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Key Takeaways
- Diverticulitis and ulcerative colitis can both cause pain and blood in the stool, but they are different conditions.
- Ulcerative colitis is treated with medications, lifestyle changes, and sometimes surgery, while diverticulitis often needs antibiotics.
Diverticulitis and ulcerative colitis may have similar symptoms, but they are different conditions. One of the main differences between diverticulitis and ulcerative colitis is that diverticulitis is a form of diverticular disease, while ulcerative colitis is a type of inflammatory bowel disease (IBD).
Both conditions can affect the large intestine (the colon and rectum). Diverticulitis occurs when bulges in weakened areas of the lining of the colon (called diverticula) become infected.
Verywell / Zoe Hansen
Ulcerative colitis is an immune-mediated disease that causes ulcers (holes) in the large intestine. People have can both conditions at the same time, but they have different causes.
Learn more about the differences between ulcerative colitis and diverticulitis. Make sure to see a healthcare professional for a diagnosis so you can receive the proper treatment.
Symptoms
Symptoms of different digestive conditions can be similar. That’s why it’s important to work with a healthcare professional to ensure that the cause of the symptoms is found and diagnosed properly.
Ulcerative Colitis
The signs and symptoms of ulcerative colitis usually affect the digestive system but can also impact other areas of the body. These symptoms may include:
- Blood in the stool
- Crampy abdominal pain
- Diarrhea
- Fatigue
- Fecal incontinence
- Fever
- Mucus in the stool
- Urgent need to move the bowels
- Using the bathroom at night
- Weight loss
Diverticulitis
Diverticulitis occurs when diverticulosis—outward bulges in the lining of the digestive system—becomes complicated by an infection. This infection can lead to digestive tract symptoms such as:
- Abdominal cramping
- Abdominal pain
- Blood in the stool
- Change in bowel habits (new constipation or diarrhea)
A Change in Bowel Habits
Diarrhea or constipation are common and usually go away in a few days. However, when either stools that are too loose or too hard continue for three days or more, it might be called a change in bowel habits.
When these changes happen over and over or go on for a long period of time, it could mean that there is a problem that needs attention. That’s why it is important to discuss stools with a healthcare professional.
Causes
The causes of ulcerative colitis and diverticulitis are quite different.
Ulcerative Colitis
The causes of ulcerative colitis are not well understood. It is thought to possibly be a combination of two factors: genetics and environment.
More than 200 genes have been found that are connected to IBD, but not everyone who has these genes goes on to develop ulcerative colitis or the other forms of IBD—Crohn’s disease or indeterminate colitis.
Additionally, one or more external—environmental—factors affect the immune system and/or the makeup of the bacteria in the digestive system. The result is a series of events that occurs in the body leading the immune system to attack the large intestine.
Diverticulitis
Constipation or a lack of dietary fiber is believed to contribute to the formation of diverticula in the colon. Without enough fiber, stools can become hard, making them difficult to pass, which leads to constipation.
Constipation increases the pressure in the colon, causing the colon wall to weaken. This weakening can result in bulges, known as diverticula.
When diverticula become infected, this condition is called diverticulitis. The exact cause of the infection is unclear, but bacteria from the stool may become trapped in a diverticulum and begin to multiply.
Additionally, some individuals may experience ongoing inflammation, resulting in diverticulitis that does not improve with treatment.
Diagnosis
Some of the tests used to diagnose ulcerative colitis or diverticulitis will be the same, but there are also key differences.
Ulcerative Colitis
A colonoscopy with biopsy is generally used in the diagnosis of all forms of IBD. A flexible tube with a light and a camera on the end is put into the large intestine through the rectum. The doctor can see the inside of the colon and choose where to take samples of small pieces of tissue (biopsies). The biopsies are then tested in a lab.
