Diverticular disease

What is diverticular disease?

Diverticular disease is a condition where small pouches, called diverticula, form in the lining of the large intestine (bowel). These pouches can cause symptoms like abdominal pain, constipation and diarrhoea.

If you have diverticula that don't cause any symptoms, it is called diverticulosis.

What is diverticulitis?

Diverticulitis is inflammation or infection of abnormal pouches known as diverticula that form in the lining of the large intestine (bowel). It is a more severe form of diverticular disease.

What causes diverticular disease and diverticulitis?

The causes of diverticular disease and diverticulitis are not yet fully understood. But it's thought that your age, diet, lifestyle and genes may play a part.

• Age – as you get older, the walls of your intestines weaken. The pressure of hard stools (poos) moving through the bowel can lead to diverticula forming.

• Diet – not eating enough fibre in your diet may be linked to diverticular disease.

• Lifestyle – smokers are more likely to develop diverticular disease. Also, being overweight or obese increases your risk.

• Genetics – having a close family member with diverticular disease means you're more likely to get diverticular disease

Symptoms of diverticular disease

Diverticular disease symptoms may include:

• Abdominal (tummy) pain, often in the lower left side, which comes and goes

• Constipation

• Diarrhoea

• Blood in your poo (in some cases)

If you have inflamed or infected diverticula (diverticulitis), you may experience diverticulitis symptoms like:

• Constant, severe pain in your abdomen

• A high temperature (fever)

• Feeling sick or vomiting

• Losing your appetite

• A faster heart rate than normal

• Diarrhoea or constipation

• Problems urinating

• Blood or mucus in your poo

• Bleeding from your bottom

How is diverticular disease diagnosed?

If you don't have any symptoms, diverticulosis is often diagnosed when you're having other tests, like a colonoscopy as part of bowel screening.

If you're having symptoms, the GP will ask you about them. They may also feel your tummy and inside your bottom for any lumps.

The doctor will ask about your medical history, diet and if you've had any changes in your bowel movements.

Diverticular disease can be challenging to diagnose because the symptoms are similar to other conditions, like irritable bowel syndrome (IBS), appendicitis, gastroenteritis, coeliac disease, urinary tract infections and bowel cancer. In women, the symptoms can be signs of an ovarian cyst or ectopic pregnancy.
The doctor may refer you to see a specialist for tests. These tests may include:

• Blood tests - to check for signs of inflammation or infection

• Computer tomography (CT) scan of your abdomen – this will show if you've got diverticulitis and any related complications

• A colonoscopy or sigmoidoscopy – to look inside your large bowel and see if you have any diverticula. This will also help rule out any other conditions

• X-ray – to confirm you have diverticular disease and to check if you have complications

Treatment for diverticular disease

Diverticular disease treatment depends on how severe your symptoms are and if you have any complications. Your treatment may include:

• Changes to your diet – Eating a healthy, well-balanced diet that includes plenty of fibre will help reduce diverticular disease symptoms and prevent complications like diverticulitis. Foods high in fibre are:

1. Wholegrain breakfast cereals, wholewheat pasta and wholegrain bread

2. Fruits like berries, pears, melon and oranges

3. Vegetables like broccoli, carrots and sweetcorn

4. Peas, beans and pulses

5. Nuts and seeds

6. Potatoes with skin

• Medicine – there are no specific medications for the symptoms of diverticular disease. The doctor may recommend paracetamol to relieve tummy pain. If you're experiencing constipation or diarrhoea, a bulk-forming laxative might help.

Diverticulitis treatment

• Fluid-only diet - If you have diverticulitis, the doctor may recommend you only have fluids for a few days until your symptoms get better.

• Low fibre diet - It's recommended you should eat a very low-fibre diet during your recovery. This will help to rest your bowels. Once your diverticulitis symptoms have gone, you'll be able to return to a higher-fibre diet. It would help if you aimed to eat about 30g of fibre a day.

• Surgery – Sometimes surgery is needed if you've got severe diverticulitis complications like fistulas or peritonitis. Doctors may need to remove part of your diseased bowel, a procedure called a colectomy. After your surgery you may have a temporary or permanent colostomy, where your bowel is diverted through an opening in your tummy called a stoma.

• Percutaneous drainage – If you've developed an abscess in your large intestine, a tube may be inserted to drain any infected fluid.

How to prevent diverticular disease

• Regular exercise – activity promotes normal bowel function, speeding up the movement of food through the colon, and reducing the risk of constipation

• Eat plenty of fibre – foods that are high in fibre help to soften your poo so that it passes through your bowels faster

• Drink lots of fluids – drinking plenty of fluid also helps you poo more easily

• Avoid smoking – cigarettes are linked to an increased risk of diverticuliti