Diverticulosis and Diverticulitis

What are diverticulosis and diverticulitis?

Diverticular disease is a digestive condition and is related to diverticulitis, which is a medical term used to describe small pouches that stick out from the colon (the large intestine). Diverticula are common, especially among older people, and the majority of people do not develop any symptoms. However, when people do experience symptoms caused by diverticula they are said to have diverticular disease.

How common is diverticular disease?

Diverticula are very common and it is estimated that 50% of people will develop diverticula by the age of 50. In many cases, diverticula do not cause any symptoms but around 25% of people with diverticula do experience symptoms, known as diverticular disease. Diverticular disease is very common and more than 30 percent of people aged over 60 have the condition. This proportion increases with age and it is estimated that around 65% of people aged 80 or over have diverticular disease. Around 75% of people with diverticular disease will experience a bout of diverticulitis.

What causes diverticular disease?

The most common site for diverticula is the lower portion of the colon and it is believed that diverticula develop here as a result of diet. Diverticular disease is much more common in Western countries, where people tend to eat more refined sugars and less fibre, than in countries where people have a high fibre diet. Fibre is essential for digestion as it helps to make the stools softer, which means that the colon needs less force to pass the stools. If you do not eat enough fibre, this makes the stools harder and it makes it difficult for the colon to pass, creating weaker spots on the outer layer of muscle in the colon.

It is not fully understood why some people develop symptoms as a result of diverticula, though some risk factors have been acknowledged:

• Smoking.
• Being overweight.
• Living a sedentary lifestyle.
• Using non-steroidal anti-inflammatory drugs (ibuprofen is the most common example of an NSAID).
• Suffering from constipation on a regular basis.

Symptoms of diverticular disease

Most people who have diverticula do not experience any symptoms but 1 in 4 people do develop symptoms, including:

• Abdominal pain (this usually comes and goes and affects the lower abdomen on the left hand side).
• Bloating.
• Bleeding from the rectum.
• Changes to your normal bowel habits (this may mean going to the toilet more or less frequently than usual).

How is diverticular disease different to diverticulitis?

Diverticular disease occurs when an individual develops symptoms related to diverticula, while diverticulitis occurs when the diverticula become inflamed. Diverticulitis usually causes more severe symptoms that diverticular disease and can potentially be serious as there is a risk of the colon rupturing.

How is diverticular disease diagnosed?

Diverticular disease causes symptoms similar to many other conditions, which is why it can be difficult to diagnose. If you experience symptoms associated with diverticular disease, visit your GP and they will most likely order blood tests. The results of the blood tests cannot be used to diagnose diverticular disease, but are nonetheless useful for ruling out other conditions.

If need be, a colonoscopy is used to examine the internal structure of the colon and identify diverticula. A colonoscopy involves passing a thin, flexible tube through the rectum and into the colon. These are carried out under local anaesthetic to prevent any pain or discomfort.

A barium enema X-ray may also be used to diagnose diverticular disease. Barium shows up on X-ray images, allowing doctors to see the colon clearly. The procedure involves injecting barium into a tube, which is passed up the rectum. It is not a painful procedure but some find it a little embarrassing. The stools will be coloured white for the first few days after the X-ray, as a result of the barium passing out of the body, but this is nothing to worry about.

Treatment for diverticular disease

In most cases, diverticular disease can be treated effectively with over-the-counter pain relief and taking paracetamol will help to ease symptoms and prevent pain. Ibuprofen and other non-steroidal anti-inflammatory medications are not usually recommended for people with diverticular disease, because they can cause an upset stomach and carry a risk of internal bleeding. Your doctor may also advise you to increase your intake of fibre to help reduce symptoms.

If you suffer from constipation as a result of diverticular disease, you may be given laxatives and advised to drink plenty of fluid to prevent obstructions from developing in the digestive system. In some cases, the diverticula can become inflamed, which is known as diverticulitis, and this can cause serious symptoms. Diverticulitis can usually be treated with antibiotics, but if symptoms get worse and pain cannot be controlled with painkillers, hospital treatment may be required.

Preventing diverticular disease

It may not be possible to prevent diverticular disease but there are steps you can take to reduce the risk. The main means of cutting your risk is to eat plenty of fibre and you should aim for at least 18 grams of fibre per day. Good sources of fibre include:

• Wholegrain foods, including wholemeal pasta, bread and brown rice.
• Fruit and vegetables.
• Nuts.
• Pulses (such as beans and lentils).
• Wholegrain cereals.

It is also important to drink plenty of water and you should aim for at least 2 litres of fluid each day.