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Diverticular disease

Diverticular disease is a condition that affects your large bowel. It occurs when small pouches, called diverticula, are pushed out through the wall of your large bowel. It’s a common condition that affects up to half of the population of Western Europe and North America.

If your diverticula become inflamed and infected, it may lead to a condition called diverticulitis.

Diverticular disease and diverticulitis are related digestive conditions that are caused by diverticula.

Diverticula are small pouches that push through the wall of your large bowel. They can occur if you don’t eat enough fibre.

Diverticular disease is when your diverticula cause you pain in your abdomen (tummy), without inflammation and infection. If your diverticula become inflamed and infected, this is known as diverticulitis.

Your risk of developing diverticula increases as you get older. It’s thought that half of all people have diverticula by the age of 50. This may increase to seven in 10 people by the age of 80.

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Image showing the areas of the bowel commonly affected by diverticular disease

Details

  • Symptoms Symptoms of diverticular disease

    If you have diverticular disease, your symptoms may include:

    • lower abdominal pain, usually on the left-hand side
    • bloating
    • constipation
    • diarrhoea
    • bleeding from your rectum (back passage)

    The symptoms of diverticulitis may be more severe and include:

    • constant lower abdominal pain, usually on the left-hand side
    • a frequent need to urinate
    • a fever (high temperature)
    • feeling sick or vomiting
    • a loss of appetite

    You may develop diverticula on the right-hand side of your large bowel. This is less common than on the left-hand side and is seen more often in Asian patients. Therefore, if you have diverticulitis, your pain may be on the right-hand side of your abdomen.

    These symptoms may be caused by problems other than diverticular disease. If you have any of these symptoms, see your GP for advice.

  • Diagnosis Diagnosis of diverticular disease

    Your GP will ask you about your symptoms and examine you. He or she will also ask you about your medical history, diet and bowel movements.

    Diverticular disease is sometimes difficult to diagnose because your symptoms may also be similar to other conditions, such as irritable bowel syndrome (IBS).

    Your GP may suggest one or more of the following tests to confirm if you have diverticula in your bowel. They may also suggest some of these tests to rule out complications of diverticular disease, such as diverticulitis, and other conditions.

    • A blood test. If your blood test shows that you have a high level of white blood cells or C-reactive proteins, it may be a sign of infection and usually occurs with diverticulitis.
    • A colonoscopy. This is a test that allows your doctor to look inside your large bowel. A colonoscopy is done in hospital using a narrow, flexible, tube-like telescopic camera called a colonoscope. This test can confirm if you have diverticula and rule out other conditions such as bowel cancer.
    • CT scan. This test uses X-rays to make a three-dimensional image of your body or a part of your body. If your symptoms are severe, a CT scan can show if you have diverticulitis and any complications linked to it.
    • A barium enema swallow and meal. This test involves swallowing a fluid containing barium (a substance that shows up on X-rays) into your bowel via your rectum. X-ray images of your abdomen then show the inside of your bowel more clearly. A barium enema X-ray is another way of confirming if you have diverticula. However, this test is not always accurate and will not be performed if you have acute, sudden pain. This is because it may cause your inflamed diverticula to burst (perforate).
  • Treatment Treatment of diverticular disease

    Your treatment will depend on the severity of your symptoms and whether or not you have had diverticular disease before.

    Self-help

    Your GP may advise you to follow a high-fibre diet (between 18 and 30g each day) to help you control your symptoms. He or she may suggest that you to follow a balanced diet, rich in whole grains, fruits and vegetables.

    Your GP will usually suggest that you gradually increase your fibre intake, as a sudden increase can lead to wind and bloating. They may also advise you to drink enough fluids if you increase your fibre intake as fibre absorbs water.

    The evidence, however, to suggest whether a high-fibre diet will improve your symptoms is small. You may notice an improvement after a few days, but it may take as long as four weeks for you to feel a difference.

    See our FAQ for more information about the types of food you should try and eat if you have diverticular disease.

    Medicines

    Your GP may give you a bulk-forming laxative if you’re unable to follow a high-fibre diet or if you have constipation. Bulk-forming laxatives increase the amount of faeces you have and softens them. This may make it easier for you to empty your bowels.

    Your GP may also recommend that you take paracetamol to help relieve any pain. You may be advised not to take NSAIDs, such as ibuprofen, as they may cause your diverticula to bleed.

