Diverticular disease

Published by Bupa's Health Information Team, March 2010.

This factsheet is for people who have diverticular disease, or who would like information about it.

Diverticular disease is a common condition affecting the digestive system. It happens when small bulges or pouches, called diverticula, form in the wall of the bowel.

About diverticular disease

Diverticular disease is very common, but most people who have it don't have any symptoms. It becomes more common as you get older.

Diverticular disease happens when small areas of the lining of your bowel weaken and form bulges or pouches, over the course of many years. These are known as diverticula. Most diverticula are found in the lower part of your large bowel, although some people get them in other parts of their bowel.

There are three terms used to describe diverticula in your large bowel.

• Diverticulosis. Many people have diverticula without having any symptoms. They may only be found when you have a scan or tests for another problem. Having diverticula without symptoms is called diverticulosis.
• Diverticular disease. If diverticula cause symptoms, this is known as diverticular disease.
• Diverticulitis. If diverticula become inflamed and cause an illness, the condition is known as diverticulitis.

Symptoms of diverticular disease

The symptoms of diverticular disease include abdominal (tummy) pain, usually on your lower left hand side. The pain may appear after eating. It may go after you have released wind or been to the toilet. Other symptoms include:

• bloating
• wind
• constipation
• diarrhoea

Symptoms of diverticulitis include:

• constant and often severe abdominal pain that starts below your belly button and then moves to the lower left hand side (though it can appear on the right for Asian people due to genetic differences)
• fever (high temperature)
• frequent need to urinate and sometimes pain
• changes in bowel habit
• nausea and vomiting

You may find that pain and disturbed bowel function go away and come back again from time to time.

Complications of diverticular disease

You may pass blood in your faeces. This is due to weakening of the blood vessels inside diverticula. If blood comes from the lower part of your large intestine, you can usually see it as blood in your faeces. Blood from higher up in your digestive system, for example your stomach, tends to make your faeces black and tarry.

Sometimes scar tissue forms around one of the inflamed diverticula, and this can cause narrowing of your bowel or a blockage.

If diverticula burst, they can cause the lining of your abdomen (peritoneum) to become inflamed and swollen. This is called peritonitis. If you have peritonitis, you may need emergency surgery.

Causes of diverticular disease

Doctors believe that a diet low in fibre, particularly one lacking fruit and vegetables, and high in red meat and fat is a major cause of diverticular disease. It's rare in vegetarians and in parts of the world where fibre intake is high.

Diagnosis of diverticular disease

Diverticular disease is difficult to diagnose because the symptoms are similar to those caused by conditions such as irritable bowel syndrome (IBS). In fact, around three in 10 people with diverticular disease also have IBS.

Your doctor will ask about your symptoms, diet and bowel movements. He or she may refer you for further tests, which may include the following.

• CT scan - this uses X-rays to make a three-dimensional image of your bowel. A CT scan can be used to examine the wall of your large bowel and look for signs of infection.
  
• Barium enema - a liquid containing a small amount of barium is passed through a tube into your back passage (anus) and into your large bowel. The barium reveals inflamed areas of your large bowel and any diverticula in X-ray pictures.
  
• Colonoscopy - your doctor may view the inside of your bowel using a thin, flexible tube called a colonoscope. It's inserted through your back passage and into your bowel, sending pictures of the inside of your bowel to a video monitor.

Treatment of diverticular disease

Medicines

Your doctor may recommend paracetamol for stomach pain or anti-spasm medicines if you have severe pain. Aspirin and ibuprofen aren't recommended because there is a risk of internal bleeding.

Your doctor may suggest that you take bulk-forming laxatives if you aren't able to increase the amount of fibre in your diet. Other types of laxative aren't recommended. Always read the patient information leaflet that comes with your medicine and if you have any questions ask your pharmacist for advice.

You will need further treatment if you're vomiting or have other signs of infection (diverticulitis). To give your bowel a chance to rest and recover, you will be given antibiotics, fluids and energy in the form of sugar, through a tube called a drip. Once your symptoms have settled, you can start eating and drinking small amounts of food and water and taking antibiotics by mouth.

Surgery

You may need surgery if a diverticulum bursts or if you've had more than two attacks of diverticulitis. This is because each episode is usually more severe than the last one.Your surgeon may carry out a procedure called a colonic resection, which involves removing the affected part of your bowel, and then joining the healthy areas together.

Alternatively, after the affected area has been removed, part of your bowel may be brought through an opening (stoma) in your abdomen, so that your bowel contents can be collected in a pouch. This is called a colostomy. It gives your bowel a chance to rest and heal. Your bowel is usually then rejoined in another operation some weeks later. A specialist nurse will give you advice on how to look after your stoma.

Prevention of diverticular disease

You can reduce your chance of getting diverticular disease by increasing the amount of fibre you eat, particularly from fruit and vegetables. Eat at least five portions of fruit and vegetables a day as this well help form stools that are bulky but soft. It's best to increase the amount of fibre in your diet gradually to reduce the risk of wind and bloating.

Make sure you drink enough fluids, to help prevent constipation.

There's good evidence to show that vigorous exercise such as jogging, running, cycling, swimming and rowing help to reduce your risk of getting diverticular disease.

Try not to take medicines that make you constipated, such as opiate-containing painkillers.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.