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February 14th, 2011

Can colonoscopy cause diverticulitis?

Many of you out there have done many tens of thousands of colonoscopy like I have and are well aware of the complications most known to be associated with this procedure, like bleeding or perforation. And most of us are aware of very unusual complications that have been reported, such as splenic lacerations or barotraumas.

However, I recently had a patient develop acute diverticulitis within 24 hours of colonoscopy, and I have consulted in the last year on another patient who developed diverticulitis shortly after the procedure.

Although diverticulitis precipitated by colonoscopy prep or the procedure itself (microperforation from the bowel prep, pressure from the shaft of the instrument or air infused during the procedure, etc.) is plausible, there seems to be little in the literature on this subject.

One reason for the lack of data might be that there is not really an association, that these are two unrelated events. Another might be that because diverticulitis is not immediately evident (like bleeding or perforation), the causal link has been missed, given that delayed complications are not often reported in large series of procedures.

So I am asking you endoscopists out there:
1) Have you observed diverticulitis in a patient shortly after a colonoscopy?
2) Do you think the procedure can cause diverticulitis?
3) If so, what do you think the mechanism is for this complication?

I look forward to hearing from you.

78 Responses to “Can colonoscopy cause diverticulitis?”

  1. Tom says:

    Am a family doc with a history of diverticulitis 18 years ago. Find since, developed diverticulitis two weeks after colonoscopy. As there is a reasonable mechanism for a causal association, this is probably a reasonably rare but significant complication of the procedure and should be studied.

  2. Janet Saluk says:

    I am a nurse practitioner who developed diverticulitis last week– and had a routine colonoscopy in mid August that showed diverticula
    I have never had this before–and had been eating the healthiest I have ever eaten and exercising regularly-and was feeling best I had in a long time
    In hindsight, I have had some mild discomfort after BM’s for a week or so–so was probably smoldering for a while. Also, while undergoing my Miralax prep, I noticed small “plugs” near end while rest was clear…could these have been materials released from diverticula??? z
    This def merits further retrospectives study!

  3. Randy says:

    Thank goodness I found this blog. I had a routine (50yo) colonoscopy with two polyps clipped. Within 48hours I developed flu-like symptoms which lasted 36hours and then an extreme lethargy/exhaustion with left lower quadrant pain for the next 4 days. I have never felt more “out of it”, dazed, faint, lightheaded, one simple task required 3-4 hours of recovery/rest. All with profuse sweating, constantly. One week after the procedure with this “exhausted/daze/haze” I was living in, I saw my regular MD and the GI doc. I thought I was anemic and/or septic or both or crazy. They both said it sounded like a “virus”. Cipro and Flagyl cleared it up almost instantly. Neither MD would admit nor link it to the colonoscopy. However now that I see this blog I am sure it was Diverticulitis secondary to the procedure. The GI doc did say I had pretty bad Diverticulosis. Whether it was the prep or the scope or the air, I guess I will never know but clearly the direct correlation just can not lie. The earlier posts on this link started with older docs stating they have never saw these complications post colonoscopy. Now that the “American diet” is making us unhealthier inside and out, I wonder if complications from colonoscopies are going to be much more common than the older generation MDs experienced. I agree this is a phenomena which should be studied, reported and presented to patients as part of the risks. Due to my family history with colon cancer I will have to do this every 5 years. Next time I will do some homework and see what diet I can do to avoid this situation from happening again. This was truly not a fun week.

  4. Rose says:

    One year agim I had my first colonoscopy which came back with a normal result outside of a very tiny polyp removed from the rectal area. Eight weeks later, I had full blown diverticulitis. It was in my lower left abdomen area (nowhere near the area where they removed the polyp. Ten months later, I started having dull pain all across my belly and ended up in the hospital with collapsed colon, fecal impaction, and small intestine dialation. I never had problems before. I am so regular that I “go” every day within a two hour period. I don’t smoke, don’t take pain medications, and I’m not diabetic. I eat a balanced diet, don’t like cheeses or dairy products, and rarely get constipation. I am completely convinced that my intestinal issues were caused by that colonoscopy. I must point out that if most people are like me, they ended up in the ER or at their doctor’s office with these issues and probably never report them to the person who performed the colonoscopy. To really find out whether or not there is a link, you may have to survey patients a year after the procedure and ask if they have experienced an onset of intestinal issues in that time period. I really do think that colonoscopy is to blame for the issues I battle now. Sadly, I’d have to get another colonoscopy to find out what kind of damage is present today, just one year later. It is what I intend to do because I’d like some answers.

