Understanding Diverticular Disease (Diverticulitis)
What Is Diverticular Disease (Diverticulitis)?
Diverticular disease is a broad term for conditions involving diverticula (small pouches that form in the colon), including diverticulosis (having diverticula) and diverticulitis (inflamed diverticula).
Most people with diverticulosis have no symptoms, but a minority can develop chronic digestive discomfort or complications like bleeding, inflammation or infection.
Diverticulosis
Multiple diverticula or small bulging pouches can often develop in the colon (large intestine), especially with advancing age. While this usually does not cause symptoms, it may cause mild chronic symptoms like bloating, constipation, or cramping.
Simply having diverticula without inflammation is not dangerous in most people. It only becomes a “diverticular disease” if those pouches lead to persistent symptoms or other issues.
Diverticulitis
Diverticulitis occurs when one or more diverticula become inflamed or infected. This can cause severe, constant pain in the lower abdomen along with other symptoms. The disease can be sudden and intense in onset but is occasionally gradual as well.
This can lead to serious complications if not treated promptly. With proper medical treatment, most diverticulitis attacks resolve and patients recover fully.
The Causes and Risk Factors of Diverticular Disease
The formation of diverticula (diverticulosis) is believed to be related to increased pressure inside the colon, which can occur when stool is hard or difficult to pass. Over time, this pressure may cause the colon’s inner lining to pouch out through weak spots in the muscle wall.
Although the exact cause isn’t fully understood, there are several contributing factors that make diverticulosis and diverticulitis more likely, such as:
- Being over the age of 50
- Having an unhealthy diet (e.g. one low in fibre and high in red meat)
- Obesity and physical inactivity, which can slow bowel transit
- Smoking, which may impair blood flow or immune responses in the colon
- Regular use of nonsteroidal anti-inflammatory drugs or NSAIDs (like ibuprofen, naproxen) and steroids
- Genetics and a family history of diverticular disease
Signs and Symptoms of Diverticular Disease
Diverticulosis produces no symptoms at all for many people, but it can cause a range of digestive symptoms when it becomes symptomatic or when diverticulitis occurs.
The severity and mix of symptoms can vary from person to person. Here are some common signs and symptoms to watch for:
- Abdominal pain, especially severe and constant pain in the lower abdomen
- Changes in bowel habits, like constipation or diarrhoea
- Fever and chills, as diverticulitis involves inflammation and often infection
- Rectal bleeding
- Nausea or vomiting
- Bloating
- Cramping
Get Assessed and Diagnosed for Diverticular Disease
If you think you may have diverticular disease or are experiencing its symptoms, let our specialist assess and diagnose you.
How Diverticular Disease Is Diagnosed
Your doctor will usually begin your clinical evaluation with a request for your medical history, and ask about your symptoms, diet, and medical history. Your doctor may also perform a physical examination of your abdomen.
This may involve pressing on your abdomen to check for tenderness or masses during the physical exam. You may also be assessed for fever, heart rate changes, or blood pressure changes that could indicate infection.
A rectal exam may be performed as well to check for pain, blockage or blood in the rectum.
If diverticulitis is suspected after this initial evaluation, further diagnostic tests will be ordered to confirm the diagnosis. Some key diagnostic tests your doctor may perform are the following:
- Stool Test: To check for the presence of infections (like bacteria or parasites) that could mimic diverticulitis. It also helps to ensure symptoms aren’t due to something like an infectious colitis or irritable bowel syndrome
- Blood tests: These can check for anaemia, other issues if bleeding is present, and an elevated white blood cell count or markers like C-reactive protein (CRP) that indicate that the body is fighting an infection that could be linked to diverticulitis.
- Colonoscopy or sigmoidoscopy: A flexible camera can be used to examine the colon and rectum, usually after recovery from acute diverticulitis. This helps rule out other causes, remove small polyps, or take biopsy samples.
- Imaging scans such as CT and MRI: These are used to see inflamed or infected diverticula and any complications (such as an abscess or perforation), as well as differentiate diverticulitis from other abdominal issues and guide treatment
Potential Complications of Diverticular Disease
Diverticulitis can lead to serious complications if not properly treated. These include:
- Diverticular bleeding: Small blood vessels in the wall of a diverticulum can rupture and bleed into the colon. While it is often painless and can stop on its own, it can occasionally be life-threatening.
- Abscess: Severe diverticulitis infections can cause tender mass to form around the affected diverticulum, requiring drainage to clear the pus from it even after antibiotics.
- Fistula: Abscesses can extend into nearby organs and form fistulas or abnormal connections between the colon and those organs, leading to recurrent issues like urinary tract infections or the presence of air or stool in urine.
- Intestinal obstruction: Chronic or repeated diverticulitis can scar and narrow the colon, as can short-term inflammation from it. This may lead to blockages that cause bloating, abdominal distension, or even inability to pass stool.
- Perforation and peritonitis: A severe diverticulitis attack can lead to rupture of a diverticulum and a hole in the colon wall, which can lead to infection as bowel contents leak into the abdomen. Peritonitis often requires emergency surgery.
Treatment of Diverticular Disease
Treatment depends on whether you are dealing with uncomplicated diverticulitis, a complicated case, or simply managing chronic diverticular symptoms.
Doctors often start with the most conservative, non-surgical treatments for mild cases and then escalate to more invasive treatments such as surgery if needed.
Non-Surgical Treatments
For most people with mild or uncomplicated diverticulitis, the treatment focus is on controlling the infection and inflammation while allowing the colon to heal.
- Dietary modification (bowel rest): Short-term clear liquid or low-fibre diets using broths and gelatin may be used to let the bowel rest during an acute flare-up. The patient may be advised to switch to a high-fibre diet once symptoms ease.
