Diverticulosis and Abdominal Distension

Definition and Prevalence

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 2

Diverticulitis occurs when these diverticula become inflamed, which happens in only about 4-5% of people with diverticulosis 2
Acute or subacute abdominal pain, typically in the left lower quadrant, is a primary symptom of diverticulitis 2
Nausea is a common symptom of diverticulitis, though vomiting is less common 2

Abdominal distension is not a primary feature of uncomplicated diverticulosis 3
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
The American Gastroenterological Association (AGA) suggests a fiber-rich diet or fiber supplementation for patients with a history of diverticulitis, but notes that high-fiber diets may cause abdominal bloating as a side effect in some patients 1

CT scan of the abdomen and pelvis with oral and intravenous contrast is the gold standard for diagnosing diverticulitis and its complications 4
Consider visceral hypersensitivity as a potential cause of ongoing symptoms after an episode of diverticulitis has resolved 3

When patients with diverticulosis present with abdominal distension, consider other potential causes of the distension rather than assuming it's directly from diverticulosis 3
Evaluate for possible complications of diverticular disease, such as active diverticulitis, stricture, or obstruction 3
Patients should be educated that complicated diverticulitis most often occurs with the first presentation rather than with recurrences 6
Chronic gastrointestinal symptoms, including abdominal distension, do not always improve with surgery for diverticular disease 6