Diverticular disease

What is diverticular disease?

Diverticular disease is the name given to a condition where small sacs or out-pouchings occur from the gut, usually the colon (large bowel). It is not contagious or cancerous.

Why is it also called diverticulitis?

Diverticulitis is the medical name used to describe the condition when these out-pouchings (diverticulae) become infected and inflamed. However, the word 'diverticulitis' is sometimes loosely and improperly used to refer to diverticular disease itself.

Who gets diverticular disease?

Diverticular disease is very common amongst adults in western countries. About 40 per cent of people over the age of fifty, and half of the population over seventy have diverticular disease, although not all of these will have symptoms. It is much less common in Africa, probably because of the differences in diet. It is more common in those who have a diet that lacks fibre, in people with a family history of diverticular disease, and in the obese.

What are the main symptoms?

Most people with diverticular disease do not have any symptoms and are completely unaware that they have it. Since symptomless diverticular disease in not dangerous in any way, this is not a problem.

Symptoms of diverticular disease include:

• crampy discomfort, commonly on the left side of the abdomen, which is sometimes relieved by opening the bowels;
• a change in bowel habit, so the person becomes more constipated or looser than normal; and
• a feeling of bloating or intermittent abdominal distension.

Symptoms of diverticulitis disease include:

• a more severe constant pain, which may become disabling and can be likened to appendicitis, but is usually on the left side of the abdomen;
• fever (ie a temperature);
• sometimes blood in the motions; and
• tenderness over the affected area of the colon.

It is important that anyone with a persistent change in their bowel habit (ie an alteration of the usual frequency or consistency of their bowel actions), especially if it is accompanied by rectal bleeding, should consult their doctor so that he or she can exclude a more serious cause for these symptoms.

Why does diverticular disease occur?

The answer to this question is not fully known, but it is thought to be caused by the modern western diet, which tends to be low in fibre. This probably causes the bowel to contract too hard in order to push the stools onward, and the resulting high pressure within the bowel causes 'blow-outs' of the lining, which become the diverticulae.

What are the complications?

Diverticular disease cannot cause cancer, although the doctor may wish to do further tests to exclude bowel cancer before making the diagnosis. However, if the diverticulae become infected they may bleed profusely or perforate, causing peritonitis, and in some cases the disease can result in thickening and scarring of the bowel wall, leading to bowel obstruction. These complications are unusual. In rare cases, a channel, called a 'fistula', can form between a diverticulum and the bladder or vagina, resulting in the passage of wind or faeces (stool) in the urine or through the vagina. This requires surgical correction.

Further investigations are often done to exclude other bowel disorders that produce similar symptoms as found with diverticular disease. The doctor may want to be confident of excluding cancer, especially if there has been a change in bowel habit or when blood appears in the motions. In these circumstances a telescopic examination of the bowel called a colonoscopy, or an x-ray of the colon (a barium enema), may be arranged.

What treatment is required?

If the diverticular disease is symptomless, then no treatment is needed. Unless acute diverticulitis has occurred, the only treatment usually required is a high fibre diet and sometimes laxatives or drugs called anti-spasmodics, which relieve the spasm in the bowel wall.

If infection occurs causing diverticulitis, antibiotics are usually given along with pain relief. If the infection is very bad the antibiotics may have to be given intravenously (ie directly into a vein) in hospital, and fluids given via a 'drip' whilst the stomach is rested with a strict 'nil by mouth' policy for a few days. An operation to remove the main affected area of the colon may occasionally be used to treat those patients with diverticular disease causing severe pain, if they are not helped by diet or drugs or in the instances where the disease causes bowel obstruction.

Medications

• Antibiotics, if the diverticula are infected.
• Stool softeners may be recommended.
• Bulk-producing laxatives, if you are unable to eat a high-fiber diet. Don’t take laxatives unless prescribed.

Information	Brand	Generic	Label	Rating
	Flagyl	Metronidazole
	Augmentin	Amoxicillin/Clavulanate
	Cipro	Ciprofloxacin

Keflex (Cephalexin), Doryx (Doxycycline), Cleocin (Clindamycin)

What is the recommended diet?

A high fibre diet is thought to reduce the symptoms and progress of diverticular disease. Therefore it is advisable to increase the intake of such foods as fruit, fresh vegetables, pulses and bran. In fact, this type of diet can help to prevent the formation of diverticular disease in the first place.

People with diverticular disease often ask what should be avoided in their diet and the answer to this varies from person to person. Generally speaking, fatty food and spicy meals should be kept to a minimum since these are likely to upset their digestive system. However, this tends to be a very individual thing, so the best advice is for the person himself or herself to experiment with their diet and to make a note of those ingredients, which they find aggravate their disease.

Last updated 18 December 2015