Crohn’s Disease vs. Diverticulitis: 5 Differences To Know

Are you experiencing symptoms like abdominal pain and nausea, but you aren’t sure if they’re from Crohn’s disease or diverticulitis? Both Crohn’s disease and diverticulitis affect the colon (large intestine), but they are separate conditions.

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Crohn’s disease and diverticulitis can be easily confused and even misdiagnosed by your doctor. This article will help you understand the differences in causes, treatments, and risk factors between Crohn’s disease and diverticulitis.

Crohn’s Disease and Diverticulitis Are Similar

Crohn’s disease is an inflammatory bowel disease (IBD) that causes swelling of the digestive tract. Diverticulitis (sometimes called diverticular disease) is inflammation of small pouches called diverticula. These pouches form on the lining of your large intestines.

Both diverticulitis and Crohn’s disease can cause the following gastrointestinal symptoms:

• Fever
• Nausea and vomiting
• Abdominal pain
• Diarrhea (more common in Crohn’s disease)

Both can lead to serious complications like bowel obstruction that may require surgery.

It’s possible to have both Crohn’s disease and diverticulitis, but this is relatively rare. In a 2014 study, researchers looked at records of more than 219,000 people in the United States who’d been hospitalized for diverticulitis. Only about 1,090 of them also had Crohn’s disease.

Despite the similar symptoms, there are important differences between Crohn’s disease and diverticulitis.

5 Differences Between Crohn’s Disease and Diverticulitis

Crohn’s disease and diverticulitis differ in causes, treatments, and some symptoms. Here are the major differences to be aware of.

1. Crohn’s Disease Is an Autoimmune Disorder

Crohn’s disease is caused by an autoimmune reaction. This is when your immune system attacks your body’s own cells, thinking they’re a foreign threat. Scientists aren’t entirely sure what causes this reaction, but researchers are evaluating whether it may be linked to certain bacteria or viruses.

There also appears to be a genetic component to Crohn’s disease. You’re at a higher risk for Crohn’s disease if you have a family history of the disease.

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The cause of diverticulitis isn’t directly related to the immune system. Diverticula form on the lining of the intestines in many adults. This is called diverticulosis and can be painless. If these pouches become inflamed as a result of bacterial infection and tear, then it becomes diverticulitis.

You may be confused by the terms “diverticulosis” and “diverticulitis.” To keep these two straight, remember that the suffix “-itis” always refers to inflammation.

2. Diverticulitis Is Usually Short-Term

Diverticulitis usually begins as an acute condition, meaning it clears up quickly. However, some people have repeated instances of diverticula tearing. This is known as recurrent acute diverticulitis. It occurs in 20 percent to 35 percent of people who have had one episode of diverticulitis. Less often, diverticulitis can become a chronic condition with long-term pain and inflammation.

Crohn’s disease is always a lifelong condition with chronic inflammation. There may be times when your symptoms are mild, then other periods, called flare-ups, when your symptoms become more severe.

3. Crohn’s Disease Can Affect Areas Outside the Colon

While symptoms of Crohn’s disease are most common in the small and large intestines, other parts of the body can also be affected. Between 6 percent and 40 percent of people living with Crohn’s disease have extraintestinal symptoms. These can include:

• Skin bumps
• Oral ulcers
• Inflammation of the eyes and joints
• Kidney stones

Crohn’s disease can also extend to the rectum, which is known as perianal Crohn’s disease.

Diverticulitis is much more localized. Most people experience pain in the lower left area of their abdomen. This is because diverticula usually form on the sigmoid colon (the last part of the colon before the rectum). In Asian countries, people more commonly develop diverticula on the upper right side of the colon, according to an article in Current Problems in Surgery.

It’s very rare to have diverticulitis in the rectum or transverse colon (the part of the large intestine that runs across the abdomen). Pain may sometimes radiate to the lower back.

4. Diverticulitis and Crohn’s Have Different Risk Factors

Diverticulitis and Crohn’s disease usually affect people at different ages. Diverticula tend to form in older adults, and the risk of diverticulitis increases with age. Only about 5 percent of people have acute diverticulitis at age 40, but 65 percent have had it by the age of 80.

Conversely, Crohn’s disease is a lifelong disease and is usually diagnosed before the age of 30.

Some factors increase the risk of diverticulitis only. These include:

• Obesity
• Alcohol intake
• Low-fiber diet
• Constipation
• Use of certain drugs, including aspirin and opioids

Other factors can worsen inflammation in both conditions. Examples are smoking and using nonsteroidal anti-inflammatory drugs (NSAIDs).

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Talk to your gastroenterologist about what you can do to decrease your risk of diverticulitis and Crohn’s disease.

5. Crohn’s Disease and Diverticulitis Have Different Treatment Plans

Because Crohn’s disease and diverticulitis have different causes, they are treated in distinct ways. Treatment for Crohn’s disease focuses on minimizing autoimmune attacks and reducing inflammation. You may be prescribed a corticosteroid like prednisone to limit the inflammatory response as a way to control flare-ups.

As a more long-term solution to Crohn’s disease, you may take immunomodulators. Immunomodulators are targeted drugs that change or suppress the immune system. Some immunomodulators are conventional drugs, like cyclosporine (Neoral, Sandimmune). Others are biologics, meaning they are produced from living cells. Examples are adalimumab (Humira) and ustekinumab (Stelara), among many others.

In mild or moderate cases of diverticulitis, symptoms may clear up on their own or with simple treatment. This is called uncomplicated diverticulitis. A liquid diet will let your bowels rest, and antibiotics will treat most infections.

In severe cases of diverticulitis (called complicated diverticulitis), the diverticula may rupture. This can cause internal bleeding or blockages and hospitalization. To treat complicated diverticulitis, you may receive intravenous antibiotics or surgery. Depending on your individual case, a colectomy (surgery that removes part of the colon) may be recommended.

Similarly, complications of Crohn’s disease may also require surgery due to bowel blockage or bleeding. Fistulas (sores that extend out of the large intestine and form a tunnel) and perforations (holes in the bowel) can also require surgery. Some people with Crohn’s disease may choose to have a colectomy to improve their quality of life.

An accurate diagnosis is crucial to managing your condition, so see a gastroenterologist right away if you’re experiencing symptoms of these conditions.

Track and Report Your Symptoms

It can be scary to have new abdominal symptoms without a known cause. This is especially true if you’re misdiagnosed or have been diagnosed with both Crohn’s disease and diverticulitis. For instance, one MyCrohnsAndColitisTeam member with Crohn’s disease had new bleeding symptoms: “I wasn’t sure if it was diverticulitis related or what. Never had bleeding with Crohn’s, and the diverticulitis is a fairly new (two years) diagnosis.”

If you’re experiencing new or worsening symptoms, be sure to discuss them with your health care provider. This can help your doctor diagnose and treat your condition as it changes. Your doctor may recommend the following tests to help with the diagnosis:

• Urine, stool, or blood tests
• Colonoscopy — Exam with a camera on a flexible tube inserted into your large intestine
• Biopsy — Removal of a small sample of tissue for examination under a microscope)
• CT scan — An imaging technique, similar to an X-ray

Tracking your symptoms can also help your doctor identify a serious complication early.

Talk With Others Who Understand

MyCrohnsAndColitisTeam is the social network for people with Crohn’s disease and their loved ones. On MyCrohnsAndColitisTeam, more than 183,000 members come together to ask questions, give advice, and share their stories with others who understand life with Crohn’s disease.

Are you living with Crohn’s disease and/or diverticulitis? Share your experience in the comments below, or start a conversation by posting on your Activities page.

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