Dr. Matthew Tytherleigh – Consultant Colorectal and Laparoscopic Surgeon at Abu Dhabi’s tertiary healthcare institution Burjeel Hospital – answers commonly asked questions about Diverticular Disease.

What is diverticular disease?

“Diverticulum” is the name given to a small pouch which bulges out from any hollow structure in the body.  “Diverticula” is the plural form of diverticulum and is used when there is more than one pouch.  The terms “diverticulosis” or “diverticular disease” usually refer to diverticula bulging out of the colon.  The word “diverticulitis” describes the condition which occurs when diverticula become inflamed and painful.

What is the cause of diverticular disease?

This question cannot be answered with certainty.  Increased pressure within the bowel probably forces pouches of bowel lining through points of weakness in the muscle layers to form diverticula.

Comparisons between different countries show that diverticular disease is more common in those countries with a diet high in animal protein and low in vegetable or cereal fibre. A low intake of fibre results in smaller volume of material passing through the colon, and in these circumstances the pressures produced inside the colon are higher. Thus, diverticular disease is thought to be a result of a low-fiber diet.

How common is diverticular disease?

It is very common in western countries, especially with advancing age. About half the population of United Kingdom who are over 60 years of age have diverticular disease and over 80% of 80-year-olds have it.  It is less common in Africa, possibly because of the differences in diet.  Once diverticula have formed, they are permanent.  But that does not necessarily mean they can cause trouble.

What are the symptoms of diverticular disease?

Most patients with diverticular disease do not have any symptoms, and go through life unaware of the condition. Some patients experience:

• a change in bowel habit (either more constipated or more loose than usual)
• colicky discomfort, especially on the left side of the abdomen
• distension of the abdomen

Occasionally, there may be:

• pain, which arises because the diverticula become inflamed (diverticulitis)
• blood in the bowel movement.

How is diverticular disease investigated?

There is no increased risk of cancer in diverticular disease.  However, since diverticular disease and bowel cancer may cause similar symptoms, you should see a colorectal surgeon if you develop any bowel symptoms. The surgeon will perform a colonoscopy – a telescopic inspection of the bowel, to make the diagnosis.

How is uncomplicated diverticular disease treated?

A high-fiber diet is often helpful. This will include: whole-meal bread, brown rice, whole-meal pasta, bran cereals, and plenty of fruit and vegetables.

For many patients simply increasing vegetables in the diet will relieve their symptoms and return their bowel activity to normal. Fiber intake can be supplemented by adding coarse bran to food (e.g., to yoghurt, soups, gravy, mashed potatoes, cereals, etc). The doctor may prescribe laxatives to help bulk the stool.

A few patients who still experience colicky pain and distension need treatment with drugs called antispasmodics or peppermint oil. These reduce the spasm in the colon which is often the cause of these symptoms and is similar to irritable bowel syndrome.

What complications can occur with diverticular disease?

There are four main complications:

• Diverticulitis. This means inflammation of the diverticular disease. It is probably due to bacterial infection, and is usually treated by antibiotics. If the symptoms are severe, admission to hospital may be required and, rarely, a surgical operation.
• Perforation (bursting) of a diverticulum with acute peritonitis (generalised inflammation of the whole abdominal cavity). This is serious and requires urgent surgery.
• Abscess formation (a local collection of pus close to the colon due to a local perforation). The abscess may have to be drained either through the skin or surgically. It is often recommended to have the perforated piece of colon removed.
• Very rarely, formation of a fistula – perforation of a diverticulum into another structure, such as the bladder or vagina, and forming a connection. Odd symptoms, such as passing air in the urine or a discharge from the vagina, may develop. Surgery is the only treatment.

Sometimes a colostomy is needed temporarily after an operation for diverticular disease, but it is very rare to need one permanently.