Diverticulitis - Diverticular Disease
What is diverticular disease
Diverticular disease is the name given to a condition where small sacs or out-pouchings occur from the gut, usually the colon (large bowel). It is not contagious or cancerous.
Why is it also called diverticulitis
Diverticulitis is the medical name used to describe the condition when these outpouchings (diverticulae) become infected and inflamed. However, the word diverticulitis is sometimes loosely and improperly used to refer to diverticular disease in general .
Who gets diverticular disease
Diverticular disease is very common amongst adults in western countries. About 40% of people over the age of 50 and half of the population over 70 have diverticular disease although not all of these will have symptoms. It is much less common in Africa, probably because of the differences in diet. It is more common in those who have a diet that lacks fibre, people with a family history of diverticular disease and the obese.
What are the main symptoms
Most people with diverticular disease do not have any symptoms and are completely unaware that they have it. Since symptomless diverticular disease is not dangerous in any way, this is not a problem.
Symptoms of diverticular disease include:
- crampy discomfort mainly on the left side of the abdomen which is sometimes relieved by opening the bowels
- a change in bowel habit so the person becomes more constipated or loose than normal
- a feeling of bloating or intermittent abdominal distension
Symptoms of diverticulitis include:
- a more severe constant pain which may become disabling and can be likened to appendicitis but is usually on the left side of the abdomen
- fever (i.e. a temperature).
- sometimes blood in the motions
- tenderness over the affected area of the colon
Why does diverticular disease occur
The answer to this question is not fully known but it is thought to be caused by the modern western diet which tends to be low in fibre. This probably causes the bowel to contract too hard in order to push the stools onward and the resulting high pressure within the bowel causes 'blow-outs' of the lining which become the diverticulae.
What are the complications
Diverticular disease cannot cause cancer although the doctor may wish to do further tests to exclude bowel cancer before making the diagnosis. However, if the diverticulae become infected they may bleed profusely or perforate causing peritonitis and in some cases the disease can result in thickening and scarring of the bowel wall leading to bowel obstruction. These complications are unusual.
Further investigations are often done to exclude other bowel disorders that produce similar symptoms to diverticular disease. The doctor may want to be confident of excluding cancer especially if there has been a change in bowel habit or when blood is mixed with the motions. In these circumstances an x-ray of the colon (a barium enema) or possibly a telescopic examination of the bowel called a colonoscopy may be arranged.
What treatment is required
If the diverticular disease is symptomless then no treatment is needed. Unless acute diverticulitis has occurred, the only treatment usually required is a high fibre diet and sometimes laxatives or drugs called anti-spasmodics which relieve the spasm in the bowel wall. If infection ensues causing diverticulitis, antibiotics are usually given along with pain relief. An operation to remove the main affected area of the colon may occasionally be used to treat those patients with diverticular disease causing severe pain who are not helped by diet or drugs or in the instances where the disease causes bowel obstruction.
What is the recommended diet
A high fibre diet has been shown to reduce the symptoms and progress of diverticular disease. Therefore it is advisable to increase the intake of such foods as fruit, fresh vegetables, pulses and bran. In fact this type of diet can help to prevent the formation of diverticular disease in the first place.
people with diverticular disease often ask what should be avoided in their diet and the answer to this varies from person to person. Generally speaking fatty food and spicy meals should be kept to a minimum since these are likely to upset their digestive system. However this tends to be a very individual thing so the best advice is for the person themselves to experiment with their diet and to make a note of those ingredients which they find aggravate their disease.
Where can I get further information
Apart from your Gp, the following organisation may be of further help:
British Digestive Foundation
pO Box 251
- GRIFFITH, H.W. Complete Guide to Symptoms, Illness and Surgery. New York: The Body press/ perigree Books.
- JONES, D.J. (1992) ABC of colorectal diseases: Diverticular disease. British Medical Journal. 304(6839) pp.1435-7.