  5. Debbie Smith says:

    My father was diognosed with diverticulitis several yrs. ago. Had a colonoscopy with polyp removal which was biopsied and found to be benign. Within two weeks of the procedure had severe abdominal pain, gas diahrea , I believe prophylactic antibiotic therapy would have been of great benefit if not preventing this ‘flare up’ altogether. Yes , absolutely there is a connection, especially when the pt. is known to have history of diverticulae and diverticulosis. Of course no one wanted to be responsible or admit the corelation so even after begging for antibiotics for my Dad, none were given until formation of fistula, introducing colon contents into his stomach, proven after nausea became overwhelming and NG tube placement revealed what had been causing it. It was too late for my Dad….for God’s sake someone get a Grant and a study group together for proof, or at the very least give antibiotics prophylactically for ANY surgical procedure, aren’t Dr.s aware that 70-90% of good and ‘bad’ bacteria live in the colon!?

  6. micharl kahler says:

    I had a colonoscopy and it was noted that I had Diverticulitis, but no issues. The Sunday following my colonoscopy on Monday I had to go to the ER for severe pains on my left side. Thought it was kidney stones but it was Diverticulitis. I think the procedure caused the issue.

  7. Mazr says:

    I recently had my first colonoscopy and coincidentally had my first bout of diverticulitis about a week later. And while correlation does not necessarily indicate causation, I find it hard to believe that it is only a coincidence. I think it should certainly be studied, but I definitely will not have another colonoscopy for at least five years after this (I had no polyps.)

  8. Dennis says:

    I had a colonoscopy October 28th, 2014 one small benign polyp removed. No immediate issues. then the following week I noticed a dull intermittent pain in left lower abdomen. After 4-5 days, went to Doctors. He diagnosed Diverticulitis and prescribed Cipro and flagyl and this resolved the pain.
    Three weeks later, December 2, I have a blackout syncope accompanied by incontinence and bloody diarrhea. Two nights in hospital while they ran tests (Xray,Cat-scan, EKG, Heart Echo scan, numerous blood tests.) Drs did not do a new colonoscopy due to the fact that I’d had one approx. 1 month ago.
    Best diagnosis was “Acute GI Bleeds, currently resolved” Causation was not clear.
    No previous incidence of diverticulitis, or lower GI bleeding. I think the subsequent issues are related to Oct 28th colonoscopy.

  9. Dean says:

    I had a colonoscopy at age 52. Up until then I had no issues with my digestion and had never had constipation, regular bowel movements every morning. For three days after the colonoscopy it felt like water was sloshing around in my gut and I felt pressure on my bladder. Going to my regular Doctor for a follow up the next month she diagnosed diverticulitis. My digestion is still not right after 2 years. I am convinced the colonoscopy caused it.

  10. Nancy Perron says:

    I had a coloscopy two weeks ago on a friday Nov 30, 2014. On Sunday night at 1am, I started with extreme pain (LLQ) and diarrhea. After 24 hours I went back to my GI who had conducted the procedure.

    I saw my GI on Tuesday where he tested me for C. Difficile. Tests came back negative. I went back to my family doctor on Thursday who put me on immodium to rest the bowels.

    On the following Monday (day 9) I returned and saw another doctor as there was no improvement. I am now on antibiodics for what she suspects maybe diverticulitis. I have been free from diarrhea/pain for 24 hours without the benefit of immodium.

    I am not aware that I had/have diverticulitis. The initial colonoscopy was ordered due to previous intermitent issues with diarrhea and vomiting which was suspected as being related to crohns (family history). I do not believe my GI saw divertculitis during the procedure or he would likely have treated me when I retunred to him on Tuesday presenting with pain in LLQ and diarrhea. I am a 57 year old female.

  11. lisa quested says:

    Had a sigmoidoscopy and 3 weeks later had my 1st diverticulitis attack. Have had diverticuliae for at least 5 yrs. Had the test for chronic constipation.

  12. lisa says:

    Hi, 48 yrs old and I had abdominal pain for weeks and went to GI doctor. He set up colonscopy for 12/30. I had one small and one large polyp. I have had back pain since which i think is due to the way they positioned me. Also, i am feeling some tenderness when i press middle of stomach, it radiates to right side where i had the polyp and pain before. Hoping normal to have pain after is normal. No fever or chills or bleeding.

