Ulcerative Colitis vs. Diverticulitis: What's the Difference? - Health Central

Although both ulcerative colitis (UC) and diverticulitis are gastrointestinal diseases and share some overlapping symptoms, they're different conditions. And each requires a distinct treatment approach, according to Pratima Dibba, M.D., a gastroenterologist with Medical Offices of Manhattan in New York City.

"UC and diverticulitis differ in their nature and location," she explains. "UC is characterized by chronic inflammation in the colon, while diverticulitis is a short-term illness involving inflammation of pouches in the colon that have developed over time from straining and constipation."

Because one condition is chronic and the other is a temporary illness, treatment will depend on which one you have. With that in mind, our experts are here to walk you through the nuances of both, including how a health provider makes a diagnosis, and what type of treatments are used to alleviate each condition's symptoms.

Causes and Symptoms of Diverticulitis

Diverticulosis occurs when small pouches, called diverticula, form in the walls of the colon. If those pouches become inflamed or infected—which can happen when undigested food or hard piece of stool gets trapped—that's diverticulitis, says Dr. Dibba.

The main cause for development of diverticula is increased intra-abdominal pressure, primarily as a result of straining, or pushing down, during bowel movements. Other contributors to diverticula formation can include a low-fiber diet, older age, smoking, lack of physical activity, and possibly genetic predisposition, Dr. Dibba adds.

Most commonly, diverticula form in just one section of the lower part of the colon, according to Steven Gronowitz, M.D., a gastroenterologist at Gastroenterology Associates of New Jersey in Clifton. "Diverticulosis is an extremely common condition felt by many to be a normal part of the aging colon, and also happens often with constipation," he says. "The most important distinction here is that diverticulitis is caused by an infection, while ulcerative colitis is caused by a dysregulation of the immune system."

Symptoms of diverticulitis include:

• Abdominal pain that is typically severe and comes on suddenly, although may sometimes be mild and worsen over several days

• Bloating

• Chills

• Constipation or diarrhea

• Fever

• Nausea or vomiting

But not everyone with diverticulitis experiences the condition in the same way. "It's important to remember that the symptoms of diverticulitis can vary from person to person," says Dr. Dibba. If these symptoms are interfering with your everyday activities and especially if they're worsening, she suggests talking with your doctor. If symptoms seem severe, such as sharp pain and fever that lingers for more than a day, then consider getting medical attention sooner.

That's because complications from diverticulitis can include worsening infection, intestinal obstruction, urinary problems, and bleeding. Such complications can occur because, when left untreated, inflamed pouches from diverticulitis can become so large they may block a portion of your lower colon—which is a medical emergency.

Causes and Symptoms of Ulcerative Colitis

Ulcerative colitis, an autoimmune condition, is a type of inflammatory bowel disease (IBD), says Dr. Gronowitz. Unlike diverticulitis, which affects just one part of the colon, UC can be present throughout the entire colon, he says, with inflammation in the inner lining of the large intestine.

"Although the precise mechanism behind why UC develops is not known, there are factors that make your susceptibility higher," Dr. Dibba adds. Those include a genetic predisposition—meaning UC runs in your family—as well as certain environmental factors, such as frequent gastrointestinal infections, poor diet, and exposure to air pollution.

Symptoms of UC include:

• Anemia

• Bloody diarrhea

• Fatigue

• Frequent and urgent bowel movements

• Joint pain

• Loss of appetite

• Persistent abdominal pain

• Skin lesions

• Unexplained weight loss

If UC becomes severe and is not handled immediately, serious health issues may result. Complication from UC can include:

• Anemia due to bleeding in the colon, which can lead to fatigue

• Higher risk of ulcers in the colon

• Long-term inflammation that may cause scar tissue to form in the digestive wall, which increases risk of bowel blockages

• Malnutrition due to poor absorption of vitamins and minerals

You may also develop problems with other organs since uncontrolled UC can prompt inflammation throughout the body, which is why many people with UC experience issues with their joints and skin.

