What is diverticular disease?
Diverticular disease occurs when small pockets or bulges (diverticula) develop within the lining of the large intestine (colon). It is a common condition with most people having no or few symptoms.
In the absence of symptoms, the condition is called diverticulosis. When symptoms, such as lower abdominal pain is present, it is called diverticular disease.
In some people with diverticular disease, the diverticula tear and become infected or inflamed, a condition known as diverticulitis.
Diverticula is usually associated with inadequate fibre intake or ageing and is caused by hard stools passing through the large intestine.
What are the causes of diverticular disease?
The exact cause of diverticular disease is not known, however, it has been linked to several factors, such as:
- Age. The walls of the large intestine become weaker with age. This may lead to the formation of diverticula from the pressure of hard stools passing through the intestines.
- Diet and lifestyle. Lack of fibre in the diet, smoking, being overweight or obese, having a history of constipation, and long-term regular use of painkillers increase the risk for diverticular disease.
- Genetics. Having a family history of diverticular disease increases the chances of a person developing the condition.
What are the symptoms of diverticular disease?
Common symptoms of diverticular disease include:
- Abdominal pain often occurring on the lower left side of the abdomen and tends to happen intermittently. However, it has been noted that pain on the right side may be present among people of Asian descent. The pain gets worse during or shortly after eating.
- Constipation, diarrhoea, or both
- Occasional bloody stool
How is diverticular disease diagnosed?
Following a thorough review of your medical history, your doctor may perform a physical examination with one or more of the following tests:
- Blood tests to test for infection, inflammation or anaemia.
- Computerised tomography (CT) scan to diagnose diverticular disease and diverticulitis. In this procedure, a combination of x-rays and computer technology is used to visualise the gastrointestinal tract.
- Colonoscopy, which uses a long, flexible, narrow tube with a camera attached to its end to have a good view of the insides of the rectum and colon. This procedure may be done to confirm a diagnosis of diverticular disease or diverticulitis and rule out other conditions.
- Barium enema. This procedure utilises x-rays and a liquid called barium to examine the large intestine. The large intestine is filled with barium using a flexible tube inserted through the anus. The barium will make the large intestine more visible on an x-ray.
How is diverticular disease treated?
For mild cases, your doctor may prescribe antibiotics and recommend lifestyle or dietary changes such as a diet high in fibre, or probiotics. For severe cases of diverticulitis or diverticular bleeding, surgical treatment may be required.
Lifestyle changes
Those with diverticular disease should consume a diet that is rich in fibre, such as fruits and vegetables, beans and pulses. Drink plenty of fluids to prevent bloating and wind. For diverticulitis, a fluid-only diet may be recommended for a few days until symptoms improve followed by a high-fibre diet upon recovery.
Medicine
Painkillers such as paracetamol can be used to relieve pain in diverticular disease.
A bulk-forming laxative helps to ease constipation or diarrhoea.
Antibiotics and stronger painkillers are usually prescribed for diverticulitis.
More severe cases of diverticulitis may need to be treated in the hospital.
Surgery
Surgery may be needed to treat rare cases of serious complications of diverticulitis such as fistulas (an abnormal connection between two organs), peritonitis (infection of the abdominal cavity), or blockage in the intestines.
The surgery is called bowel resection which involves the removal of diseased segments of the intestine and then reconnecting the healthy segments.
If it’s not possible to reconnect the colon and the rectum, a colostomy will be performed.