  13. Dennie says:

    I’m 57 years old, had a bout of diverticulitis 3 weeks after lifting and throwing something very, very heavy and slipped, twisting the sigmoid area. My physician ordered a colonoscopy after I got well. I have moderate diverticulas in the sigmoid and a normal ileum and cecum, no polyps, no tumors, no cancer. Less than one week after I had the colonoscopy I once more have developed diverticulitis, after being free of it for nearly three months. So yes, there is a connection between seriously messing with this part of the body, inadvertently such as a traumatic accident or shoving crap up there for “miles and miles,” just to explore. Even under “controlled” medical conditions. I say it like I see it– this is Medieval torture designed to make money for the Cancer Industry. Skin cancer is The Number One form of cancer in the U.S. and NO ONE insists on checking all of your skin every year, mainly because it’s just not profitable for the shareholders– unless, of course, you actually get cancer. Sheesh.

  14. Dennie says:

    To clarify: I had a first bout of diverticulitis three weeks after the hillside slipped out from under my foot while chucking a large tree branch, seriously twisting my torso to the right and rapidly compressing the sigmoid area. I felt very overheated in the lower abdomen for three weeks, then the first bout of diverticulitis started. I was treated with flagyl and an antibiotic. My physician ordered a ‘scopy for me and I went through with it on Wednesday, 12/31/14. I came down sick, again, with yet another bout diverticulitis, on Tuesday, 1/6/15.

    I do not have a terrible diet, I eat salads with at least four kinds of lettuces, shredded carrots, two kinds of cherry tomatoes and grilled chicken breast with a wonderful vinaigrette dressing, at least four times a week. I eat whole-grain bread, oatmeal, some eggs, a little cheese and butter and I drink every kind of milk. I have not had as much exercise as I’d like and am working on it. I do not drink more than two glasses of red wine in a week. I’m not eating twinkies and bon-bons, sitting around doing nothing all day long, watching teevee at night (my t.v. doesn’t work and it’s going to stay that way– I like the “pictures” much better when I read a book ; ). We are hearing out of one side of The Mouth that you must eat a low-fiber diet to “cure” diverticulitis, because FIBER CAUSES it, then once well, we are told to eat a high-fiber diet– WWT? This kind of “logic” makes ZERO sense.

  15. Jim Fiorino says:

    I had my second colonoscopy in October of 2014. During the first one they removed a polyp and made no mention of diverticulitis. They removed a large polyp during the second one and said they had to “clip” the area. I actually woke up in pain during this colonoscopy which was very upsetting. When I went for my follow-up, the Dr. said that I had mild diverticulitis. Since the procedure I have had frequent bouts of nausea, gurgling stomach, and constipation which I never had prior. I believe that the procedure is causing this.

  16. Madeleine Chaleyer says:

    I have had a couple of colonoscopies (5 year intervals), because of a history of Bowel cancer in my family. Purely investigative and not because I had any symptons. I had no after effects from these two previous colonoscopies. The last one indicated diverticula but nothing serious. But I have had another colonoscopy 10 days ago, and this time I have been having pains in my gut area and other unusual discomfort. This time it was reported that I had advanced diverticulitis (weird because I’d never had symptons). I found this blog because I think the colonoscopy may have caused my symptons.

  17. Suzette says:

    I had my first colonoscopy at 62 and was diagnosed with colo-rectal cancer. I had surgery resulting in a permanent colostomy. Six months after the surgery, I had a colonoscopy without any post problems. I could eat anything without having gut problems. My next colonoscopy was a year after the second one. Ever since that one, I have an ever growing list of foods that cause me to suffer fever, chills, nausea, throwing up, etc. I swing from diarhea to what I considered blockages with terrible gut pain. I am overdue for another colonoscopy and am trying to decide whether to do it or not.

    I always thought that the third colonoscopy created these problems. After reading all the comments here, I feel validated in that thinking.

  18. Annie says:

    I have been diagnosed with severe diverticulitis for over 10yrs now. I have gone gluten free, researching anti inflammatory diet changes, and use no dairy except for kefir everyday. I went extreme as I was facing a resection. I havent had an infection for over a year, which is unheard of for me. My doc now wants to schedule another colonoscopy, it is now the 10 yr mark. I am very reluctant to undergo this as I am strongly feeling going through this procedure will not go well. I have no familial history. I just informed my gastro that I am going to forgo this screening. The reception to that was lukewarm at best. I feel I have to do whats right for my body and its my choice.

