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Diverticula (including Diverticulosis, Diverticular Disease and Diverticulitis)

diverticula

A diverticulum is a small pouch with a narrow neck that protrudes from the wall of the gut. Diverticula means more than one diverticulum. They can develop on any part of the gut (intestines), but usually occur in the colon (sometimes called the large bowel or large intestine). They most commonly develop in the section of the colon leading towards the rectum, where the stools (sometimes called faeces or motions) are becoming more solid.

What causes diverticula?

The reason why diverticula develop is probably related to not eating enough fibre. Fibre is the part of food that is not digested.  The stools tend to be drier, smaller, and more difficult to move along if you don't eat much fibre. Your gut muscles have to work harder. High pressure may develop in parts of your gut when it squeezes hard stools. The increased pressure may push the inner lining of a small area of your gut through the muscle wall to form a small diverticulum.

What are the symptoms and problems caused by diverticula?

It is common for no symptoms to develop - called diverticulosis

Diverticular disease

This term is used when diverticula cause intermittent, lower abdominal pain or bloating. The pain is usually crampy and tends to come and go. The pain is most commonly in the lower left part of the abdomen. You may get ease from pain and bloating by going to the toilet to pass stools.

A diagnosis of diverticular disease is usually made by confirming the presence of diverticula and by ruling out other causes of the symptoms. A test called colonoscopy may be advised. This is where a doctor uses a special flexible telescope to look into the bowel. This can confirm the presence of diverticula, and rule out bowel cancer.

Diverticulitis (infection)

Diverticulitis is a condition where one or more of the diverticula become inflamed and infected. Symptoms of diverticulitis include:

  1. A constant pain in the abdomen.
  2. Fever.
  3. Constipation or diarrhoea.
  4. You may have some blood mixed with your stools.
  5. You may feel sick or vomit.
  6. Obstruction, abscess, fistula, and peritonitis

An infected diverticulum (diverticulitis) sometimes gets worse and causes complications. Possible complications include: a blockage (obstruction) of the colon; an abscess (a collection of pus) that may form in the abdomen; a channel (fistula) that may form to other organs such as the bladder; a perforation (hole) in the wall of the bowel that can lead to infection inside the abdomen (peritonitis). Surgery is usually needed to treat these serious but uncommon complications.

Bleeding

A diverticulum may occasionally bleed and you may pass some blood via your anus. The bleeding is usually abrupt and painless.

What is the treatment for diverticulosis?

As diverticulosis means diverticula with no symptoms, there is no need for any treatment. However, a high-fibre diet is usually advised.

What is the treatment for diverticular disease?

High-fibre diet, and possibly fibre supplements. Fibre supplements may be advised if a high-fibre diet does not ease symptoms. You should have lots to drink when you have a high-fibre diet. Aim to drink at least two litres (about 8-10 cups) per day.

What is the treatment for diverticulitis?

When symptoms are not too severe

If you develop diverticulitis you will normally need a course of antibiotics and be encouraged to drink plenty of clear fluids. You may be advised not to eat anything until symptoms settle. You may need some strong painkillers for a while.

If symptoms are severe or prolonged

If symptoms are severe then you may need to be admitted to hospital. You may be given antibiotics and fluids directly into a vein via a drip. You may need to have painkiller injections.

If complications develop

As mentioned earlier, some people with diverticulitis develop complications such as bowel obstruction, abscess, fistula, and peritonitis. Surgery is usually needed to treat these serious but uncommon complications.

Treatment of a bleeding diverticula

As mentioned earlier, a large bleed requiring an emergency blood transfusion sometimes occurs in people with diverticula. However, the bleeding stops on its own in about 3 in 4 cases. Sometimes an operation is needed to stop the bleeding.


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