Diverticular Disease

This common benign condition can cause abdominal pain, change in bowel habit and bleeding out of the anus.

Diverticular disease is a very common condition in mature people especially in the Western World.  It is thought that people develop diverticular disease because there is not enough bulky moist fibre in their diets.  This means that the colon has to squeeze hard to move the food around to the anus and this may result in blow-out bubbles on the surface of the colon and this is diverticular disease, also called diverticulosis.  These little bubbles can often be left alone and they do not turn cancerous.  Once formed they never go away.

Unfortunately they can sometimes become blocked with a little pellet of faeces or something like a pip and they can then become inflamed.  This is called diverticulitis.  Diverticulitis can cause abdominal pain, often on the left side of the abdomen, and sometimes this is very severe.  It can also cause bleeding from the anus and change in bowel habit.  A course of oral antibiotics from a community doctor is usually effective in treating diverticulitis but occasionally this does not work and emergency admission to hospital will be required.

If a patient is admitted to hospital they will be assessed there by an emergency on-call surgery team and they often have emergency investigations such as blood tests and an ultrasound or CT scan.  The majority of patients admitted to hospital get better with a course of intravenous antibiotics given via a drip.

Rarely the diverticulitis can perforate which can require an emergency surgical operation and sometimes a colostomy stoma bag.

If the diverticular disease becomes troublesome in the longer term and it reduces a patient’s quality of life then an elective operation to remove the diseased segment of colon and join the bowel back together again may prove helpful.  This can now be performed by keyhole or laparoscopic surgery.  Patients who are getting recurrent diverticular disease abdominal discomfort or rectal bleeding or a problematic change in bowel habit should ask their GP to refer them to a laparoscopic colorectal surgeon hospital specialist to discuss the pros and cons of elective surgery to remove the diverticular disease.  This will have the benefits of getting rid of a patient’s abdominal and bowel symptoms at the cost of taking the risk of a major bowel operation.  An expert surgeon can assess a patient’s symptoms and signs in clinic and then advise that patient whether or not a planned keyhole operation to treat the diverticular disease would be a reasonable option.

Patients with diverticular disease are advised to maintain a high fibre and high fluid intake diet.  This can be as simple as drinking an extra glass of water in the morning.  It is not recommended that you drink the extra water in the evening or you may have to get up during the night to pass urine.  An extra apple in the morning can be a good way to add fibre or alternatively snack on prunes, dates or figs during the day.  Some say that patients should avoid pips and nuts because these may get stuck in the diverticular bubbles and cause infection but there is no hard evidence to say that this is actually the case.

Some patients may develop a diverticular stricture where recurrent attacks of diverticulitis cause a narrowing in the colon and these patients are instead advised to be on a very low fibre diet so that their food can easily get past the narrowing. A lot of these type of patients will benefit from planned keyhole resectional surgery.

Diverticular disease is diagnosed by a colonoscopy or special X-Ray such as barium enema or CT cologram.  It is important that patients with worrying abdominal or bowel symptoms are investigated properly by a qualified specialist before a diagnosis of diverticular disease is finally given because other conditions such as bowel cancer can give the same symptoms.  If you notice a change in your usual bowel habit or bleeding out of the bottom or abdominal discomfort or pain that last longer than 3 weeks then you should make an appointment with your GP to let them know about this so that they can make sure that you are properly investigated and treated if any treatment is required.