What is diverticular disease?
Diverticula are pockets in the large bowel. They can occur anywhere in the colon, but are most common in the sigmoid colon, which is in the left lower part of the abdomen.
What symptoms do you get with diverticular disease?
Most patients have no symptoms at all and the diverticula are found in routine tests. The incidence increases with age, 50% of Australians over the age of 50 have diverticular disease. One to two percent per year will develop symptoms.
Symptoms occur when the pockets become inflamed and cause diverticulitis. This can present with abdominal pain in the left lower abdomen. Most attacks are mild and need no treatment, sometimes oral antibiotics are required and very occasionally intravenous antibiotics in hospital are required.
There can be much more serious presentations with perforation, bleeding, communication with other organs (fistula) and bowel obstruction. Urgent treatment is required.
What causes diverticular disease?
The condition is caused by high pressures forming in the colon due to a diet low in fibre. Fibre adds bulk and allows the colon to work more efficiently. A diet low in fibre means that the colon is working harder generating higher pressures and causing pockets.
What is diverticulitis?
Diverticulitis is when the pockets become inflamed. Initially there is local inflammation around the pockets but there can be more serious inflammation causing abscess and perforation.
Do seeds and nuts make the condition worse?
It has never been proven that a specific dietary factor causes the problem. There is a theory that small undigested seeds and nuts clog the diverticula and certainly some patients do have some symptoms related to this, but on the whole this is rare.
What is the treatment?
An increase in dietary fibre is all that is usually required. Diverticulitis requires oral or intravenous antibiotics. Surgery is only rarely required.
What are the indications for surgery?
Sometimes the indications are obvious with emergency presentations. In this situation, patients present with uncontrolled diverticulitis, abscess formation, perforation, and communication with other organs or bowel obstruction. Urgent treatment is required.Some patients have a more planned operation if they have recurrent episodes of symptoms requiring repeat visits to doctors and hospitals.
What investigations are required?
Patients require a colonoscopy and sometimes a CT scan.