Diverticular Disease

What is diverticulosis of the colon?

Diverticular disease, also known as colonic diverticulosis, is the medical term given to small out-pouchings (diverticulae) through the large bowel wall.  Diverticulae become more common with age, and it is estimated that the proportion of the population with diverticulosis of the colon is equivalent to age; so, approximately 70% of 70 year olds will have the condition.  The majority of people with diverticular disease have no symptoms, and it is often discovered during investigations for other problems.

What causes diverticular disease?

Diverticulae in the colon are thought to be caused over a period of years by high pressure within the colon as it contracts (peristalses) to propel bowel contents through the colon.  This is exacerbated by a diet relatively lacking in dietary fibre.  A high fibre diet, combined with adequate fluid intake, reduces the risk of diverticular disease; however, it cannot prevent it completely as the out-pouchings may also occur simply as part of the aging process.

What are the symptoms of diverticular diease?

Most people with diverticular disease will not experience any symptoms and, indeed, it can be regarded as a “normal” finding in the Western population.  However, a number of problems can arise due to diverticulae in the colon, which include:
• Abdominal discomfort, commonly in the lower left side
• A change in bowel habit, either towards diarrhoea or constipation, or alternating between the two
• Abdominal bloating
• Rectal bleeding, which can either be dark red blood mixed in with the motion or brighter blood

What is diverticulitis?

Diverticulitis is the medical name given to inflammation of colonic diverticulae.  Patients with diverticulitis will experience severe pain in the left lower abdomen, a fever, and nausea and vomiting.  Diverticulitis can either resolve (often with the aid of antibiotics), or it can lead on to further problems; these include heavy bleeding or perforation of the bowel, the latter of which can either cause a localized abscess (fluid collection) or peritonitis.

Most cases of diverticulitis settle with simple measures, such as antibiotics.   However, the healing process can be accompanied by scarring of the bowel that leads to a narrowing.  This can either result in complete bowel obstruction or, as is more common, a narrowing of the bowel that causes long-term problems with pain and constipation.

What investigations are used to detect diverticular diease?

Diverticulae of the colon are often detected on CT scans or during a camera examination of the bowel (flexible sigmoidoscopy or colonoscopy).  Usually these tests are performed to exclude another, more serious underlying cause for the patient’s symptoms.

What treatment options are available?

No treatment is required for colonic diverticulosis without symptoms.  In patients with symptoms of pain or bloating, a high fibre diet (including plenty of fruit, vegetables and whole grains) is recommended, combined with adequate fluid intake.  Sometimes laxatives and / or antispasm medicines help reduce abdominal discomfort.

Diverticulitis is treated with antibiotics, pain relief, extra fluids and rest.  If the inflammation progresses onto bowel perforation, emergency surgery might be necessary; this is the case in about 5% people with diverticulitis.  If there is a localized perforation and fluid collection, surgery might entail washing the pus out and leaving an abdominal drain in; occasionally this can be accomplished using scans to guide drain placement under local anaesthetic.  If the perforation results in peritonitis, surgery generally involves removing the affected part of the bowel.  An intestinal stoma may be required, usually on a temporary basis.  Elective surgery may be undertaken to remove the affected part of the colon if symptoms become recurrent.

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