This month’s column is about a bowel condition called diverticulosis and diverticular disease, which is closely related. In this condition, the large bowel, which normally is like a smooth tube, develops small out pouches in its lining. These pouches are called diverticulae and the condition is called diverticulosis when it has no symptoms. Diverticulosis is very common. It happens in most people’s bowels as we get older.
Not eating enough fibre, being constipated, being overweight and smoking are all implicated in the out pouches developing. Having a family history of the condition also increases the chances of developing it. Many people are unaware they have diverticulosis as it may cause no problems at all. The condition is often noticed when people are having tests or scans for other reasons.
So, when does diverticulosis cause a problem? In some people with diverticulosis, digested food material can get stuck in the out pouches when it is working its way through the bowel. This can cause irritation to the lining of the bowel and lead to symptoms, such as lower left sided abdominal pain that comes and goes, or constipation and diarrhoea. When you have symptoms like this it is called diverticular disease.
Sometimes, the diverticulae can become inflamed and infected. If this happens it is called diverticulitis. When this happens, symptoms can include constant abdominal pain, constipation or diarrhoea, bleeding from the back passage and a high temperature. Diverticulitis can make some people very unwell.
You might recognise that some of the symptoms of diverticular disease and diverticulitis overlap with symptoms of bowel cancer. If you have any abdominal pain, change in bowel habit or bleeding from the back passage you should seek a medical opinion. Your GP will be able to examine you and arrange further tests to find out what is going on. Often, diverticular disease is discovered during a camera test to look at the bowel in more detail (a colonoscopy). This might be arranged to see where any bleeding is coming from. Diverticulae can also be seen on CT scans and sometimes a specialist CT scan called CT colonography is required.
Diverticular disease can be managed effectively with lifestyle changes. Increasing dietary fibre, or taking a fibre based supplement can help bulk up food waste and create larger stools (poos) that are easier to pass. This means there is less pressure and straining when you go to the toilet and the muscles in the bowel wall do not need to work as hard. Good sources of fibre in the diet include fresh and dried fruit and vegetables, nuts, cereals, beans and pulses. Drinking plenty of water is important with a high fibre diet.
Medication can be used to help manage pain from diverticular disease. Simple painkillers like paracetamol are recommended. Because non-steroidal anti-inflammatories like ibuprofen and aspirin can upset the stomach, they are not recommended in this condition. Using a bulk forming laxative, like fybogel, can help ensure constipation does not occur.
If diverticulitis develops people can become very unwell. Antibiotics are needed to help treat infection. Complications of diverticulitis can include abscess formation in the bowel or even a small hole forming in the bowel wall (known as a perforation). In these cases, an operation may be required.
So, diverticular disease is very common. You might have it and not know about it. It is always best to have any symptoms like abdominal pain, change in bowel habit or bleeding from the back passage checked out and investigated, so please contact your GP if needed.
For further information on Diverticular Disease from the NHS visit https://www.nhs.uk/conditions/diverticular-disease-and-diverticulitis/