Other tests might also be used during the process of diagnosing ulcerative colitis. These help determine whether there is another reason for the symptoms, such as a bacterial infection. These tests might include:
- Barium enema: A series of X-rays after an enema containing contrast media is given
- Computed tomography enterography (CTE): A CT scan using X-rays and contrast media to get detailed images of the digestive system
- Magnetic resonance enterography (MRE): Detailed images taken by magnetic resonance imaging (using strong magnets rather than X-rays) and contrast media
- Fecal calprotectin: Testing a stool sample for a protein found in inflammatory white blood cells
- Sigmoidoscopy: Uses a flexible tube with a camera to see the last third of the colon
- Upper gastrointestinal series: An X-ray series of the esophagus, stomach, and first part of the small intestine using contrast media
Diverticulitis
Diverticulitis may cause symptoms that need to be investigated. A provider may suspect diverticulitis if diverticular disease has been found in the past. However, tests may be done to ensure that symptoms like bleeding and abdominal pain are diagnosed correctly.
Some of the tests used might be:
- Barium enema
- Computed tomography (CT) scan
- Colonoscopy
- Sigmoidoscopy
- Stool sample to check for bacterial or parasitic infection
Treatment
One of the reasons that the correct diagnosis is essential is because the treatments for ulcerative colitis versus those for diverticulitis are quite different.
Ulcerative Colitis
The treatments for ulcerative colitis include lifestyle changes, over-the-counter (OTC) medications, complementary therapies, prescription drugs, and surgery. Some of the most commonly used medications include:
- 5-aminosalicylates (5-ASA), such as sulfasalazine and Asacol HD (mesalamine)
- Corticosteroids, such as prednisone
- Biologics, such as Entyvio (vedolizumab), Humira (adalimumab), Omvoh (mirikizumab), Remicade, Zymfentra (infliximab), Simponi (golimumab), Stelara (ustekinumab), and Tremfya (guselkumab)
- Immunosuppressants, such as Imuran (azathioprine), Purinethol (mercaptopurine), and Velsipity (etrasimod)
- JAK-inhibitors, such as Xeljanz (tofacitinib)
Lifestyle changes can include altering your diet and quitting smoking. Complementary therapies may include yoga, acupuncture, and probiotics.
Surgery to remove the intestine, with either the placement of an ileostomy or a j-pouch, is another form of treatment for complicated ulcerative colitis. More types of treatments might be used to treat either the disease or its effects on other parts of the body.
Diverticulitis
The treatment for diverticulitis may occur either at home or in the hospital. Which treatments are used will depend on the severity of the symptoms. Antibiotics may be given as first-line therapy, either orally or through an IV in the hospital.
Diverticulitis can lead to complications in about 12% of cases. Other treatments, including medications or surgery, might also be needed if there is a high fever, an inability to eat or drink, a high white blood cell count, or sepsis.
More treatments are being studied for diverticulitis, including Asacol HD (mesalamine), Xifaxan (rifaximin), and probiotics, although these are not yet proven to help.
Prevention
Ulcerative Colitis
It’s not well understood what causes ulcerative colitis. For that reason, there’s not a lot of information about how to avoid the disease. However, for those at risk, it may be worth talking to a physician about how to live a healthy lifestyle and avoid potential triggers.
Preventing complications from ulcerative colitis can include making sure the disease is under control. Staying on a treatment plan and seeing a gastroenterologist on a regular basis will be important in managing symptoms.
Diverticulitis
It may not be possible to avoid developing diverticular disease, and not much is known about prevention. However, a high-fiber diet may be recommended once diverticula are present in order to avoid diverticulitis.
Other prevention methods that might be recommended include drinking more water and getting the right amount of exercise. It might also be recommended to avoid eating red meat.
People who have diverticular disease may also be told to avoid certain medications that are known to cause bleeding in the digestive system in some people. This may include aspirin, cyclooxygenase inhibitors (cox inhibitors), and nonsteroidal anti-inflammatory drugs (NSAIDs).