Diverticular Disease

Diverticulosis is a common condition of the colon that causes small pockets to form along its length.

Overview

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What are diverticulosis and diverticulitis?

Diverticulosis is a common condition of the colon that causes small pockets to form along its length. This is a western disease, and diverticulosis is very common; it affects 50% of people over the age of 60, and it leads to 2.7 million outpatient appointments and 300,000 hospital admissions in the USA each year.

Diverticulitis describes acute inflammation of a segment of colon with diverticula. It does not mean that there is infection, but that the bowel is inflamed; at surgery it looks thickened, stiff and oedematous.

What causes diverticulosis / diverticulitis?

Diverticula were originally thought to be caused by the innermost lining of the bowel (called the mucosa) being forced out by pressure within the lumen of the bowel. However, it is now generally thought to be caused by chronic low grade inflammation in the gut.

It is becoming more common, and there has been a 21% rise since 2003. The prevalence in younger patients is also increasing.

Patients suffer from this condition because of a combination of lifestyle factors and their genetic predisposition. The most important modifiable risk factors are:

  1. A low fibre diet. The chance of getting diverticular disease reduces with every 5g/day fibre you take, but this reduction does depend on the type of fibre you eat.
  2. Red meat intake (particularly unprocessed red meat) is associated with an increased risk of diverticulitis. Substitution of poultry or fish for one serving of unprocessed red meat per day can reduce your risk.
  3. Vitamin D level. Diverticulosis is also associated with Vitamin D levels, and lower levels are associated with an increased risk of diverticulitis.

Smokers and those that have had gallstones are also at an increased risk.

What are the symptoms of diverticulosis?

Most people with diverticulosis are asymptomatic and probably never know they have the condition. It is commonly found during routine colonoscopy or CT scans. Some people may have diverticulosis and be very symptomatic.

Symptoms may include bloating, constipation, abdominal pain and it presents much like Irritable Bowel Syndrome. This is known as Symptomatic Uncomplicated Diverticulosis (SUDD).

Patients with diverticulitis will often complain of pain in the left side of the abdomen, and develop a temperature and an altered bowel habit.

The severity of diverticulitis ranges, but it is often described in terms of being ‘uncomplicated’ or ‘complicated’. Uncomplicated means it can be treated with simple medicines and lifestyle advice, while complicated means that the diverticulitis has caused a structural change in the bowel (like a perforation, stricture or obstruction). Occasionally, a diverticulum can be obstructed by faeces and this can lead to perforation and the development of an abscess. This can make patients very unwell indeed and it may require treatment in a hospital and occasionally it needs surgery.

How is diverticulosis diagnosed?

Diverticulosis is commonly diagnosed as an incidental finding on a CT scan or at colonoscopy. However, if you are symptomatic your doctor will choose one of these two tests to investigate the colon. This is made on an individual patient basis and based on an individual’s specific risk, the presentation of the condition and their risk profile for colonoscopy and the associated bowel preparation.

Treatment for diverticulosis

Treating uncomplicated asymptomatic diverticulosis

It is important that you recognize that this suggests your diet may not be doing your bowel any good and that you need to change some of your lifestyle factors to improve your health and prevent this becoming worse. This means you need to do the following:

  1. Aim to eat at least 30g of fibre per day.
  2. Ensure you make changes to your diet slowly, and increase the fibre by 5g each day over a week until you reach the recommended daily intake or you will be bloated.
  3. You need to do this for life! A healthy gut requires a fundamental change in many people’s dietary behaviour.
  4. Reduce the amount of red meat and processed meat you eat. Try replacing one meal a day with white meat (poultry or chicken).
  5. You can eat nuts and seeds! This is a common misconception.
  6. Stop smoking – if you do
  7. Exercise regularly.
  8. Ask your GP to check your Vitamin D levels.
  9. Avoid taking Ibuprofen or drugs known as NSAIDs unnecessarily.
  10. Try taking a bulk forming laxative like methylcellulose if you are constipated. Your GP can help prescribe it.
  11. Drink enough water – you need about 2 litres of fluid a day.
  12. Lose weight – if you do the above, this will happen anyway!

Have you noticed this is the same advice for reducing your risk of cancer or heart disease? This is no accident and it’s because the same biological processes that cause diverticulosis cause these diseases.

Treating symptomatic uncomplicated diverticulosis

This is more difficult and it requires a more personalised approach. All of the advice above is important, but sometimes other approaches are needed.

This is because some evidence suggests patients with SUDD have very sensitive guts to stretch which causes pain. They also have low levels of inflammation.

The trial data for the use of anti-inflammatory medicines like Mesalazine has been disappointing, and they are not typically recommended. Drug trials with specific antibiotics such as Rifaxamin have also not shown an effect.

Patients should see a gastroenterologist or surgeon with a specialist interest in this condition.


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Condition overview
Diverticular Disease

Causes

Smoking, diet

Symptoms

Bloating, constipation, abdominal pain

Tests

CT scan, colonoscopy

Treatment

Lifestyle changes, improved diet, key-hole surge...

Diverticular Disease Specialists

We have brought together a group of leading colorectal and general surgeons and gastroenterologists to create our Digestive Health team. With over 300 years of combined experience, these expert clinicians are the best in their field and are all focused on delivering the very best patient care.