  19. WOW. Wish I had done more research into this before my colonoscopy. I had one 6 months ago and it was relatively normal with a couple small polyps removed according to the doctor. Never had any problems before, but my Doctor kept insisting every time I saw him to have one. Had my first bought of lower left abdominal pain about a week ago. It was very tender. This could be the location where they removed one of these small polyps which weakened the wall, or….. STOP PUSHING COLONOSCOPIES FOR ALL. There should be some medical symptoms or tests first that would indicate the need – it should not.be based solely on age .- THANKS!

  20. Phyllis says:

    Had a colonoscopy yesterday. Sitting here feeling the onset of a diverticulitis attack. My first bout with diverticulitis was last Fall 2014. Thought this strange so checked the internet about this very issue. Darn it! Should have checked BEFORE the colonoscopy which was because I just turned 50 and for symptoms most likely associated with the diverticulitis itself!

  21. Donna says:

    I had my first colonoscopy at 55 and my first diverticulitis attach 7 months later. I had my second colonoscopy 2 years after my first due to precancerous polyps. On the morning of my colonoscopy, I was experiencing some pain in my lower abd after prepping the day before but thought it was due to the prep. When I woke from the scope, I still had lower abd pain which continued to get worse over the next day. Diagnosed with another diverticulitis. Was not medicated for it in the last 3 years but in Dec. developed it again but this time ended up with an abcess and spent 9 days in the hospital and had a percutaneous drain put in that finally broke the infection. Went home on 2 weeks of IV antibiotics. Need to have a sigmoid colectomy in the spring to get rid of this piece of colon but am scheduled for a colonoscopy at the end of the month and I am scared to death this will throw me into another attack!

  22. Donna Estes says:

    Had a colonoscopy in July 2011. In October of 2011 went to my family doctor with bad stomach pain and she prescribed Bentyl. Last August 2014 I submitted a school sample to determine constant diarrhea which showed pseudonomas arg. In Feb. 2015 went to different doctor and got put on Ciproflaxin and Flagly for diarrhea which I’ve struggled with for years. As I researched the history on my stomach pain and diarrhea, I can trace it to the colonoscopy! Doctor diagnosed diverticulosis in Feb. 2015.

  23. kkabir says:

    Very interesting discussion. As a former diverticulitis sufferer, I know how frustrating it can be to find answers.
    Best of luck to everyone!

  24. lo says:

    To M. Brian Fennerty. While reaserching as to weather I should undego a colonscopy after a sudden onset of diverticulitis after four days of miralax! Here is what I found..The insurance will not pay for anything except “polyethlene glycol” ETHLENE GLYCOL is antifreeze..also used in plastic manufacturing. poly is a greek word for much or more. look up The effects of antifreeze poisiong start with nausea, diarrhea, possibly vomiting, sweating, dehydration, sizures, heart and blood pressure abnormalties including prolonged QT’s, renal failure. A patient may recover from it and gain full renal function back but will probably need diyalisis for some time..( some of that sound familar.. its on the list of possible serious side effects on the product.) It is also a mucous membrane irritant, put it in your nose or eye, it will burn. What is the stomache and intestines..mucus membrane. However, there are acceptable levels of it as it is found in flavored coffees, dessert icing, boxed cake mix, margirine, soda pop, carbonated beverages,some alcholic beverages (some beverages have been banned in Europe due to the level of ethlene glycol excedding Europe’s acceptable level. apperently Europe’s acceptable level is lower than the U.S.) it is also in ice cream ( it is what gives it a creamy texture and keeps it from becoming a frozen block of ice. So basically you are taking an overdose of antifreeze that will produce moderate to severe diarrhea, just (hopefully) not enough to kill you. Although that is going on what the average population can tolerate. Now I would put money on the fact that is you put 2000 people in a room and gave them all a big dose of it some will become sick faster and more severe than others and probably die faster without treatment. So possibly a percentage of the population may be more sensitive to the effects. In my belief would be in of itself the irriatating effects could cause a flare of diverticulitis..then further insult from the infusion of large amounts of air and the scope itself any averegely intelligent person would come to the conclusion that ( yes anyone of the three in itself or the combination could cause diverticulitis!) Furthermore, many Doctors simply don’t care as long as you do not die in front of them! I aske several what the risks are..all I got was ” There is a very small risk of perferation.” HUMMM.. I did talk to the Dr. about how the four days of Miralax burnt the hell out of my digestive system and made me pee like crazy..she ordered osmoprep instead but when the insurance didn’t pay for it she changed it back to antifreeze, I only found out when I went to the pharmacy to pick up perscriptions, no one even called to explain the changes in directions. I refused it and came home to do the research because somehow I remembered the word Ethlene glycol. Additionally the osmoprep should not be used by anyone who has had stomache surgery that used staples. I have had a TIF procedure so I have at current 16 polyprolene plastic staples in my stomach, I really don’t want to find out if the osmoprep is safe to use with those. Due to my experiance with miralax I will not take ANY PREP with polyethlene glycol in it, sadly there aren’t any that don’t have it that insurance would cover.. the ones that don’t contain it are out of my financial reach. Thats ok though the fact that I have high blood pressure puts me at greater risk for complications from the prep..in my opinion at the very least my blood pressure should be monitered by a professional as a person may not realize they are having dangerous changes in blood pressure..so I would feel highly unsafe being home alone..than again what do I know afterall I am just a stupid patient. I am sorry but I do not feel that this is safe procedure for all..and I feel they are more than willing to scope anyone..what do they care they won’t even remember your name in a year.To tell you the truth I don’t think they even bother to read the chart or look for factors that would put a patient at higher risk for complications..how many times have they said ” no we can’t preform this procedure because of your high risk factors” which may be due to the patients own doing like smoking, alcholic, drug addict..not one even bothered to ask me about those factors!

