Ulcerative colitis (UC) and diverticulitis are both inflammatory conditions of the bowel. Although certain symptoms overlap, they are very different conditions and require different forms of treatment. The main difference is that diverticulitis is a form of diverticular disease, and ulcerative colitis is an inflammatory bowel disease (IBD). And unlike UC, diverticulitis is not a lifelong condition.
What is Diverticulitis?
Diverticulitis is a complication of diverticulosis is a condition in which the diverticula (small pouches that develop in the colon lining) become inflamed. When this happens, they can push out through vulnerable areas in the outer wall of the colon. Treatment of diverticulitis generally involves antibiotics and dietary and nutritional support.
What is Ulcerative Colitis?
Ulcerative colitis is an inflammatory bowel disease (IBD) involving chronic inflammation and ulcers in the lining of the large intestine. UC is a lifelong condition with periods of flare-ups and periods of remission. While there is no known ‘cure’, treatment aims first to relieve and manage UC flare-ups and then prolong remission maintenance.
Symptoms & Signs
UC and diverticulitis share certain symptoms. One way to tell the difference is that constipation is more common with diverticulitis, whereas UC is more likely to cause diarrhea. If you’re experiencing discomfort or urgency when urinating, it’s likely diverticulitis. This happens when the inflamed area of the colon makes contact with the bladder wall.
If you are experiencing fatigue or symptoms of arthritis, it is more likely to be ulcerative colitis. This applies to mucus or pus in the stool as well.
If you suspect either condition, it’s crucial to alert your doctor as soon as possible and receive a professional diagnosis.
Symptoms & Signs of Diverticulitis:
- Abdominal pain
- Rectal bleeding
- Fever and/or chills
- Nausea or vomiting
- Constipation or diarrhea
- Swelling or bloating of the abdomen
- Increased urgency, frequency, or discomfort when urinating
Abdominal pain caused by diverticulitis varies from severe and sudden to mild pain that worsens over days. This pain can be constant or come and go.
Symptoms & Signs of Ulcerative Colitis
- Persistent diarrhea
- Rectal bleeding or blood in stool
- Mucus or pus in stool
- Cramping or abdominal pain
- Lack of appetite and/or weight loss
- Fever and fatigue
- Symptoms of arthritis
- Urgent need to have a bowel movement (even when bowels are empty)
UC patients have periods of ‘flare-ups’, when symptoms appear gradually or suddenly, and periods of remission, when no symptoms occur. These periods of remission can last from weeks to years.
Causes & Risk Factors
Researchers are still investigating root causes of ulcerative colitis and diverticulitis, but have pinpointed common risk factors. Firstly, white people are more likely than any other race to have UC or diverticulitis. The risk of developing either condition also increases with age.
Causes of Diverticular Disease
Diverticulitis may stem from not eating enough fiber. The lack of fiber can cause waste buildup in the colon, putting extra strain on the colon walls. This pressure can cause small pockets (diverticula) to form in vulnerable areas of the colon. Bacteria in stool can also get pushed into the diverticula.
Other factors that may play a role in the development of diverticulitis include:
- Genetics
- Obesity
- Smoking
- High amounts of red meat
- Not enough physical activity
- Immune system dysregulation
- Altered microbiome in the intestines
- Non-steroidal anti-inflammatory drugs and steroids
- Issues with muscles, nerves, or connective tissue in the colon
Causes of Ulcerative Colitis
The root cause of ulcerative colitis remains a mystery, although researchers are currently investigating the role that the microbiome and environmental stressors play in its development.
Genetics appears to be an important factor, as you are more likely to develop UC if you are of Ashkenazi Jewish descent (Eastern or Central European), or have a family member with an inflammatory bowel disorder.
Ulcerative Colitis involves an abnormal immune response. The immune system can mistakenly attack healthy tissues in the gut causing severe inflammation of the large intestine. Gut dysbiosis (an imbalance of gut bacteria) has also been linked to UC, as well as certain environmental factors that appear to increase the risk of development.
Treatment, Prevention & Complications
Ulcerative colitis and diverticular disease are different conditions and therefore require different approaches to treatment and support.