Earliest availability 22 Jul
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Mr Jonathan Wilson

Consultant Colorectal and General Surgeon

Specialist expertise: Endoscopy, Inflammatory Bowel Disease, General Surgery, Gallbladder and Bile Duct Disease, Colonoscopy, Groin Hernias, Hernia Repair, Abdominal Wall Hernias, Laparoscopic Cholecystectomy, Minimally Invasive Surgery, Anal Fistula, Anal fissure, Colon Cancer, Rectal Cancer, Gallstones, Diverticular Disease, Crohn's Disease, Ulcerative Colitis, Changes in Bowel Habit, Rectal Bleeding, Haemorrhoids, Rectal Prolapse, Pilonidal Disease.

Earliest availability 22 Jul
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Mr Gregory Thomas

Consultant Colorectal Surgeon

Specialist expertise: Colorectal Surgery, Hernia Repair, Lower Gastrointestinal Endoscopy, General Surgery, Anal Fistula, Pelvic Floor Disorders, Anal fissure, Diverticular Disease, Haemorrhoids, Inflammatory Bowel Disease, Pilonidal Disease, Faecal Incontinence, Rectal Bleeding, Rectal Prolapse, Rectal Pain.

Earliest availability 24 Jul
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Dr Simon Peake

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Specialist expertise: Endoscopy, Acid Reflux, Management of Acid-Related Disorders, Abdominal Pain, Changes in Bowel Habit, Inflammatory Bowel Disease, Gastroenterology, Gastrointestinal Medicine, Colonoscopy, Gastroscopy, Advanced Polypectomy, Polypectomy, Endoscopic Mucosal Resection, Capsule Endoscopy, Diarrhoea, Bowel Cancer, Bowel Cancer Screening, Colonic Polyps, Gastrointestinal Bleeding, Bloating.

Earliest availability 25 Jul
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Dr Lisa Das

Consultant Gastroenterologist

Specialist expertise: Endoscopy, Colorectal Cancer Screening, Colonoscopy, Gastroenterology, Irritable Bowel Syndrome, Emphasis on Women's Healthcare, Therapeutic Endoscopy, Diagnostic Endoscopy, Bowel Cancer Screening, Capsule Endoscopy, Gastroscopy, Endoscopic Mucosal Resection, Advanced Polypectomy, Abnormal Liver Function, Constipation, Diarrhoea, Dyspepsia, Gastroesophageal Reflux Disease, General Hepatology, Inflammatory Bowel Disease, Percutaneous Endoscopic Gastrostomy, Polypectomy, Rectal Bleeding, Functional Gut Disorders, Obesity, Coeliac Disease, Helicobacter Pylori Infection, Gastrointestinal Bleeding.

Earliest availability 07 Aug
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Mr James Kinross

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Specialist expertise: Minimally Invasive Surgery, Colorectal Cancer, Inflammatory Bowel Disease, General Surgery, Laparoscopic Procedures (Keyhole Surgery), Colorectal Surgery, Abdominal Resection, Bowel Diversion Surgery, Trans-anal Minimally Invasive Surgery (TAMIS), Transanal Endoscopic Microsurgery, Gut Microbiome, Irritable Bowel Syndrome, Anal Cancer, Crohn's Disease, Ulcerative Colitis, Diverticular Disease, Appendicectomy, Complex Hernia Surgery, Anal Fistula, Faecal Incontinence, Pelvic Floor Disorders, Appendicitis, Bowel Obstruction, Robotic Surgery.

Ms Sarah Mills

Consultant Colorectal Surgeon

Specialist expertise: Trans-anal Minimally Invasive Surgery (TAMIS), Abdominal Wall Hernias, Groin Hernias, General Surgery, Colorectal Cancer, Anal Cancer, Anal Fistula, Pelvic Floor Disorders, Gastrointestinal Surgery, Colonoscopy, Laparoscopic Procedures (Keyhole Surgery), Minimally Invasive Surgery, Diverticular Disease, Crohn's Disease, Ulcerative Colitis, Haemorrhoids, Anal fissure, Rectal Prolapse, Faecal Incontinence, Anal Intraepithelial Neoplasia.

Professor Long Jiao

Professor of Surgery and Consultant Surgeon in Hepatopancreaticobiliary and General Surgery

Specialist expertise: Minimally Invasive Surgery, Laparoscopic Hepatobiliary and Pancreatic Surgery, General Surgery, Gallbladder and Bile Duct Disease, Hepatology, Laparoscopic Cholecystectomy, Hepato-Biliary and Pancreatic Disease, Hernia Repair, Complex Hernia Surgery, Liver Disease, Gallstones, Robotic/Laparoscopic Whipples, Pancreatic Cancer.

Professor Hemant Kocher

Consultant General and HPB Surgeon

Specialist expertise: Gallbladder and Bile Duct Disease, Liver Disease, Pancreas Disease, General Surgery, Laparoscopic Hepatobiliary and Pancreatic Surgery, Gastrointestinal Surgery, Liver Surgery, Hernia Surgery, Open Cholecystectomy, Pancreatic Surgery, Gallstones, Liver Cancer, Pancreatitis, Pancreatic Cancer, Complex Hernia Surgery, Abdominal Wall Hernias, Complex Abdominal Wall Hernias, Inguinal Hernia, Liver Metastasis.

Dr Aymer Postgate

Consultant Gastroenterologist

Specialist expertise: Therapeutic Endoscopy, ERCP, Gastroenterology, Endoscopy, Gastroscopy, Colonoscopy, Bowel Cancer Screening, Therapeutic Colonoscopy, Capsule Endoscopy, Inflammatory Bowel Disease, Hepatobiliary Medicine, Dyspepsia, Gastroesophageal Reflux Disease, Irritable Bowel Syndrome, General Hepatology, Changes in Bowel Habit, Anaemia, Abdominal Pain.

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