How Diverticulitis Develops in the Sigmoid Colon

Abnormal colonic motility (or movement), which may cause pressure, is believed to be a risk factor for developing diverticula.

This condition can be caused by multiple factors, including:

• Genetics
• A low-fiber and higher red meat diet
• Smoking
• Lack of exercise
• Age (diverticulitis is more common after age 50)

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Other risk factors for diverticulitis include:

• Obesity
• Heavy alcohol consumption
• Low vitamin D levels
• Medications such as steroids, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), ibuprofen (Advil, Motrin IB, others), and naproxen sodium (Aleve).

“Signs of problems in the sigmoid colon, such as diverticulitis, may include fever, pain in the left lower quadrant (of the abdomen), nausea, vomiting, and changes in bowel habit (often constipation),” says Daniel Motola, MD, PhD, a gastroenterologist and hepatologist with Optum Medical Care in Mount Kisco, New York.

Diagnosis

• Blood tests
• Urine test
• Stool test
• A computerized tomography (CT) scan

Treatment

If you have serious symptoms or signs of complicated diverticulitis, you'll likely need to be hospitalized and given intravenous antibiotics.

You may need to have a simple procedure to drain an abscess or stop diverticulitis-related bleeding.

You may need surgery on the colon in the following scenarios:

• You’ve had complicated diverticulitis.
• You have complications including ruptures in the colon wall, fistulas, or other serious tissue damage.
• You’ve had multiple episodes of uncomplicated diverticulitis.
• You have a weakened immune system.

“Generally speaking, inflammation from diverticulitis can cause scar tissue formation and breakdown of the colon wall, and if the colon wall develops a hole, then an abscess will form,” warns Will Bulsiewicz, MD, a gastroenterologist and gut health expert in Mount Pleasant, South Carolina.

Bands of scar tissue developing between the abdomen and other organs can create abnormal connections (fistulas), resulting in pain, constipation, and intestinal blockage. And when a fistula develops near another organ, such as the bladder, you may experience urinary tract infections, difficulty urinating, or frequent urination, explains Dr. Bulsiewicz.

An abscess, on the other hand, is a collection of pus caused by an infection.

“In mild cases, an abscess may be small and may only require antibiotics. In severe cases, there can be a larger abscess or even peritonitis, meaning infection of the peritoneum that lines the abdominal cavity,” says Bulsiewicz.

Signs of peritonitis, a life-threatening medical emergency, include fever, increased thirst, and severe abdominal pain.

It’s important to realize, however, that not all problems with the sigmoid colon are related to diverticulitis, notes Dr. Motola.

“Obstruction of the sigmoid colon by mass or cancer can lead to difficulty having bowel movements despite laxatives, and if severe enough, can also result in abdominal pain, nausea, and vomiting.”

• Get regular, vigorous exercise.
• Eat fiber-rich foods including fruits, vegetables, whole grains, seeds and beans to improve the movement of waste through the colon.
• Reduce consumption of red meats.
• Maintain a healthy weight.
• Drink adequate fluids to prevent constipation.
• If you smoke, quit, and if you drink alcohol, do so only in moderation.

Aging and possibly diet can cause diverticula to form, which can put you at risk for diverticulitis. In North America, diverticula are most common in the sigmoid colon. But by eating a fiber-rich diet, drinking enough water, and getting regular exercise, you can help prevent diverticulitis and keep your colon healthy.