I am a 28-year-old woman with a history of diverticulosis, including several bouts of diverticulitis that have required hospitalization. Surgery is inevitable. My main concern is this: I want to have children in the future. Does carrying a baby put more pressure on my sigmoid colon (where the most acute problem is)? Is it advisable to have the surgery even before I consider becoming pregnant?

H.K.

Diverticulosis is an acquired condition in which small pouches, called diverticula, develop in the wall of the colon. While diverticula usually develop in people who are much older than you are, gastroenterologists certainly see some younger patients with problems like yours.

The two most common complications associated with diverticulosis are infection and bleeding. Infection occurs when stool blocks the opening of a pouch, causing pressure to build up inside. This can lead to a small perforation with inflammation and infection of the region near the pouch. This process is known as diverticulitis. The most common location for diverticulitis is in the sigmoid (left side) colon. Patients with diverticulitis typically experience pain in the lower-left abdominal area, fever, nausea and diarrhea or constipation. A CT scan of the abdomen and pelvis is the diagnostic test of choice. Uncomplicated diverticulitis, in which the inflammation remains localized, is treated with antibiotics and by restricting food and beverages. It usually improves after several days.

However, diverticulitis can become complicated if the infection spreads to the abdomen, resulting in large collections of pus (which may need to be drained). Alternatively, the small perforation can enlarge, allowing bowel contents to leak into the abdomen, sometimes requiring emergency surgery. Finally, healing of diverticulitis can result in a narrowing, or stricture, of the colon that can lead to a bowel obstruction.

Doctors often recommend that people who've suffered an episode of diverticulitis (especially a complicated one) undergo elective surgery to remove the portion of colon that contains the diverticula. The reasoning is that once patients have one attack of diverticulitis, they are at risk for more. This approach is especially recommended for young patients because they have many years ahead of them, and the risk associated with such surgery is very low in younger people.

To answer your specific concern, there is no association between pregnancy and a higher risk of diverticulitis. However, if you are considering having children, it may be advisable to have the surgery before getting pregnant. This would avoid the possibility of suffering a diverticulitis attack while you are pregnant, which could put both you and the baby at considerable risk because of potential complications. This is an important decision that you should discuss with your gastroenterologist, obstetrician and potential surgeon.