    If you have diverticulitis, your GP may prescribe you antibiotics for the infection. They may also advise you to take paracetamol to help relieve any pain. You may also need to follow a fluid-only diet for a few days until your symptoms get better. You can then gradually introduce solid foods back into your diet.

    See our FAQ for more information about how diverticulitis is treated.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.

    Surgery

    If you have diverticular disease, you won’t usually need surgery because you may be able to successfully treat your symptoms at home.

    If you have diverticulitis, your GP may refer you to a colorectal surgeon (a doctor who specialises in conditions that affect the bowel) who may advise that you have surgery. You may have surgery only if you have had symptoms of diverticulitis more than once. You may also need to have surgery if you develop a complication, such as peritonitis, an abscess, fistula or a blockage in your bowel.

    See our FAQ for more information about diverticulitis and surgery.

  • Bowel treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including bowel treatment.

  • Recovery After your treatment

    If your symptoms don’t improve after a month of having treatment, it’s important to seek advice from your GP. They may need to review your diet. Your GP may also do more tests to check for other conditions. He or she may offer you a trial of IBS treatment if you have not had this before.

  • Causes Causes of diverticular disease

    Although the reason isn’t clear, it’s thought that lifestyle and diet may play a part in causing diverticular disease.

    If you don’t eat enough fibre, your faeces may become pellet-like and hard. This can make it more difficult for you to empty your bowel, creating additional pressure inside your bowel. Small pouches called diverticula, push through the wall of your large bowel.

    Diverticular disease may be less common in vegetarians and in parts of the world where people have more fibre in their diet.

    Other factors that may cause diverticular disease include:

    • alcohol
    • caffeine
    • certain types of medicines, such as non-steroidal anti-inflammatory drugs (NSAIDs)
    • red meat
    • being overweight
    • lack of exercise
  • Complications Complications of diverticular disease

    Complications are uncommon if you have diverticular disease.

    If your diverticula become inflamed and infected, this may lead to diverticulitis. If you have diverticulitis, it may develop into more serious problems. These are explained below.

    • A pus-filled lump, called an abscess, may form on the outside wall of your bowel.
    • Severely infected diverticula can sometimes burst and cause an infection in your abdomen. This is called peritonitis.
    • If you have an abscess and it bursts into your one of your organs, for example, your bladder, a fistula may form. A fistula is a passageway that connects two parts of your body together that aren’t normally connected. If you have a fistula, you may need an operation to close it.
    • If your diverticula repeatedly become inflamed, the affected part of your bowel may become narrow or blocked. If this happens you may have constipation and pain, and you may also feel sick.
    • Blood vessels inside your diverticula can weaken and burst causing bleeding from your rectum.

    If you have any of these complications, it’s important to get them treated urgently so they don’t cause you more serious problems.

  • Prevention Prevention of diverticular disease

    Some examples of what you can do to help reduce your chance of getting diverticular disease are listed below.

    • Increase your fibre intake by eating at least five daily portions of fresh fruit and vegetables. Also include wholegrain foods such as brown rice, pasta and oats in your diet. It’s important to increase your fibre intake slowly to reduce any side-effects, such as excessive wind.
    • If you increase your fibre intake it’s important that you drink enough fluids.
    • Regular exercise, such as running, may help to prevent diverticular disease.
  • FAQs FAQs

    How is diverticulitis treated?

    Answer

    If you have diverticulitis, it can usually be treated at home.

    Explanation

    If you have mild diverticulitis, your GP may give you antibiotics and advise you to take paracetamol to help relieve any pain. Your doctor may also suggest that you have clear liquids and introduce solid foods as your symptoms improve. If your diverticulitis is more severe, you may need to go into hospital. You will have to go into hospital if:

    • your symptoms don’t improve after 48 hours of having treatment at home
    • you have a weak immune system
    • your pain can’t be managed with paracetamol
    • you can’t take antibiotics as tablets
    • you have a complication, for example, peritonitis

    If you do need to go into hospital, you will be given antibiotics and fluids through a drip inserted into a vein in your hand or arm. You will be monitored and if after 48 hours your symptoms improve, you will be given antibiotic tablets to take. If your symptoms don’t improve, it may be that an abscess has formed in your bowel. If this happens, you may need to have surgery or have the abscess drained under CT scan.