- Antibiotics: These are prescribed to treat bacterial infection in diverticulitis, though some mild uncomplicated cases may be managed without them under close medical supervision.
- Pain relief and rest: Acetaminophen or paracetamol is often used to manage pain for the patient’s comfort, combined with rest. NSAIDs like ibuprofen are typically avoided. Most uncomplicated episodes improve within a week.
- Management of constipation: As constipation can worsen colon pressure, stool softeners or laxatives may be used under medical guidance during acute attacks.
- Probiotics and supplements: Probiotics may be used to restore gut bacteria and fibre supplements like psyllium husk may be used to bolster dietary fibre. Evidence is still emerging for these measures, but they may help manage ongoing symptoms.
- Treatment of chronic symptoms: Patients with chronic or recurring symptoms (symptomatic uncomplicated diverticular disease) may follow treatments similar to IBS management, e.g. high-fibre diet, antispasmodic medications, etc.
Even with non-surgical management, regular communication and visits with a doctor are vital. These allow the doctor to reassess symptoms regularly to ensure improvement and quick adjustment of treatments if complications arise that require a different approach.
Surgical Treatments
Surgery is reserved for complicated diverticular disease or cases where non-surgical treatment fails. The aim is typically to fix the problem definitively by removing or bypassing the diseased portion of the colon.
Here are the common surgical approaches:
- Abscess drainage: If diverticulitis causes an abscess (pocket of pus), it may need draining. Moderate-sized ones are often drained by radiologists using CT- or ultrasound-guided needles. Larger or complex ones may require surgical drainage. The goal is to help clear the infection, which is why it is often performed before a colon surgery.
- Colectomy (colon resection surgery): Recurring or complicated cases may require surgical removal of the affected colon segment, usually the sigmoid colon. In elective surgery, the surgeon may reconnect the healthy ends through anastomosis in the same operation.
In emergency cases, such as during peritonitis-related perforation, surgery may require two stages and a temporary colostomy. Laparoscopic or robotic techniques may be used to keep the procedure minimally invasive and lead to faster recovery. - Fistula repair: If a fistula forms due to the condition, surgery is often required to close it. The surgeon typically removes the part of the colon causing the fistula and may also repair the affected organ.
For a colovesical fistula, this involves removing the fistulous tract and possibly part of the bladder wall, then closing the bladder. This is often combined with colon resection to prevent recurrence. - Emergency surgery for perforation: If diverticulitis leads to a perforation and widespread peritonitis, immediate surgery is required. The surgeon cleans the abdominal cavity and usually performs a colon resection to remove the source of infection.
A temporary colostomy is often created for safety, with a second surgery later to reconnect the colon. This surgery carries higher risks, and doctors generally advise early treatment to avoid this stage.
Recovery and Prognosis for Diverticular Disease
The expected recovery varies by type of treatment.
In uncomplicated cases treated with antibiotics, improvement is often noticeable within 2 to 3 days, with significant symptom relief within about a week.
Recovery from surgical treatments depends on the procedure and severity of the condition:
- For uncomplicated elective colectomy, hospital stays are usually 4 to 7 days, with full recovery at home over a few weeks
- For emergency surgeries with colostomy, recovery is longer and patients are monitored closely for infection or complications.
- If a temporary colostomy is created, patients are taught care before discharge.
The prognosis for diverticular disease is generally good when properly managed:
- Uncomplicated diverticulitis does not affect life expectancy and usually leaves no lasting effects once healed.
- Even complicated cases often resolve completely with antibiotics, drainage, or surgery.
- After surgical removal of the affected colon segment, the risk of future diverticulitis in the remaining colon is low, and patients often experience significant symptom relief.
Prevention and Management Tips
Some healthy lifestyle habits can help prevent diverticular problems and manage chronic symptoms. Here are some prevention and management tips to keep your colon as healthy as possible:
- Eat a fibre-rich diet: This can soften stool, ease bowel movements, and reduce colon pressure. It may even lower the risk of diverticulitis flares over time. Focus on foods like whole grains, fruits, vegetables, beans, and nuts. A gradual increase is advised to avoid bloating.
- Stay hydrated: Fibre absorbs water and helps stool move smoothly. As you increase your fibre intake, remember to take 6 to 8 glasses of fluid daily. You may need more if active or in hot weather.
- Maintain a healthy weight and stay active: Regular physical activity stimulates bowel function and reduces colon pressure. A sedentary lifestyle increases diverticulitis risk, so encourage enjoyable activities to stay active. Being overweight also increases risk due to higher inflammation and abdominal pressure.
- Avoid smoking: Smoking is a risk factor for diverticulitis and its complications. Chemicals in tobacco can impair gut circulation and healing, so quitting is strongly advised.
- Limit alcohol consumption: Excessive alcohol intake may worsen gut inflammation and irritate the digestive tract. Moderation is recommended, especially for individuals prone to digestive issues.
- Avoid frequent NSAID use: Medications like ibuprofen, naproxen, and aspirin may increase the risk of bleeding or perforation. Switch to acetaminophen for minor pain or discuss safer long-term alternatives with a doctor. If NSAIDs are necessary (e.g., for arthritis), use the lowest effective dose under medical guidance.
- Manage bowel habits: Avoid delaying bowel movements, excessive straining, and habits that may lead to constipation (like low fluid intake or irregular bowel routines).
- Follow up on medical advice: It is essential to attend all follow-up appointments after diverticulitis for regular monitoring of the condition, so that potential problems can be identified and attended to early.
Conditions
Schedule an Appointment for Diverticular Disease Screening
If you have symptoms or concerns about diverticular disease, book a consultation with our specialist for an assessment. We can provide an early evaluation and propose a treatment plan if needed.