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Clinically reviewed by Robert Borakov, MD, MPH
Most people don’t know they have diverticula (small sacs in the lining of the colon). They are sometimes discovered during a colonoscopy that is done to screen for colon cancer.
As people get older, they can develop diverticula – a condition called diverticulosis. Diverticula usually don’t cause any problems. But if they become inflamed, which is known as diverticulitis, they can cause symptoms such as pain.
When diverticula become inflamed and cause symptoms, a colonoscopy is not usually performed. Alternatively, a colonoscopy and/or other tests may be done several weeks later after the diverticulitis is under control.
This article will discuss how colonoscopy can reveal a diagnosis of diverticulosis, how colonoscopy is used after treatment for diverticulitis, and how to develop habits for a healthy colon.
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Laparoscopic diagnosis of colitis diverticulitis
Colonoscopy is a test done to look at the inside of the colon. The health care provider inserts a thin tube with a light and camera on the end into the anus and up through the rectum and other parts of the large intestine. You will usually be given medication and be asleep during this test.
It is not uncommon for one or more diverticula to be found during a colonoscopy for colon cancer. A screening colonoscopy is recommended for most people at risk of colon cancer once they reach the age of 45.
As people get older, diverticulosis becomes more common. It is less common in people under the age of 40. However, it has been increasing in this group in recent years.
Diverticulosis is the most common condition found during a colonoscopy. Between the ages of 50 and 59, about 33% of people have diverticulum in the colon. For those over 80, the estimate rises to 71%.
Most people with diverticulosis will not have any problems. Between 4% and 5% of people experience symptoms that are usually due to uncomplicated diverticulitis. Of this low percentage with diverticulitis, about 20% will have complicated diverticulitis.
It is possible, though unlikely, that diverticulosis could be missed during a colonoscopy. A colonoscopy may not be completed due to poor preparation or other reasons, such as narrow areas of the colon (strictures), making it difficult for the scope to pass, thus preventing these areas from showing through.
One study found that after developing diverticulitis, colonoscopy missed finding diverticula in about 8% of people. The study authors note that completing a colonoscopy is more difficult in people with a history of diverticulitis.
Another test, such as a computerized tomography (CT) scan, may be used if the colonoscopy cannot be completed.
Related: Possible complications of diverticulitis
A hemorrhoid is a swollen vein in the anus or rectum. They may cause pain, bleeding, or itching. However, some people do not know they have hemorrhoids because they do not have symptoms. Hemorrhoids can be found during a colonoscopy. It can often be managed with home care or, in rare cases, with surgery.
Diagnosis of diverticulosis through computed tomography
Diverticulosis can also be diagnosed with a CT scan. CT colonography is a test that uses X-rays to create an image of structures in the abdomen.
A CT colonoscopy may be done to screen for colon cancer for those who cannot or do not wish to have a colonoscopy. Diverticular disease may be found during this examination. A CT scan done to diagnose the cause of your GI symptoms can also find diverticula.
A CT scan can help diagnose diverticulitis. It is a commonly used test when diverticulitis is suspected. This test can help control diverticulosis or rule it out as symptoms in the gut.
Related: How is diverticulitis diagnosed
Do you need another colonoscopy after treatment?
When feeling better after developing diverticulitis, a colonoscopy may be recommended. There can be differences based on previous history, if there were any other digestive problems, and if there were any complications from diverticulitis.
Diverticulitis can be complicated or uncomplicated. In the case of uncomplicated diverticulitis, there are no complications, and it is often treated at home. In complicated diverticulitis, there are other problems such as an abscess (a pocket of pus in the body) or a fistula (an abnormal tunnel between two organs). Complicated diverticulitis may need to be treated in the hospital.
Some studies have found that people diagnosed with diverticulitis using a CT scan may have an increased risk of developing colon cancer. For this reason, a follow-up colonoscopy may be recommended after uncomplicated diverticulitis.
If a recent CT scan was normal along with uncomplicated diverticulitis, a colonoscopy may not be needed.
Related: Treating diverticulitis
Colonoscopy guidelines for patients with diverticulosis
Colonoscopy is often used in the management of diverticulosis. In the case of diverticulitis, it can be used at different points, depending on the severity of the symptoms. There may be differences in how often health care providers order colonoscopies for diverticulosis.
One review of the medical literature recommends the following criteria when a colonoscopy should be performed for people with diverticulosis:
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For bleeding in the lower GI tract thought to be due to diverticular disease, a colonoscopy should be performed within 24 hours. The usual procedure of cleaning the colon of stool before the test is recommended.
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When a person has acute diverticulitis, a colonoscopy should be performed seven days after symptoms begin. Enemas may be used in place of a complete colonoscopy preparation.
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For uncomplicated diverticulitis, a colonoscopy may be done six weeks after symptoms began, but only if a colonoscopy or other test such as a CT colonogram has not been done recently.
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For complicated diverticulitis, a colonoscopy should be performed six weeks after symptoms began.
For people with diverticular disease without any symptoms, there is no preferred timeline for how often they need a colonoscopy. A health care provider — usually a gastroenterologist or colorectal surgeon — will make a recommendation. It can be up to five years or 10 years between colonoscopies for diverticulosis.
Related Topics: How Often Should You Get a Colonoscopy?
Healthy colon habits with diverticulosis or diverticulitis
Diverticulitis causes symptoms in the gut, usually pain, as well as either diarrhea or constipation. When symptoms start, you may need to go on a liquid diet for a few days.
After a few days, the diet may be expanded to include more foods. About a week later, there may be another appointment with the healthcare provider to check progress. After about six weeks, the colon may have healed enough for a subsequent colonoscopy.
Many people feel better two weeks (or sooner) after a flare-up of uncomplicated diverticulitis. If symptoms persist for longer than this, consider following up with your healthcare provider.
Certain lifestyle changes may be recommended for diverticulosis that does not cause any symptoms (diverticulosis). These include:
Your health care provider can help make changes to try to prevent diverticulitis flare-ups. It may not be possible to completely avoid diverticulitis. But for those who have had an attack of diverticulitis or have chronic symptoms, working with a healthcare provider to create a management plan may help.
Symptoms of diverticulitis are a reason to go to a healthcare provider. Diverticulitis can be treated at home, but it must be diagnosed to ensure there are no complications.
Severe abdominal pain should be investigated immediately. Rectal bleeding, fever, nausea, and vomiting, along with abdominal pain, are also reasons to see a healthcare provider as soon as possible.
Related: Does diverticulitis go away?
summary
Colonoscopy is a useful tool for diverticulosis. Especially in the presence of severe symptoms or bleeding that may be due to diverticulitis, a colonoscopy can be performed immediately.
A follow-up colonoscopy is usually done after diverticulitis symptoms have cleared up. A colonoscopy may be needed every several years to monitor diverticulosis or other problems in the colon.