The following symptoms and complaints may indicate diverticular disease/diverticulitis:
Leading symptoms
- Pain in the lower abdomen (colicky), usually in the left lower quadrant (left lower abdomen); both spontaneous and release pain, lasting up to several days (approximately 90% of diverticula are localized in the sigmoid) [motion dependence of pain is suggestive of sigmoid diverticulitis; similar to appendicitis, also referred to as “left-sided appendicitis.”]
- Signs of local peritonitis (peritonitis) such as defensive tension.
- Fever [37.6-38 °C]
- Stool irregularities: Diarrhea (diarrhea) or constipation (constipation; “sheep feces-like stool”).
- Tenesmus – constant painful urge to defecate.
- Anorexia (loss of appetite)
- Roll-shaped tumor (palpable and pressure-dolent/painful roll in the left lower abdomen).
After ingestion of food, there may be an increase in symptoms (due tomotility increase).Flatulence (increased gas formation; flatulence) and defecation (defecation) and lead to relief or elimination of symptoms.
The classic symptom triad of diverticulitis consists of:
- Abdominal pain/abdominal tenderness (usually left lower quadrant/lower abdomen).
- Fever [37.6-38 °C]
- Leukocytosis (increase of leukocytes (white blood cells) in the blood:) [> 10-12,000/μl]
Associated symptoms
- Meteorism* (flatulence)
- Flatulence
- Nausea (nausea)*
- Stool irregularities* (changes in stool frequency, labored passage of stool, increased urge to defecate, small-volume bowel movements, mucus discharge).
- Rectal hemorrhage (bleeding from the rectum) – more common in diverticulosis (in 10-30% of cases) than in diverticulitis
- Pollakisuria (urge to urinate frequently without increased urine output), dysuria (unpleasant, difficult or painful bladder emptying), pneumaturia (excretion of gases through the urine) – in rare cases due to compression of the ureter even accompanied by micro or Macrohematuria (presence of visible blood in the urine) – as well as pain in the genital area / dyspareunia (pain during intercourse) indicate local complications (fistula, perforations into the bladder, irritation of the sacral plexus).
* Additional findings of irritable bowel syndromeOther indications.
- Right-sided or suprapubic (“above the pubic bone“) pain localization must also be considered differential diagnosis of diverticulitis.
- The symptomatology of symptomatic uncomplicated diverticular disease shows a similarity to irritable bowel syndrome.
- Inflammation-free diverticula are asymptomatic, except for rare bleeding. The largest proportion of diverticula carriers (over 80%) remains symptom-free throughout life (asymptomatic diverticulosis).
- The covered perforation (breakthrough of a diverticulum) with abscess formation is sometimes clinically indistinguishable from simple diverticulitis! It can be asymptomatic or accompanied by the signs of local peritonitis.