Diagnosing Ulcerative Colitis vs. Diverticulitis

Often, it's not clear from your symptoms alone which condition you might have. That's why a comprehensive assessment by a gastroenterologist is important. "There is certain key information from a patient's medical history that would allow a gastroenterologist to grasp an idea of whether a patient has diverticulitis versus UC," says Dr. Dibba. For instance, "very often, UC is diagnosed in younger patients, who present with chronic, persistent symptoms of rectal bleeding, diarrhea, abdominal pain, or urgency."

Meanwhile, diverticulitis can be present in young patients, but is often diagnosed in older patients who have a history of constipation or who have been found with diverticulosis on a prior colonoscopy, she adds. A colonoscopy is an endoscopic evaluation that uses a long, flexible tube with a light and small video camera at the end, according to the American Cancer Society. It's inserted through the anus and into the rectum and colon to look for signs of infection, ulcers, or other GI problems.

In addition to a colonoscopy, your gastroenterologist may consider doing blood tests, including inflammatory markers, stool tests, and imaging studies to confirm the diagnosis. "Differentiating between these conditions is relatively straightforward," adds Dr. Gronowitz. "In a patient with lower abdominal pain, I would suspect diverticulitis if the patient has abdominal tenderness, constipation, and fever. If the patient has bloody diarrhea, I would suspect ulcerative colitis."

Treatment Options for UC and Diverticulitis

Treatment is different for each of these conditions, says Dr. Gronowitz. Many cases of diverticulitis can be treated by simply restricting the diet for at least a couple days, with an emphasis on clear liquids only at first, followed by gradually introducing low-fiber foods back into the diet for another few days. "Antibiotics can be also used but are not always required, unless the case is complicated by perforation or abscess formation," he says.

That minimal approach is in contrast to UC treatment, which often requires ongoing treatment. Reducing inflammation and managing symptoms are the primary focuses of UC therapy, adds Dr. Dibba. Medications for UC include aminosalicylates, corticosteroids, immunomodulators, and biologics, she says, and that treatment would go along with diet modifications that can help resolve symptoms.

The primary diet that tends to be helpful for UC is a low-FODMAP approach. This stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are short-chain carbohydrates that the small intestine doesn't absorb well, which means the foods pass through your system more quickly. Dr. Dibba says many people with UC feel less gas and other symptoms as a result. These foods include:

• Almond milk

• Certain cheeses, such as brie and cheddar

• Eggs

• Fruits including grapes, oranges, strawberries, blueberries, and pineapple

• Grains, such as rice, quinoa, and oats

• Vegetables including eggplant, potatoes, tomatoes, cucumbers, and zucchini
  

Working with a registered dietitian can be helpful for putting together a tailored approach that addresses your symptoms specifically, Dr. Dibba suggests.

Prevention for UC and Diverticulitis

There are no definite prevention strategies for either UC or diverticulitis, but Dr. Dibba says there are approaches you can use to improve gut health, which may be helpful for either condition:

• Avoid smoking and excessive alcohol consumption, since both of those habits raise inflammation levels in the body.

• Drink adequate water to prevent constipation.

• Eat a diet full of fruits, vegetables, whole grains, and lean meats to help keep your gut healthy.

• Exercise regularly, which can improve the movement of the intestines and the health of the digestive system as a whole.

Another major strategy for preventing problems related to both gastrointestinal issues is to have routine checkups and follow-up visits with your doctor, says Dr. Dibba. That includes following colorectal cancer screening guidelines, since a colonoscopy done as part of that screening can detect other issues such as diverticulitis and UC.

"Most of all, checkups and screenings can help your doctor identify issues before they get serious," she says. "Like any condition, finding problems early makes treatment more effective."

Notes: This article was originally published August 22, 2023 and most recently updated August 25, 2023.

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