  25. Mark Lijek says:

    I had a Sigmoidoscopy at age 60. Dr. informed me I had diverticulosis but also that this was common in my age group. Shortly after started experiencing abdominal discomfort, then five weeks later had full blown diverticulitis. Flagyl and Cipro resolved it, but since then have had episodes once or twice a year. No proof of course, but certainly believe that the link should be investigated.

  26. michaela Jefferson says:

    Same here. Just a ct scan today. Have had problems, intermittent pain, ever since my last colonoscopy. It was my routine 10 yr screening — never had any problems, no polyps. Went to my GP after two months of discomfort, not the GI, and after ruling out an ovarian cyst, we decided the colonoscopy must have kicked up some IBS. I increased the yogurt and probiotics, and was given a colon spasm med, that didn’t help. A year out, with unremitting LLQ pain for 13 days, she decided it was diverticulitis and started me on anti-biotics, and ordered the scan. The weird thing was, while I was in the waiting room drinking barium, another woman was there doing the same thing, for the same reason — had a colonoscopy and now had problems months later. This definitely needs to be studied. The first prep did not involve Miralax and I had no problems after, but this prep did, as I recall. I am angry that I follow all protocols, am very healthy at 66, and now this!

  27. Jill says:

    I had my first and only colonoscopy in sept 2012. Since then I have struggled and suffered with extreme digestive issues. I have been to my doctor multiple times and have even changed doctors to help get to the ‘bottom’ of my gastro issues. I have even gone gluten free for over a year now. I waited 18 months to see a gastroenterologist who suggested I take Metamucil twice a day. This has helped but not solved my problem. Did I need to wait 18 months to hear that?
    My life has changed due to my GI issues. I can’t travel, going out for dinner is a challenge, even visiting friends is difficult. I’ve been told I probably have IBS. I think that is the medical ‘default’ word for when the specialist have no idea.
    I have been talking to a lot of people and putting together my own theory that colonoscopies can cause GI problems. I had a colonoscopy because my brother was diagnosed with colon cancer. Now I need another one to find out the problem!

  28. Dennis says:

    Follow-up on my previous entry #8 Dec 2014: After diverticulitis and lower GI bleed within months of the colonoscopy, my GI specialist said that he didn’t see a connection and blamed the troubled on diverticulosis. CT scan showed nothing in the colon, but they did see “a mass on the left kidney.” Further tests resulted in a decision to proceed with surgery. In March I had a partial nephrectomy to remove a 4.7 cm clear cell carcinoma tumor. There were no symptoms of the tumor on the kidney, which means it had not invaded the kidney. 2 1/2 months later I am back to normal – free and clear of cancer. No subsequent problems with lower GI and hopefully keeping things moving with a high fiber diet. Feeling very lucky that tumor was discovered before it affected the functionality of kidney. I’m thinking everyone over 65 should get scanned every 5 years. In summary, I’m not convinced that the colonscopy caused subsequent issues. I will have no problem doing it again in 4 years, but I hope they discover a prep that doesn’t taste like elephant ass.

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Gastroenterology Research: Author M. Brian Fennerty, M.D.

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