Diverticular Disease Treatment
A mild case of diverticulitis can be treated with antibiotics and a low-fiber diet. Even though the condition might stem from too little fiber, experts advise that lowering fiber intake early in treatment can help reduce discomfort during flares. Once symptoms have been relieved, fiber intake is increased slowly. More severe cases may require hospital care.
Diet & Nutrition
Dietary and nutritional support should be tailored for the individual. Treating a flare of diverticulitis may involve a period of consuming a clear liquid diet until the condition improves, although different dietary approaches may be more suitable depending on your condition. A clear liquid diet will involve soup broth, gelatine, clear electrolyte drinks, water, and ice chips.
Some recommend following a low FODMAP diet, which limits carbohydrates. This may prevent pressure in the colon. The diet involves avoiding fermentable oligosaccharides, disaccharides, monosaccharides, and polyols such as dairy foods, fermented foods, beans, certain fruits, legumes, soy, trans fats, onions and garlic.
Since a diet high in red and processed meat may increase the risk of developing diverticulitis, it may help to limit those foods, as well as any food high in sugar and fat.
Low-fiber foods for when you have diverticulitis symptoms:
- Dry, low-fiber cereals
- Olive oil
- Processed fruits
- Cooked spinach
- Potatoes (no skin)
- Fruit and vegetable juices
- White rice, white bread, white pasta.
- Animal proteins such as fish, eggs or poultry
Ulcerative Colitis Treatment
Treatments for ulcerative colitis generally focus on reducing inflammation so that the damaged tissue can heal. Depending on your state of condition or resistance to certain medications, you may be prescribed:
- Anti-inflammatory drugs are the first-line treatment. These will either be 5-aminosalicylates (ex. sulfasalazine, mesalamine) or corticosteroids
- Immunosuppressants not only reduce inflammation but suppress the immune response that triggers inflammation. These are more appropriate for short-term use as they can increase the potential for serious side effects.
- Biologics target proteins produced by the immune system that drive inflammation. Some work to inhibit tumor necrosis factor (TNF), and others block inflammatory cells from reaching the site of inflammation.
There are also novel natural treatments for UC, such as curcumin and qing dai. Both target TNF-α cytokines and combat oxidative stress that can drive chronic inflammation. Curcumin has been found to improve outcomes when used as an add-on treatment along with first-line medication. Curcumin has also been found to improve ‘loss of response’ to Remicade treatment. Qing Dai is effective as a short-term treatment for severe ulcerative colitis, but should only be taken under the advice of a healthcare expert.
Complications of Diverticulitis
Complications of diverticulitis include:
- Fistula formation
- Abscess formation and peritonitis
- Rectal bleeding
- Colonic stricture
According to a 2019 meta-analysis, a higher risk of colon cancer is also associated with complications of diverticulitis, so make sure to get screened regularly.
Prognosis
The prognosis for UC and diverticulitis differ, as they are very different conditions.
Diverticular Disease
Roughly 85% of patients with uncomplicated diverticulitis respond to treatment. 15% of patients may require surgery, but the majority have positive outcomes. After treatment of the first attack, one-third may remain without symptoms and one-third may have a second attack. The prognosis following a second attack appears to be similar to after the first attack.
Ulcerative Colitis
It is very possible to live a full life with UC, with lengthy periods of remission, although this depends on the individual patient, their lifestyle, mental health, and their response to various treatments and therapies.
Roughly 10% of patients get better after one attack, although flares are likely to recur at some point. That said, you can go months or years without flaring. Lengthier periods of remission are better for your overall health as flares put much stress on the body.
IBD requires a well-rounded treatment which may include conventional medicine as well as complementary and alternative support and therapies. Treating UC naturally is possible, and should be discussed with your healthcare team.
Diverticulitis Associated Colitis
Diverticulitis and UC can co-exist, although whether one can cause the other is still unclear. The association between the two is exceptionally rare and not well understood. If you’re still unsure, the best course of action is to consult your doctor and address symptoms as early as possible.
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