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Diverticular Disease

What is diverticular disease?

Diverticular disease is when parts of the lining of the bowel form pockets through the muscle of the bowel wall (diverticuli).

What is the cause of diverticular disease?

It is thought to be caused by high pressure within the bowel secondary to several causes including constipation and straining, which causes the bowel mucosa (lining) to herniate through the muscle wall alongside small blood vessels supplying the bowel. This forms the diverticuli.

Incidence

Diverticular disease is very common, particularly in western countries. Prior to 30 years of age, the disease is uncommon.  However one in 3 people over the age of 60 years and one in two over the age of 80 years have diverticular disease.

Complications

Most people with diverticular disease have no symptoms.  Occasionally the following complications can occur:

  • Infection

    • usually due to the diverticuli becoming blocked with faeces and subsequent pressure on the bowel lining leading to lack of blood supply and subsequent inflammation and possibly:

      • Infection

      • Perforation

      • Bowel Stricture

      • Bowel Fistula 

    • needs antibiotics and occasionally immediate surgery

  • Bowel perforation

  • Bleeding

Symptoms

  • Most are asymptomatic

  • Symptoms of complications:

    • Infection/perforation: fever, abdominal pain, change in bowel habits

    • Bleeding: small or large volume

Diagnosis

Diverticular disease can be diagnosed by CT, barium enema or colonoscopy.  A colonoscopy performed following full resolution of any complications of diverticular disease provides the benefit of being able to visualise and biopsy any abnormalities on the bowel wall. This is important as complications of diverticular disease have similar symptoms to those of bowel cancer.

Treatment

Most patients will have no or intermittent symptoms.  Patients are encouraged to have:

  • a high fibre diet

  • adequate fluid intake

  • adequate physical activity

  • avoid constipation and straining

Patients that develop complications of diverticular disease need a range of treatment depending on the severity.  Mild infections can be managed with antibiotics.  Patients with severe infections or bowel perforations need hospitalisation, antibiotics and occasionally emergency bowel operations which may result in a stoma (bag). The stoma is usually temporary and is reversed in the following months. If a patient has recurrent complications from diverticuli in a short segment of large bowel, a planned elective operation may be performed to remove the affected bowel and rejoin the bowel, usually preventing the need for a stoma.