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Diverticular diseasePublished by Bupa's health information team, January 2008. This factsheet is for people who have diverticular disease, or who would like information about it. Diverticular disease is a common condition affecting the digestive system. It happens when small bulges or pouches, called diverticula, form in the wall of the bowel.
About diverticular diseaseDiverticular disease is very common. According to CORE Charity (formerly Digestive Disorders Foundation), between one third and half of people in western Europe and North America will have diverticula at some time in their lives, although most won't have any symptoms. Most diverticula are in the lower part of the large bowel called the colon, although some people get them in other parts of the bowel. The large intestine produces solid faeces from the remains of food after all the nutrients have been absorbed. Constipation increases pressure within the intestine and over many years this forces small areas of the lining of the intestine to weaken and form the small bulges or pouches. These are known as diverticula. Diverticula can become blocked with faeces and, once blocked, they can then become inflamed or infected. There are three terms used to describe the presence of diverticula in the large bowel wall. These are as follows.
SymptomsThe symptoms of diverticular disease are usually abdominal pain, bloating or wind. You may also have constipation and feel that you are not able to completely empty your bowels when you open them. Diverticulitis can come as mild attacks of discomfort, or as a more serious illness needing hospital treatment. Symptoms include:
You may find that pain and disturbed bowel function come back from time to time. You won't usually need to go into hospital if you have these mild symptoms, without a high temperature or severe pain. ComplicationsAround one in 20 people with diverticular disease will go on to have complications. Possible complications are as follows. BleedingDiverticula can bleed, but this is usually in small amounts that you won't notice. This bleeding is due to weakening of one or more blood vessels inside one of the diverticula. Eventually this causes blood to leak into the bowel and out into the faeces. About one in five people with diverticular disease pass blood in their faeces. Regularly taking non-steroidal anti-inflammatory drugs such as ibuprofen increases the risk of bleeding. Because the blood comes from the lower part of the large intestine, it's usually a reddish colour and recognisable as blood in the faeces. Blood from higher up the digestive system, for example in the stomach, tends to be partly digested and is black and tarry. PeritonitisIf diverticula become infected, they cause the bowel to become inflamed and swollen. In some places swollen areas called abscesses can form. These damage the bowel wall, leading to peritonitis, which the infection and pus can pass through. This is a life-threatening complication that may need emergency surgery. However, it can also be treated with antibiotics and rest. BlockagesSometimes scar tissue forms around one of the inflamed diverticula, and this can cause narrowing of the colon or a blockage. CausesThe underlying cause of diverticular disease is thought to be related to constipation. It's not fully understood why some people with diverticula go on to get symptoms and some don't, and why it's mostly a disease of people living in western countries.
DiagnosisYour doctor will ask you about your symptoms, diet and bowel movements. He or she may send you for further tests. These may include the following.
TreatmentMedicinesYour doctor may prescribe bulk-forming laxatives (eg bran or Fybogel) if you aren't able to increase the amount of fibre in your diet. Other types of laxative (eg senna) aren't helpful and may make your symptoms worse by causing abdominal cramps. Your doctor may prescribe anti-spasm medicines (eg mebeverine) if you have abdominal pain. You will need further treatment if you are vomiting or have other signs of infection (diverticulitis). To give your bowel a chance to rest and recover, you will be given antibiotics, fluids and energy in the form of sugar through a tube called a drip. Once your symptoms have settled, you can start eating and drinking small amounts of food and water. The amount is gradually increased and if your symptoms don't come back, the drip can be stopped and you can also take your antibiotics by mouth. SurgeryYou may need surgery if you have a perforation of a diverticulum, or sometimes if you have severe diverticulitis. The surgery involves cutting out the damaged part of the bowel. Your surgeon may do this and rejoin the two healthy ends of your bowel in one operation. Alternatively, the rejoining process may be done in a second operation and part of your bowel may be brought through an opening (stoma) in your abdomen, so that your bowel contents can be collected in a pouch. This procedure is called a colostomy. It gives the rest of your bowel a chance to rest and heal. Your bowel is then usually rejoined in another operation some weeks later. A specialist stoma nurse will give you advice and answer questions about how to look after your stoma. PreventionIf you know you have diverticular disease, you can help prevent future problems with lifestyle measures to prevent constipation. You can:
Further information
Related topicsSources
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: January 2008
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