Diverticular Disease & Diverticulitis

Diverticular disease is a condition that generally effects the colon (also known as the large bowel or large intestine) but it can in fact involve anywhere along the gastrointestinal tract including the oesophagus, stomach and small bowel.

It is the presence of “pockets” or “pouches” that push out from the wall of the bowel. The most common part of the bowel that is affected is the sigmoid colon. This is a segment of bowel down on the lower, left side of the abdomen. There can be very few or many pockets and they can vary in size from very small (smaller than a pea) to very large (the size of a large marble).

It can affect younger people, but it usually starts to appear in people in their 40’s. By the age of 50, it is thought that 40% of the Australian population will have these pockets and by the age of 80, it is thought as many as 70% of the population will be affected.

Strictly speaking, the presence of these pockets without any symptoms is referred to as “diverticulosis”. It is only when you develop symptoms that it is considered “diverticular disease”. When these pockets become inflamed, it is called “diverticulitis”. For the purpose of this discussion however, diverticular disease means all of the above.

Symptoms of Diverticular Disease

The vast majority of patients with this problem have no symptoms at all. There are millions of people worldwide with these pockets who will go through their whole life and may never know they are there!

In a smaller group (approximately 10% of patients with diverticular disease), symptoms will develop. Most of these symptoms are mild and require very little treatment but occasionally, more severe symptoms can develop that require antibiotic treatment and in rarer circumstances, surgery is required.

The most common symptom people notice is a vague discomfort or pain in the affected area (normally the lower left abdomen) that can come and go. Sometimes the pain can persist for longer periods (days).

This pain can sometimes be associated with constipation or diarrhoea. Sometimes the symptoms are made worse with particular types of food but there is no set pattern.

Less commonly, fever can occur and even more rarely, rectal bleeding can also occur.

Most rarely of all, diverticular disease can result in abnormal connections between the bowel and bladder (called a colovescical fistula) that can result in gas or faecal matter in the urine. In women, a connection can develop between the bowel and vagina (called a colovaginal fistula) with faeces discharging and passing through the vagina.

What are the causes of Diverticular Disease?

Diverticular disease is more common in developed countries and it is believed to be partially due to a low residue diet. Countries with diets high in proteins and fats have the highest rates of diverticular disease in the world (eg European, North American and Australasian countries).

Countries with high fibre diets have less diverticular disease. It is thought that this high fibre adds bulk to the faeces making it easier for the bowel muscles to push the motions through. When the motions have little bulk, higher pressures are needed to empty the bowel and it is thought this causes the ballooning of the pockets to occur.

Dietary fibre is not the complete story however, as there may also be a genetic component. The disease can certainly effect some families more than others. Ultimately, there is still a lot of information we do not have regarding the causes of this very common problem.

Is Diverticular Disease dangerous?

Generally, diverticular disease will not cause any major complications or harm to nearly 90% of the people that have it. Most symptoms are mild and do not progress.

In less than 10% of patients, more serious problems can occur and are associated with diverticulitis (inflammation of the pockets).

Diverticulitis can lead to infections and sometimes an abscess or a leak from one of the pockets in the bowel. These leaks can generally heal up without surgery. A severe leak however, can require an operation, but this is in less than 1% of patients.

Bleeding from diverticular disease can occur in many patients but it is usually mild and settles on its’ own quickly. Rarely, bleeding can be quite bad and require urgent treatment in hospital.

Overall, the risk of diverticular disease being a serious threat to your health is less than 2%.

There is no association between diverticular disease and bowel cancer.

What can I do to help?

The only beneficial lifestyle change that can sometimes help symptoms, is to make sure you have good amounts of fibre in your diet; either with the food you eat or by taking fibre supplements. Generally this helps, but on some occasions, patients find fibre supplements can make their symptoms slightly worse.

There is no proof that avoiding foods such as seeds and nuts makes any difference to the severity of the disease or its’ complications but for some patients, avoiding these particular types of foods makes them feel more comfortable.

Ultimately, there is no rule book to follow and each person’s bowel behaves differently. If a particular food makes your symptoms worse, than avoiding that type of food will make you feel better.

Why am I seeing a surgeon for my problem and do I need an operation?

Well over 99% of people with diverticular disease do not need surgery. Generally, both surgeons and gastroeneterologists can specialise in the treatment of diverticular disease and most patients are referred to see one of us if the symptoms require it.

When it is first suspected that you may have diverticular disease that is causing prolonged symptoms, confirming the diagnosis with a colonoscopy can be done and is usually recommended. This is mainly to make sure there is no other cause for your problem. Once you have had a colonoscopy and diverticular disease is the only problem found, continuing to have a colonoscopy regularly is not necessary generally if your symptoms remain mild and unchanged over the coming years.

Operations for diverticular disease are not usually required unless you have repeated infections that require hospital and intravenous antibiotics multiple times a year or you develop a fistula that doesn’t heal. The other possible reason for surgery is in an emergency situation, where you develop a serious abdominal infection from diverticulitis – this is very uncommon however.

Start typing and press Enter to search