Diverticular disease, or colonic diverticulosis, is the term given to small pouches, which form in the wall of the bowel as one gets older, . These pouches, called diverticulae, occur commonly after the age of 40 and are normally harmless.
However, if they become infected or inflamed you can develop severe abdominal pain, nausea, fever and your bowel habits may be affected – leading to constipation or diarrhoea. With repeated attacks of infection the bowel can narrow causing the sensation of a blockage. In the most severe cases surgery is sometimes necessary, but milder bouts of the condition can be treated with dietary changes and antibiotics for infection.
Causes of Diverticular Disease
The colon has natural points of weakness in the muscular wall of the bowel. At these points small pouches, a few millimetres in size, can develop with age. These pouches protrude through the wall of the bowel. Diverticuale are normally harmless but if they rupture or become inflamed, diverticulitis can result.
You are more likely to develop diverticular disease as you age and the risks also increase if you are obese, smoke or have a sedentary lifestyle with little exercise.
Dietary factors also play a part. If you have a diet that is low in fibre and high in animal fats you are more likely to develop the condition and certain medications, including steroids, opioids and anti-inflammatories, also increase your risk. Studies also indicate there is a genetic component and more research on this is being conducted.
Symptoms of Diverticular Disease
Symptoms that could indicate that you have diverticular disease include persistent pain that lasts several hours or days, fever and bloating. You may also develop constipation or diarrhoea.
In roughly a quarter of cases, potentially serious complications can occur, including:
- An abscess around the bowel or in the pelvis.
- Peritonitis which occurs when one of the diverticula ruptures causing the contents of your intestines to leak into your abdominal cavity. This requires emergency medical treatment and potentially surgery.
- A blockage in your intestines or a fistula (abnormal passageway) between sections of your bowel or the bowel and bladder.
- Bleeding from an area in the bowel where there is marked inflammation.
For this reason, it is important to get a prompt diagnosis and treatment if diverticula disease is suspected.
Diverticular Disease Diagnosis
Your doctor will conduct a physical examination of your abdomen to check the location and severity of the pain. Women will also have a pelvic examination to rule out pelvic disease.
A range of tests may be used to diagnose diverticular disease and rule out other causes of the pain, including:
- Blood and urine tests to look for signs of infection.
- A CT scan to identify if you have diverticula and, if so, whether there are signs of infection.
- A colonoscopy to rule out cancer or polyps.
- A pregnancy test for women of childbearing age to rule out pregnancy.
- A stool test for infection.
Treatment of Diverticular Disease where complications arise
Treatment will depend on how severe the condition is and what symptoms you are experiencing. In the case of mild diverticulitis, you may be given antibiotics to treat the infection. You will need to follow a low residue diet, , for a few days while your bowel heals and the infection resolves. This is so that the bowel is not irritated whilst the antibiotics are working. You can also take over the counter pain relief.
If you have severe diverticular disease or are experiencing complications, you may need intravenous antibiotics and if you have developed an abscess you may need a drainage procedure with a tube inserted under local anaesthetic.
In some cases, you may wish to considerkeyhole surgery, for example if you have a fistula to the bladder or vagina, or repeated attacks of infection. In an urgent setting surgery is offered if the bowel has perforated or obstructed.. You may also be offered surgery if you have repeated episodes of diverticular disease and symptoms of recurrent pain.
There are three main types of surgery:
- Keyhole bowel resection (colectomy) which entails removing the diseased sections of bowel and reconnecting the healthy sections.
- Bowel resection with colostomy – this is performed if the inflammation is so extensive that it is not possible to re-join your colon and rectum. In this case, an opening will be made in your abdominal wall through which waste will pass into a colostomy bag. Once the inflammation has cleared, the colostomy may be reversed, and the bowel reconnected.
- Diagnostic laparoscopy and washout. This is a keyhole operation to washout the abdominal cavity and relieve infection or abscess and leave the bowel intact.
Prevention with lifestyle changes
There are some simple steps you can take to protect yourself against diverticular disease, including:
- Eating more fibre which helps to soften stools and increase bulk, to help it pass more easily through your colon.
- Drinking plenty of fluids which helps to prevent constipation.
- Exercising for at least 30 minutes a day to improve bowel function.
Help is available
Windsor Bowel Clinic are specialists in treating a full range of gastrointestinal disorders including diverticular disease and IBS.
Our specialist consultants will ensure prompt, accurate diagnosis after which we will discuss your treatment options.
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