Diverticular Disease

What is diverticular disease?

Diverticular disease or diverticulosis is a common condition of the colon (large bowel) that affects people as they get older. About 50% of the population will have diverticular disease by the time they are 60 and nearly everyone is affected at the age of 80. Despite its prevalence, only a small number of people have any symptoms or have any idea that they have the condition. A diverticulum is a small pocket or out-pouching that forms in the colon wall. Although they can occur anywhere in the colon diverticular disease predominantly affects the left side of the bowel and sigmoid colon in particular. The term diverticulitis is used when these pockets become inflamed and cause symptoms.

What are the symptoms of diverticular disease?

The majority of people have no symptoms, however if a diverticulum becomes blocked with faeces it may become inflamed and lead to abdominal pain, fevers and an alteration in the bowels. These attacks usually respond to simple antibiotic treatment but occasionally require a short admission to hospital before they settle. Rarely severe cases may result in perforation of the bowel, formation of an abdominal abscess or severe bleeding. These conditions may be life threatening and often require surgery. Some patients develop a fistula following an attack of diverticulitis. A fistula is an abnormal connection between the colon and another organ such as the bladder or vagina. Symptoms in these patients include recurrent urine infections, passing wind on urinating or passing stool from the vagina.

What causes Diverticular Disease?

Although the cause of diverticular disease is not fully understood, it is most common in the western world and probably relates to eating a low fibre diet. This leads to passing hard stool, increasing the pressure the colon needs to generate to move the stool along. This in turn results in pockets being pushed out from the bowel wall at points of weakness such as those where small blood vessels pass through to reach to inner lining of the gut.

What is the management of diverticular disease?

The best treatment for diverticular disease is to increase the amount of dietary fibre (grains, vegetables, etc.) eaten and increase the volume of liquid drunk to avoid constipation. Mild cases of diverticulitis can be treated with oral antibiotics, more severe cases may require hospitalisation with intravenous antibiotics but most attacks respond to these measures. Surgery is required in the emergency setting for abscesses, bleeding and perforation and involves removal of the affected part of the bowel. Often the bowel can be reconnected at the same operation (primary anastamosis) although if the patient is very unwell it may be safer to form a stoma and allow the patient to recover fully (a Hartmann’s procedure). This may be amenable to reversal at a later stage should the patient wish. Planned (or elective) surgery is reserved for patients who have developed a fistula or who are troubled with recurrent severe attacks of diverticulitis. Most elective operations for diverticular disease can be carried out using laparoscopic (key hole techniques) and this should be discussed with your surgeon.