Diverticular Disease

What is Diverticular Disease?

Diverticular disease (Diverticulosis) of the colon is a common condition that is present in around 50 percent of people by the age of 60. Diverticulae are pea-sized pockets or outpouchings that develop in the wall of the colon, most commonly in the sigmoid (left-sided) colon, but maybe found anywhere in the colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes the condition when these pockets become inflamed or infected. Only a small percentage of those with diverticulosis have symptoms.

What are the symptoms of diverticular disease?

Uncomplicated diverticular disease is usually not associated with symptoms. Symptoms are related to complications of diverticular disease including diverticulitis and bleeding. Diverticular disease is a common cause of significant bleeding from the colon. Diverticulitis may cause one or more of the following symptoms: pain in the abdomen, chills, fever and change in bowel habits. More intense symptoms are associated with serious complications such as perforation, abscess or fistula formation (an abnormal connection between the colon and another organ such as the bladder or vagina). Symptoms such a change in bowel habits and / or rectal bleeding can also be caused by bowel cancer, although diverticular disease is a more common cause. A colonoscopy is usually required however, to rule out bowel cancer.

What is the cause of diverticular disease?

The cause of diverticular disease is not precisely known, but it is more common for people with a low fibre diet. It is thought that over many years, a low-fibre diet creates increased colon pressure (particularly in the narrower left colon) which results in outpouchings forming in weak spots within the wall of the colon.

How is diverticular disease treated?

Increasing the amount of dietary fibre reduces the pressure in the colon by improving stool transit and may decrease the risk of complications due to diverticular disease. Diverticulitis requires different management. More severe cases require hospitalisation with intravenous antibiotics and temporary dietary restrictions.

When is surgery necessary?

Surgery is reserved for the few patients with recurrent episodes of diverticulitis, complications (such as stricture, perforation, fistula or abscess formation) or severe attacks when there is little or no response to medication. Surgery may also be required in individuals with a single episode of severe diverticular bleeding. Surgical treatment removes the diseased part of the colon, most commonly the left colon. In less severe cases, this can be performed with keyhole surgery. Depending on the severity of the disease and fitness of the patient, often the remaining colon is re-connected (anastomosed) again to the rectum. Sometimes a temporary ileostomy is required until the join (anastomosis) between the bowel and rectum heals. In emergency surgery, patients may require a temporary colostomy bag and more surgery later on to reverse this. Patients are encouraged to seek early medical attention for abdominal symptoms to help avoid complications.