Does diverticulosis cause abdominal distension?

Does Diverticulosis Cause Abdominal Distension?

Diverticulosis itself does not typically cause abdominal distension, but complications such as diverticulitis can lead to abdominal distension in approximately 25% of patients. 1

Understanding Diverticulosis vs. Diverticulitis

• Diverticulosis is an anatomical condition characterized by the presence of outpouchings (diverticula) in the colon wall, which is extremely common in Western populations, affecting up to 71.4% of people over age 80 1
• Most patients with diverticulosis remain asymptomatic throughout their lives 2
• Diverticulitis occurs when these diverticula become inflamed, which happens in only about 4-5% of people with diverticulosis 1, 3

Symptoms Associated with Diverticulosis

• Uncomplicated diverticulosis is typically asymptomatic and often discovered incidentally during colonoscopy or other imaging studies 2
• When diverticulosis becomes symptomatic (diverticulitis), the primary symptoms include:
  • Acute or subacute abdominal pain, typically in the left lower quadrant 1
  • Fever and systemic unwellness 3
  • Changes in bowel habits 4
  • Nausea (though vomiting is less common) 1

Abdominal Distension and Diverticular Disease

• Abdominal distension is not a primary feature of uncomplicated diverticulosis 1
• Long-term complications including abdominal distention, cramping, altered defecation, and fecal incontinence are reported in approximately 25% of patients after elective surgery for diverticulitis 1
• When patients with a history of diverticulitis experience chronic symptoms like abdominal distension, physicians should consider:
  • Ruling out ongoing inflammation with imaging and lower endoscopy 1
  • Considering visceral hypersensitivity as a potential cause if no active inflammation is found 1

Dietary Considerations and Abdominal Distension

• The American Gastroenterological Association (AGA) suggests a fiber-rich diet or fiber supplementation for patients with a history of diverticulitis 1
• However, high-fiber diets may cause abdominal bloating as a side effect in some patients 1
• Patient preferences and potential side effects like abdominal bloating should be considered when recommending fiber supplementation 1
• The AGA suggests against routinely advising patients with a history of diverticulitis to avoid nuts and popcorn 1

Clinical Management Implications

• When patients with diverticulosis present with abdominal distension:
  • Consider other potential causes of the distension rather than assuming it's directly from diverticulosis 1
  • Evaluate for possible complications of diverticular disease, such as active diverticulitis, stricture, or obstruction 1
  • CT scan of the abdomen and pelvis with oral and intravenous contrast is the gold standard for diagnosing diverticulitis and its complications 1, 5
  • Consider visceral hypersensitivity as a potential cause of ongoing symptoms after an episode of diverticulitis has resolved 1

Important Caveats

• Abdominal distension in a patient with known diverticulosis should prompt investigation for other causes, as uncomplicated diverticulosis rarely causes this symptom 1
• Complicated diverticulitis (with abscess, perforation, obstruction, stricture, or fistula) occurs in only about 12% of diverticulitis cases but is more likely to cause abdominal distension 3
• Patients should be educated that complicated diverticulitis most often occurs with the first presentation rather than with recurrences 1
• Chronic gastrointestinal symptoms, including abdominal distension, do not always improve with surgery for diverticular disease 1