    What kind of diet should I eat if I have diverticular disease?

    Answer

    Try to eat a diet that contains enough fibre in the form of whole grains, fruits and vegetables. This is important for your general health, as well as preventing the risk of diverticular disease.

    Explanation

    There are two types of fibre – soluble and insoluble. Soluble fibre can be partially digested by your digestive system and includes things like oats, beans and lentils. This type of fibre may help to reduce the amount of cholesterol in your blood.

    Insoluble fibre passes through your digestive system undigested. This type of fibre helps other food and waste products move through your digestive system more easily, keeping your bowels healthy and helps to prevent constipation.

    You should aim to eat between 18 and 30g (grams) of fibre each day. Some examples of good sources of insoluble fibre include:

    • two slices of wholemeal bread (3.5g)
    • half a tin of baked beans (7.4g)
    • three whole apricots (5g)
    • three whole prunes (5g)
    • one medium pear (3.7g)

    It’s also important that you drink enough fluids if you increase your fibre intake as fibre absorbs water.

    The evidence to suggest whether a high-fibre diet will improve your symptoms is small. You may find it more helpful to eat fibre in the form of fruit and vegetables, rather than having fibre from cereals.

    Will I need surgery if I have diverticulitis?

    Answer

    Most people with diverticulitis can usually treat it at home and won’t need surgery.

    Explanation

    Surgery is not recommended very often and you may only have it if you have had symptoms of diverticulitis more than once. You may also need to have surgery if you develop a complication, such as peritonitis, an abscess, fistula or a blockage in your bowel.

    If you need to have surgery, the affected part of your bowel will be removed and the remaining healthy parts will be joined together. This is known as a colectomy.

    If the healthy parts of your bowel can’t be safely joined back together (for example, because of a severe infection), you will need to have stoma surgery. A stoma is an artificial opening of your bowel on the front of your abdomen (tummy) created during an operation, to collect faeces. A stoma can be either temporary (and reversed later) or permanent, depending on which part of your bowel has been removed.

  • Resources Resources

    Further information

    Sources

    • Diverticular disease. Core. www.corecharity.org.uk, published 2 July 2013
    • Diverticular disease. NICE Clinical Knowledge Summaries. www.cks.nice.org.uk, published March 2013
    • Diverticular disease. BMJ Best Practice. www.bestpractice.bmj.com, published 18 July 2013
    • Stoma care. PatientPlus. www.patient.co.uk/patientplus.asp, published 18 February 2011
    • Diverticular disease. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 October 2011
    • Acute phase proteins, CRP, ESR and viscosity. PatientPlus. www.patient.co.uk/patientplus.asp, published 21 May 2010
    • Abscesses. The Merck Manual. www.merckmanuals.com, published November 2012
    • Diverticulitis treatment & management. Medscape. www.emedicine.medscape.com, published 27 January 2014
    • Intestinal fistulas. Medscape. emedicine.medscape.com, published 29 March 2012
    • Crowe FL, Appleby PN, Allen NE, et al. Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians. BMJ 2011; 343(d4131). doi:doi:10.1136/bmj.d4131
    • Ünlü C, Daniels L, Vrouenraets BC, et al. A systematic review of high-fibre dietary therapy in diverticular disease. Int J Colorectal Dis 2012; 27(4):419–27. doi:10.1007/s00384-011-1308-3
    • Bulk-forming laxatives, non-steroidal anti-inflammatory drugs. British National Formulary. www.medicinescomplete.com, published January 2014
    • Diverticular disease. World Gastroenterology Organisation. www.worldgastroenterology.org, published 2007
    • Starchy foods, fruit and veg. Food Standards Agency. www.eatwellscotland.org, accessed 10 February 2014
    • Strate LL, Liu YL, Aldoori WH, et al. Physical activity decreases diverticular complications. Am J Gastroenterol 2009; 104(5):1221–30. doi:10.1038/ajg.2009.121
    • Concise colour medical dictionary. 3rd ed. Oxford: Oxford University Press, 2002:145 (printed version)
    • Diverticular disease – suspected, complications of diverticulitis. Map of Medicine. www.mapofmedicine.com, published 23 November 2012
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    Reviewed by Kuljeet Battoo, Bupa Health Information Team, March 2014.

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