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Bowel Problems

Diverticular disease

Description

A diverticulum is a small out-pouching from the wall of the gut. Diverticulae mean mores than one diverticulum. They can develop on any part of the gut but most often in the large bowel (colon) on the left side. They tend to be multiple and this is called diverticulosis. If they cause symptoms then this is known as diverticular disease and if they become infected or inflamed this is called diverticulitis.
Diverticulae are common particularly as we get older. Approximately 1 in 3 people in their 60s and half of 80 year olds will have these in their colon. Men and women are equally affected.

Symptoms

Most people never know they have diverticulae and have no symptoms. Some people may get bloating and/ or crampy pain in the abdomen which is eased by going to the toilet. However in some they may become more problematic if stools get trapped in them, bacteria will then multiply and cause infection. The symptoms for this include pain in the abdomen (usually left sided), fever, constipation or diarrhoea, blood mixed in your stool. If the infection is severe, a collection of infection (abscess) may form.

Diagnosis

Visit your GP, especially if you experience any sudden change in your bowel pattern or bleeding from the bottom because it may mean you have a different bowel problem that will need investigation. Diverticular disease can be mistaken with IBS (Irritable Bowel Syndrome) because of the similarity of symptoms. Tests carried out by your GP will help to rule this out. The pouches may be noticed during a barium enema, when a liquid is inserted into the intestine through the anus and an X-ray of the abdomen is taken. Alternatively the pouches may be discovered during an endoscopy, when a thin tube with a camera is put down the throat and into the digestive system.

Treatment

Diverticulitis is usually treated with antibiotics and in some cases you may need to be admitted to hospital.

Surgery may be needed to drain an abscess, if a diverticulum bursts (peritonitis) or causes the bowel to become blocked (obstruction). Sometimes this can be done using X-ray guidance so you can avoid an anaesthetic. Occasionally a section of badly affected bowel may need to be removed surgically.

A diverticulum may bleed causing you to pass blood with your stool. If this is heavy you may have to be admitted to hospital for rest and to treat the bleeding. Very occasionally an operation has to be done to remove the part of the bowel that is bleeding.

Using painkillers and anti-spasmodics (drugs to reduce tummy cramps) are also very helpful.

Outcomes and further sources of support

A change in diet often helps in the management of diverticulae. Generally, a a high fibre diet is recommended but it is important to increase gradually and find the best level of fibre for you – in a few people high fibre intake can make some symptoms worse. Types of fibre also differ, fibre from fruit and vegetables may improve your symptoms more than the grain-based fibre found in bread, wheat cereals etc. You may also find that you feel more bloated or pass more wind when you first change your diet but this should settle down as your bowel becomes used to your new regime.

IMPORTANT: Please inform your doctor of any sudden change in your bowel pattern or bleeding from the bottom because it may mean you have a different bowel problem that will need investigation.

The information on this page is reproduced from material put together by the Colorectal Development Unit at the Royal London Hospital, part of Barts and the London NHS Trust. An information leaflet prepared by the Colorectal Development Unit, Barts and the London NHS Trust will soon be available to download here.

Further information can be found at Patient UK, NHS Direct.and Bladder & Bowel Foundation.