Symptoms | Causes | Risk Factors | Prevention | Diagnosis | Treatment | Next step
Diverticular disease and diverticulitis are related digestive conditions both of which affect the large intestine (Colon). Diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older. They are found most often in the colon and are common especially over the age of 40. Most people do not have symptoms and only know they have them after they get a scan for something else.
If diverticula become inflamed, it's called diverticultis. In some cases the diverticula become infected which can cause severe abdominal pain, fever, nausea and a marked change in your bowel habits. Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring diverticulitis may require surgery.
Symptoms of diverticular disease include:
Pain, which may be constant and persist for several days. Normally the pain may be experience on the lower left side of the abdomen. Periodic pain may get worse when eating or shortly after.
Emptying your bowels or passing wind eases the abdominal pain.
Constipation or less commonly, diarrhoea
Symptoms of diverticular disease / diverticulitis include:
Constant severe abdominal pain
High temperature
Diarrhoea or constipation
Mucus or blood in your faeces or rectal bleeding
Nausea and vomiting
Abdominal tenderness
Diverticula usually develop when naturally weak places in your colon give way under pressure. This causes marble-sized pouches to protrude through the colon wall.
Diverticulitis occurs when diverticula tear, resulting in inflammation, and in some cases, infection.
Risk factors
It is not known why some people get diverticular disease. It seems to be linked to age, diet and lifestyle, and genetics. There are a number of factors that may increase your risk of developing diverticulitis:
Aging. As you get older the walls of your large intestine become weaker and the pressure from hard stools can cause diverticula. The majority of people will develop some diverticula by the time they are 80.
Obesity. Being overweight increases your risk of developing diverticulitis.
Smoking. Regular smokers are more likely than non-smokers to experience diverticulitis.
Lack of exercise. Vigorous exercise appears to lower your risk of diverticulitis.
Diet. A low-fibre diet in combination with a high intake of animal fat seems to increase the risk of diverticula as it puts more pressure on the walls of the intestines
Certain medications. Particular medications are associated with an increased risk of diverticulitis, including steroids, opioids and nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen.
About 25% of people with acute diverticulitis develop complications, which may include:
An abscess, which occurs when pus collects in the pouch.
A blockage in the bowel caused by scarring.
Development of an abnormal passageway (fistula) between sections of bowel or the bowel and other organs.
Peritonitis, which can occur if an infected or inflamed pouch ruptures. Peritonitis is a medical emergency and requires immediate care.
Eat more fibre. Fibre-rich foods, such as fresh fruits and vegetables and whole grains, soften waste material and help it pass more quickly through your colon. Eating seeds and nuts isn't associated with developing diverticulitis.
Drink plenty of fluids. Fibre works by absorbing water and increasing the waste in your colon. It is important to drink enough liquid to replace what's absorbed
Exercise regularly. Exercise promotes normal bowel function and reduces pressure inside your colon.
Avoid smoking.
Diverticulitis is usually diagnosed during or as a result of an acute attack. Because abdominal pain can indicate a number of problems, such as irritable bowel syndrome (IBS), coeliac disease or bowel cancer, your doctor will need to rule out other causes for your symptoms.
This may involve the following tests, a Colonoscopy, a CT scan or sometimes both:
Blood and urine tests, to check for signs of infection
A liver enzyme test, to rule out liver-related causes of abdominal pain.
A stool test, to rule out infection in people who have diarrhoea.
Colonoscopy
A colonoscopy is where a thin tube with a camera at the end is inserted into your bottom and into your bowel. The doctor will then look for diverticula or signs of diverticulitis. You will be given a laxative beforehand to clear out your bowels. More details about colonoscopy is available here…insert link to Colonoscopy section
CT scan
A CT scan – CT Colonoscopy is used to identify inflamed or infected pouches and confirm a diagnosis of diverticulitis. A CT can also indicate the severity of diverticulitis and the treatment required.
Treatment will depend on the severity of signs and symptoms.
Uncomplicated diverticulitis
If symptoms are mild, your doctor may recommend:
Antibiotics to treat infection may be prescribed but in mild cases, they may not be needed.
A liquid diet for a few days while your bowel heals. Once the symptoms improve, solid food is reintroduced gradually. This treatment is successful in most people with uncomplicated diverticulitis.
Complicated diverticulitis
If you have a severe attack or have other health problems, you'll likely need to be hospitalised. Treatment normally includes:
Intravenous antibiotics.
Surgery
In rare cases you may require surgery to treat serious complications of diverticulitis particularly if:
You have a complication, such as a bowel abscess, fistula or obstruction, or a perforation in the bowel wall
You have had multiple episodes of uncomplicated diverticulitis
You have a weakened immune system
There are two main types of surgery:
Primary bowel resection. The surgeon removes the diseased segments of the intestine and then reconnects the healthy segments. This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure.
Bowel resection with colostomy. If you have so much inflammation that it is not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.
The decision on surgery is an individual one and is often based on the frequency of attacks and whether complications have occurred.
If you have signs or symptoms that are worrying you, your first port of call is to talk to your GP. If your GP thinks that you may have diverticulitis, you may be referred to either a gastroenterologist or to a General Surgeon.