Diverticular disease and diverticulitis

Diverticular disease and diverticulitis are digestive conditions that primarily affect the large intestine or bowel.

What is diverticular disease and diverticulitis?

Diverticula are small pockets or bulges that can develop in the lining of the intestine as we age. Many people have diverticula without experiencing any symptoms, and these cases are referred to as diverticulosis. However, when diverticula cause symptoms such as pain in the lower abdomen, it is known as diverticular disease. If the diverticula become inflamed or infected, leading to more severe symptoms, it is called diverticulitis.

Symptoms of diverticular disease

  • recurring abdominal pain, typically on the lower left side, which may worsen after meals (pain usually eases after bowel movements or passing gas)
  • alternating constipation and diarrhoea
  • the occasional presence of blood in the stool

Symptoms of diverticulitis

If the diverticula become inflamed or infected, the symptoms may include:

  • constant, more intense abdominal pain
  • high temperature
  • diarrhoea or constipation
  • presence of mucus or blood in the stool, or rectal bleeding

When to seek medical advice

If you experience symptoms of diverticular disease or diverticulitis, it is crucial to contact your GP as soon as possible. If you have already been diagnosed with diverticular disease and are experiencing bleeding or severe pain, seek immediate medical advice. If a GP is unavailable, you can call NHS 111 or your local out-of-hours service.

Tests for diverticular disease and diverticulitis

When you visit your GP with symptoms suggestive of these conditions, they will review your medical history and listen to your symptoms. They may need to rule out other conditions with similar symptoms, such as irritable bowel syndrome (IBS), coeliac disease, or bowel cancer. Blood tests may be conducted, and depending on the results, you may be referred for a colonoscopy, a CT scan, or sometimes both.

Colonoscopy

A colonoscopy involves inserting a thin tube with a camera (colonoscope) into the rectum to examine the bowel. This procedure helps the doctor identify diverticula or signs of diverticulitis. Before a colonoscopy, you will be given a laxative to clear your bowels. While the procedure is generally not painful, it may feel uncomfortable. You may receive pain relief and a sedative to help you relax.

CT Scan

In some cases, a CT scan may be recommended instead of or in addition to a colonoscopy. CT colonography, also known as virtual colonoscopy, is a procedure where a CT scan is performed after you have taken a laxative.

Treatments for options for diverticular disease and diverticulitis

  • Diet: During an episode of diverticulitis, a GP may recommend a fluid-only diet for a few days until symptoms improve. Afterwards, gradually reintroduce a low-fibre diet to rest your digestive system. Once symptoms have subsided, you can gradually transition back to a higher-fibre diet, aiming for approximately 30g of fibre per day.
  • Medication: Diverticulitis can often be treated at home with antibiotics prescribed by a GP. For pain relief, paracetamol can be taken. However, if paracetamol alone does not provide sufficient relief, consult your GP. Avoid using aspirin or ibuprofen, as they can cause stomach upsets.
  • Hospital Treatment: In more severe cases of diverticulitis, hospital treatment may be necessary. Treatment typically involves receiving antibiotics via injections, along with intravenous fluids for hydration and nourishment. Stronger painkillers may also be prescribed if paracetamol is insufficient.
  • Surgery: Surgery is rare but may be required in cases where serious complications of diverticulitis occur, such as fistulas, peritonitis, or intestinal blockages. The surgical procedure typically involves removing the affected section of the large intestine, known as a colectomy. In some cases, a temporary or permanent colostomy may be necessary, where part of the bowel is redirected through an opening in the abdominal wall. The decision to undergo surgery will be carefully discussed between you and your doctor, weighing the benefits and risks.

Causes of diverticular disease and diverticulitis

The exact causes of these conditions are unknown. However, several factors are believed to contribute, including:

  • Age: As we age, the walls of the large intestine weaken, and the pressure from hard stools passing through the intestines can lead to the formation of diverticula. It's estimated that the majority of individuals will have some diverticula by the age of 80.
  • Diet and Lifestyle: A lack of dietary fibre is strongly associated with the development of diverticular disease and diverticulitis. Adequate fibre intake helps soften and bulk up stools, reducing pressure on the intestinal walls. Other risk factors include smoking, being overweight or obese, a history of constipation, and long-term regular use of certain painkillers like ibuprofen or aspirin.
  • Genetics: Individuals with a close relative who has diverticular disease, especially if it developed before the age of 50, may have an increased risk of developing diverticula.

Doctor
General Practitioner

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