What is Diverticular Disease?
Diverticular disease of the colon occurs when diverticula or “pockets” develop in the colon, especially the sigmoid colon. More than one third of people over 45 years of age, and two thirds of people over 85 years of age have some diverticular pockets. Only about a quarter of people with diverticular pockets develop some symptoms of disease. A colonoscopy, barium enema or CT scan is usually used to diagnose diverticular disease.
What causes Diverticular Disease?
It may be that not having enough fibre in the diet can contribute to diverticular disease although the condition is often familial. A low fibre diet possibly leads to increased pressure inside the bowel, and diverticula are caused by this pressure acting on the walls of the bowel.
Treatment of Diverticular Disease
A good intake of dietary fibre is the most important part of the treatment of diverticular disease. The fibre does not get rid of the diverticular disease, but reduces the risk of complications of the disease. There is no obvious reason to avoid nuts and seeds, as has been suggested in the past. Diverticulitis is usually treated with antibiotics, and over 70% of patients treated this way make a full recovery.
Surgery is sometimes necessary to treat some of the complications of diverticulitis. Emergency surgery is needed to treat potentially life threatening complications of diverticular disease, such as bowel perforation, ongoing severe colonic bleeding or where acute diverticulitis fails to settle. In these circumstances the affected part of the bowel must be removed. Often it is not possible for the surgeon to join up the healthy parts of the bowel to one another at the time of the initial surgery because of the degree of inflammation and contamination. Therefore with emergency surgery, a temporary stoma (bag) is sometimes necessary. The unaffected parts of the bowel are rejoined later when the health of the patient has improved.
Diverticular pockets are a common condition that causes few problems for the majority of people with it. It can, however, cause life-threatening problems in some. Modern medical care reduces the risk of such problems and the vast majority of people with diverticular disease lead normal healthy lives.
Diverticulitis is the most common complication of diverticular disease. Diverticulitis occurs when one or more diverticula become inflamed. The symptoms experienced are usually pain in the lower left abdomen together with feelings of nausea and loss of appetite. Bowel habits may be disturbed and there is often a fever. The symptoms of diverticulitis settle once the inflammation has been controlled with antibiotics. Patients may experience a single attack of diverticulitis in a lifetime, but some experience multiple attacks.
Possible complications of Diverticulitis
Complications of diverticulitis are rare. If complications occur, it is usually necessary to treat them in hospital.
- Narrowing of the colon (stenosis) can occur as a result of ongoing chronic diverticulitis. It results in a change of bowel habit with increasing constipation and lower abdominal pain.
- Severe bleeding is a rare, but serious complication of diverticular disease. This condition usually requires hospital admission, but once it settles, it rarely recurs.
- Fistula formation is another rare complication. It occurs when the bowel is perforated and there is communication between the bowel and another structure such as the bladder or vagina. The symptoms of a fistula may include frequent urinary tract infections, passing bubbles of gas with urine or passing gas from the vagina.
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