How to prevent diverticular disease

Diverticular disease is a common condition affecting your digestive system. It occurs when small pouches, called diverticula, are pushed out through the wall of your bowel.

Most people with diverticula won’t have any problems. However, if you have symptoms caused by your diverticula, this is known as diverticular disease.

If your diverticula become inflamed and infected, this is known as diverticulitis.

Diverticular disease is very common in the Western world, and affects men and women equally. Once you reach the age of 40, your risk of getting diverticular disease increases.

Symptoms of diverticular disease

If you have diverticular disease, your symptoms may include:

• lower abdominal (tummy) pain and cramping

• bloating

• changes to your bowel movements, such as constipation or diarrhoea

The symptoms of diverticulitis may be more severe and include:

• constant lower abdominal pain on the left-hand side

• a frequent need to urinate

• a fever (high temperature) and chills

• feeling sick or vomiting

• a loss of appetite

You may find your symptoms begin suddenly and gradually get worse over a few days.

Asian people sometimes develop diverticula in a different part of their bowel. If you’re Asian, the pain may be in the right-hand side of your abdomen. This is thought to be hereditary.

These symptoms may be caused by problems other than diverticular disease. If you have any of these symptoms, see a doctor for advice.

Complications of diverticular disease

Complications are uncommon, but if you have diverticular disease or diverticulitis, you may develop more serious problems that include the following.

• A pus-filled lump (an abscess) can form on the outside wall of your bowel if the diverticula become very inflamed.

• Infected diverticula can sometimes split and cause an infection in your abdomen. This is called peritonitis.

• If an infection spreads to the area surrounding your bowel, it may cause two organs to stick together (such as the bladder and the vagina if you’re a woman) and lead to the formation of what is known as a fistula. A fistula is a passageway that connects two parts of the body together that aren’t normally connected. If you have a fistula, you may need an operation to remove it.

• If your diverticula have caused swelling or scarring on the lining of your bowel, it may become partially or totally blocked. This will make it difficult for you to empty the contents of your bowel.

• Blood vessels inside the diverticula can weaken and burst causing bleeding from your rectum (back passage). If you have rectal bleeding, see your doctor.

If you have any of these complications, it’s important to get them treated urgently so they don’t cause more serious problems.

Causes of diverticular disease

Although the reason isn’t clear, it’s thought that lifestyle and diet play a part in causing diverticular disease. If you don’t have enough fibre in your diet, your faeces may become small, pellet-like and hard.

This makes it more difficult for you to empty your bowel and your bowel has to contract more vigorously to expel them. This creates additional pressure inside your bowel and causes weak points to develop in the muscle. Diverticula can then form and push through these weak points.

Diverticular disease is rare in vegetarians and in people who eat enough fibre in their diet.

Diagnosis of diverticular disease

Diverticular disease is sometimes difficult to diagnose because your symptoms may also be similar to those of other conditions, such as irritable bowel syndrome (IBS).

Your doctor may suggest one or more of the following tests to rule out other conditions.

• A blood test to check the level of your white blood cell count. A high level of white blood cells can be a sign of infection and usually occurs with diverticulitis.

• A colonoscopy is a test that allows your doctor to look inside your large bowel. The test is done in hospital using a narrow, flexible, tube-like telescopic camera called a colonoscope.

This test can confirm if you have diverticula and rule out other reasons for a change in your bowel movements, such as polyps or bowel cancer. Although this is a useful test, you won’t have a colonoscopy if you have severe symptoms of diverticulitis. A colonoscopy can perforate the inflamed and infected diverticula, and cause peritonitis.

• A barium enema X-ray involves placing a fluid containing barium (a substance that shows up on X-rays) into your bowel via your rectum. X-ray images of your abdomen show the inside of your bowel more clearly.

This test is another way of confirming if you have diverticula. Again, you shouldn’t have this if you have severe symptoms of diverticulitis as it can perforate the inflamed and infected diverticula, and cause peritonitis.

• A CT scan uses X-rays to make a three-dimensional image of your body or a part of your body. If your symptoms are severe, this test can show if an infection has spread to other parts of your body or if any complications have developed, such as an abscess. A CT scan is the preferred test if you have severe symptoms of diverticulitis.

Treatment of diverticular disease

Your treatment will depend on the severity of your symptoms and whether or not you have had diverticular disease before.

Medicines

For all types of diverticular disease, your doctor may recommend that you take paracetemol (acetaminophen) to help relieve any pain. You may be advised not to take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin (acetylsalicylic acid), because these can upset your stomach and increase your risk of internal bleeding.

Your doctor may also give you a bulk-forming laxative if you have constipation. Bulk-forming laxatives increase the amount of faeces you have and soften them. This makes it easier for you to empty your bowels.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice.

If you have diverticulitis, your doctor may prescribe antibiotics for the infection. You may also need to follow a fluid-only diet for a few days until your symptoms get better. You can then gradually introduce solid foods back into your diet.

If your diverticulitis is more serious, you may need to go into hospital to have antibiotic injections. You may also have a drip inserted into a vein in your hand or arm to give you fluids. Usually, you will only need to go into hospital if you:

• can’t drink enough fluids to stay hydrated

• can’t take antibiotics as tablets

• still have pain after taking paracetamol

• have a fever or your abdomen feels tender

Surgery

If you have diverticular disease you won’t need surgery because you can treat your symptoms at home.

If you have diverticulitis, your doctor may refer you to a colorectal surgeon (a doctor who specialises in conditions that affect the bowel) for surgery. You will usually only be referred for surgery if you have had symptoms of diverticulitis more than once.

The affected part of your bowel will be removed and the remaining healthy parts will be joined together. You may also need to have surgery if you develop a complication, such as peritonitis, an abscess, fistula or a blockage in your bowel.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of diverticular disease

Some examples of what you can do to help reduce your chance of getting diverticular disease are listed below.

• Increase your fibre intake by eating plenty of fresh fruit and vegetables, as well as wholegrain foods such as brown rice, pasta and oats. It’s important to increase your fibre intake slowly to reduce any side-effects, such as excessive wind.

• Drink enough fluids. This will help to keep your faeces soft and easier to pass through your bowels.

• Go to the toilet when you feel the urge. If you delay going to the toilet, your faeces can become harder and you will need to strain more to empty your bowels.

• Exercise regularly. This may help reduce the pressure in your bowels.