Although they are found most often in the colon, diverticula can be found in nearly all parts of the digestive tract.


Symptoms

Diverticulosis

It is rare for uninfected pockets (diverticula) to cause symptoms. A small number of people may develop:  

  • Stomach cramps
  • Discomfort in the lower stomach
  • Bloating 
  • Constipation

Diverticulitis

Diverticulitis means that the abnormal pockets in the colon wall are infected and inflamed. Symptoms are much more likely, including:

  • Stomach cramps 
  • Pain in the lower stomach, usually on the left side, that lasts for hours or days
  • Nausea and bloating
  • Fever
  • Constipation
  • Change in daily bowel habits
  • Diarrhea

In rare cases, blood vessels in the diverticula can hemorrhage. This causes lightheadedness and rectal bleeding. Contact us right away if you experience these symptoms.

Diagnosis

Only about 20 percent of people with diverticular disease have symptoms. We typically diagnose the condition during routine screening for colorectal cancer.  When you come in for an appointment, we will:

  • Discuss your medical history 
  • Examine you
  • Order blood tests
  • Schedule a procedure to examine the inside of your colon. 

If you have serious complications, we may recommend additional tests such as:

  • A contrast enema X-ray 
  • A CT (computed tomography) scan 

Causes and Risk Factors

We don’t know the exact cause of diverticular disease. We do know that you are more likely to develop it if you don’t eat enough fiber. Fiber is found in fruits, vegetables, legumes, nuts, seeds, and whole grains. A low-fiber diet can cause hard stools and constipation. Fiber: 

  • Stays in the colon
  • Absorbs water 
  • Makes bowel movements easier

Other risk factors include:

  • Aging
  • Eating a diet high in meat and fat
  • Family history of diverticulosis
  • Obesity 
  • Living in a Western country
  • Connective tissue diseases, such as Marfan syndrome or scleroderma.

Factors associated with diverticulitis flare-ups include:

  • Use of nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen
  • Previous attacks
  • Suppressed immune system

Prevention

It is not clear whether diverticular disease is preventable. However, we do know that:

  • People who eat a high-fiber diet are less likely to develop it. Taking fiber supplements may be helpful.  
  • Vegetarians have a lower risk of developing the disease. This is probably because they eat plenty of fruits and vegetables. They also avoid animal fats.
  • Gender, history of alcohol use or smoking, and history of colorectal cancer do not affect your risk.  
  • Nuts, seeds, and popcorn may be protective. We used to think that these foods could block diverticula and cause infection. A recent study disproved this theory. 

Dietary Changes

Changing your diet is one of the most effective things you can do.  Eating well can treat, or prevent, symptoms. 

Diet changes during a flare-up

We may recommend a low-residue diet for a short period of time. A low-residue diet involves eating less fiber. Eating this way:

  • Slows down bowel movements
  • Decreases the amount of stool in the intestines
  • Reduces blockages 

Diet changes to prevent flare-ups 

We may recommend that you eat more fiber if:

  • You have no symptoms 
  • You’ve had 1 or more flare-ups that have healed

Choose foods with fiber such as:

  • Fruits: Apples, oranges, peaches, nectarines 
  • Vegetables: Broccoli, cabbage, Brussels sprouts, spinach, carrots, squash, or others 
  • Starchy vegetables: Peas, beans, potatoes
  • Grains: Whole-wheat bread, high-fiber cereals, brown rice, oatmeal

Treatment

Medications

There is no cure for diverticular disease. However, most people don’t develop symptoms. If symptoms occur they are usually mild and get better with minimal treatment. If dietary changes don’t help we may prescribe medications. These include:

Antispasmodics are pain killers that help control mild symptoms such as:

  • Colon muscle spasms 
  • Stomach pain or cramping

Antibiotics help:

  • Destroy bacteria
  • Clear infection
  • Relieve moderate to severe symptoms such as pain on the left side of your stomach or fever

Surgery

Most people don’t require surgery. However, the following conditions may require surgical treatment: 

  • Diverticula hemorrhage 
  • Perforations that enable colon contents to leak out
  • Abscesses that don't respond to medications
  • Obstructions in the colon

Possible Complications

Diverticular disease can lead to serious complications. They include:

  • Abscesses. These can develop when diverticula swell and fill with pus. Antibiotics usually clear this up. Minor surgery may be needed to drain the infection. 
  • Perforations in infected diverticula. They can leak pus into the abdomen.
  • Peritonitis. This can develop when pus leaks into the abdomen. Immediate surgery is required to clean infection out of the abdominal cavity and remove damaged parts of the colon.
  • Fistulas. These are abnormal openings between adjacent organs. They are caused by inflamed tissue sticking together. The most common type develops between the bladder and the colon. 
  • Intestinal blockages. These can happen as a result of swelling and scar tissue. Symptoms include stomach pain and vomiting. Medication can reduce inflammation. Surgery may be necessary if the obstruction is severe.
  • Hemorrhage. This occurs when blood vessels in the diverticula rupture and bleed. Call us right away if you experience serious rectal bleeding.

Surgical Procedures

During surgery we open the stomach wall. We then remove or repair the damaged part of the colon. We usually use a surgical approach called a laparoscopy. This approach uses smaller incisions. People recover more quickly. 

If the colon cannot be repaired, we may recommend a colostomy. During this surgery:

  • We create a small hole in the stomach.
  • The contents of the colon are diverted away from the damaged section of colon to this hole.  
  • The content of the colon then empties from the hole into a bag. 
  • Once the colon has healed, the diversion can be removed. Normal bowel function is restored.

Typically, we don’t perform surgery when diverticulitis symptoms are active. We only perform surgery during an attack if there is a life-threatening complication.

Lifestyle Changes

There are a number of things you can do to manage your symptoms: 

  • Track symptoms to identify triggers. Write down when symptoms occur. Note what you ate and drank before you felt them. Avoid those triggers. 
  • Slowly increase your fiber intake. This will prevent constipation.
  • Take over-the-counter fiber supplements. They can reduce cramping and prevent diarrhea and constipation.  
  • Drink more water. This prevents bloating and constipation. Water is especially important if you use fiber supplements. 
  • Exercise to relieve stress and encourage bowel movements. This prevents bloating, gas, and constipation. 
  • Manage stress. Try deep breathing and meditation. Yoga, exercise, and journaling can also help.
  • Avoid chewing gum, carbonated drinks, and eating too quickly. They all cause gas and discomfort.

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This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.