The vast majority of people who have diverticulosis (simply the presence
of diverticulae in the colon) never have any significant symptoms
at all! It is important to keep this in mind since a multitude of
complaints are often attributed to diverticulosis just because they
happen to be found on an X-ray. But since over 50% of people over
the age of 50 have them, merely identifying them on an X-ray is not
enough to prove that they are responsible for any particular symptoms.
Symptoms of diverticulosis
In some cases, however, diverticulosis will be associated with some
fairly nonspecific symptoms such as gassy distension of the abdomen,
abdominal cramps (usually in the left lower or right lower abdomen),
or bouts of constipation alternating with loose movements. Keep
in mind that it is probably not the diverticulae that are actually
causing any of this. Rather, it is more likely the result of the
same spasm in the colon that caused the diverticulae to develop.
It used to be thought that diverticulosis was one of the commonest
causes of significant bleeding from the rectum in elderly patients
but that has now been attributed to something else called "vascular
ectasia" of the colon.
Symptoms of diverticulitis
While it may be that most people who have diverticulosis are not
aware of it, they will certainly know something is wrong if they
develop diverticulitis. In almost all cases of diverticulitis, there
will be a noticeable change in bowel habit with diarrhea, cramps,
bloating, and sometimes constipation. Often there will be left lower
abdominal pain and tenderness. In addition, the patient may experience
urgency to pass water more frequently than usual, caused by an irritated
bladder adjacent to the diverticulitis. Chills, sweats, and a fever
may occur as well. In short, patients with diverticulitis are ill,
and in some cases can become critically ill if the disease progresses
and is not treated appropriately.
If the diverticulum perforates (causing a hole in the bowel wall)
symptoms can become severe and dramatic. When there is a perforation,
colon gas and stool may leak out into the abdominal cavity causing
a condition known as "peritonitis." The peritoneum is the lining
surface of the abdominal cavity. The leaking colon contents cause
an intense and painful inflammation of the peritoneum (peritonitis).
Even the most stoic of individuals will seek medical attention if
they develop peritonitis as it can be intensely painful and is made
worse by any movement. A patient with peritonitis will experience
abdominal pain with every little bump on the drive to the hospital.
In fact, this is a common question asked by emergency room physicians
when assessing a patient on arrival, since it can quickly identify
a patient with peritonitis - leading to a quick referral to the
surgeon for his or her opinion regarding treatment.
Peritonitis may remain localized (walled off) in the area of the
trouble (usually the left lower quadrant of the abdomen since this
is where the sigmoid colon is) or it may become widespread if the
leakage is not contained. The symptoms of a localized perforation
are pain, tenderness, fever, increased heart rate, and sweating, among
others. Symptoms of a perforation that is not localized may be very
severe including widespread abdominal pain, diminished urine output,
weakness, altered consciousness, and ultimately death if the situation
is not corrected promptly.