Diverticularticular Disease

What is diverticular disease?
Diverticular disease and diverticulitis are related digestive conditions that most usually affect the large bowel, the colon, but occasionally affect the small bowel, the ileum, and other parts of the body. In diverticular disease, small bulges or pockets (diverticulae) develop in the lining of the intestine. Diverticulitis is when these pockets become inflamed or infected.

Diverticular disease is very common in the western world with one third to one half of the population developing the condition. It is more common as we age. It is thought to be caused by the western world diet containing less fibre.

Fibre in our diet makes the bowel motions bulkier and easier to pass when we open our bowels. If we do not eat enough fibre the stool is smaller and harder to pass putting pressure on the side of the bowel.

What are the symptoms of diverticular disease?
Some people who have diverticular disease experience no symptoms at all. Some people experience pain in the tummy (abdomen) particularly on the left hand side. This can be associated with bloating of the abdomen. People can also experience changes in their bowel pattern having either constipation which is a hard, difficult to pass bowel motion or diarrhoea which is more frequent looser stools. Some people will vary from constipation to diarrhoea.

What is the colon (large bowel)?
The food that we eat travels from the mouth to the stomach where digestion begins. It then travels into the small bowel (ileum) where the nutrients are absorbed and the waste that is left moves into the large bowel (colon). The main functions of the colon are to remove fluid from your body’s waste and to store it until you are ready to go to the toilet to open your bowels.

How is diverticular disease diagnosed?
There are a number of tests that can show this:

• Colonoscopy or flexible sigmoidoscopy – where a narrow tube camera is inserted through the back passage to visualise the colon.
• CT scan – where an x-ray scan is done to look at the inside of the abdomen and bowel.
• Barium enema – where liquid barium is put into the bowel via the back passage and x-rays are taken.

What will I be advised if I am diagnosed with diverticular disease?
You will be advised to make sure you eat a diet higher in fibre and you may be prescribed sachets of medication that help to add fibre. This may reduce the chance of more diverticulae developing and reduce the chance of hard stool becoming lodged in the diverticulae. It can also help to reduce the risks of complications such as diverticulitis.

Try to eat a mixture of high fibre foods. Fruit, vegetables, wholemeal bread and pasta, wholegrain cereals and brown rice are all good sources of fibre. Aim to have at least one high fibre food with each meal and try to have five portions of fruit or vegetables each day. Drink at least two litres (8 to 10 cups) of fluid every day.

People with symptoms of diverticular disease respond differently to fibre in the diet. Some people may be helped by increasing the amount of plant fibre in their diet and others may feel that their symptoms become worse. The type of fibre you can eat may be varied. Some people find that it helps to take fibre in the form of fruit and vegetables (soluble fibre) rather than that in cereals and grains (insoluble). This is because insoluble fibre may cause more bloating and pain. Bran aggravates symptoms for some people and is not routinely recommended. Avoiding large or fatty portions of food is a common sense measure if symptoms are worse after meals. It is not possible to make rules about diet to suit everyone, an element of trial and error in what we eat is often helpful in finding what fibre suits us best.

Problems that can occur with diverticular disease:
Problems with diverticular disease are fairly uncommon and many people never experience any of these complications:
Diverticulitis is when the diverticulae become inflamed. This can cause severe abdominal pain, a high temperature and feeling unwell. When diverticulitis is extremely severe a diverticulum can burst causing peritonitis (inflammation and infection inside the abdomen). Bleeding can occur if a blood vessel in the lining of the diverticulum bursts. Scar tissue can form around inflamed diverticulae causing narrowing (stenosis). This could lead to a blockage of the bowel. You may be advised to take a diet low in fibre in this situation. Occasionally the complications listed above can lead to surgery.

If you think you have any of the symptoms listed above then you need to seek urgent medical advice from your GP, NHS111 or the Emergency Department.

After two or more episodes of diverticulitis you may be advised to consider surgery to remove the affected bowel. If you have recently been in hospital for treatment of diverticular disease and if you have any urgent problems, for example fever (temperature), bleeding from the back passage or severe pain within 14 days of discharge home then you may contact the Surgical Assessment Unit (SAU) on 01274 383205 for advice.