What is diverticular disease?

A diverticulum is a small pouch or pocket that forms when the inner lining of your bowel pushes through a weak area in the muscle wall. If you have more than one, they are called diverticulae.

• Diverticulosis – The presence of diverticulae without symptoms

• Diverticulitis – Inflammation or infection of diverticulae, which can cause pain and other complications

Some people are born with diverticulae, but in most cases, they develop over time. By the age of 50, around half of people in the UK have diverticulae, and by 80, nearly three-quarters are affected.

What causes diverticular disease?

The exact cause is unknown, but low-fibre diets are believed to play a role. Eating insufficient fibre forces the bowel muscles to work harder, increasing pressure inside the bowel and leading to the formation of diverticulae over time.

Symptoms of diverticular disease

Many people with diverticulae experience no symptoms and do not require treatment. However, some may develop:

• Cramping pain in the lower left abdomen, usually mild but persistent

• Changes in bowel habits, such as constipation or diarrhoea

Symptoms of diverticulitis (inflamed diverticulae)

• Severe pain and tenderness in the lower left abdomen

• Fever, chills, and feeling generally unwell

• Change in bowel habit including bloating, constipation, or diarrhoea

Complications of diverticulitis

Abscess formation – Infection can lead to an abscess next to the bowel, causing severe pain, high fever, and chills

Fistula formation – an abscess may burst into the bladder, vagina or through the abdominal wall leading to the formation of a fistula.

• Colo-vesical fistula – when a diverticular abscess bursts into the bladder, a tract may form between the bowel and the bladder. You may experience symptoms of urinary tract infections and debris in the urine and the passage of air bubbles in the urine (also known as pneumaturia)

• Colo-vaginal fistula – when a diverticular abscess bursts into the vagina, a tract may form between the bowel and the vagina. You may experience symptoms of passing gas and bowel contents through the vagina

• Colo-cutaneous fistula – when a diverticular abscess bursts out through the abdominal wall, a tract may form between the bowel and the skin. You may experience symptoms of passing gas and bowel contents through the hole that forms in the abdominal wall

Bleeding from a diverticulum – This can result in dark or bright red blood in the stool

Peritonitis (ruptured abscess or bowel perforation) – A medical emergency causing severe abdominal pain, vomiting, and a rigid abdomen. Urgent surgery is usually required

Large bowel obstruction – When diverticular disease causes a severe narrowing of the bowel, a bowel obstruction may occur. This is a medical emergency associated with severe abdominal pain and distension. Urgent surgery is usually required.

How is diverticular disease diagnosed?

Diverticulae are often found during investigations for other bowel conditions. If you have symptoms, your doctor may recommend:

• Blood tests – To check for infection and inflammation

• CT scan – The first-choice test for diagnosing diverticulitis, abscesses, and complications

• Colonoscopy – Often performed after inflammation has settled to confirm the diagnosis and rule out other conditions like bowel cancer

Once diverticulae have formed, they do not disappear on their own.

Treatment for diverticular disease

Diverticulitis treatment

• Antibiotics – Often required, sometimes given in hospital if the infection is severe

• Pain relief and dietary changes – A low-fibre diet may be recommended temporarily until symptoms improve

• Rest and fluids – Drinking plenty of fluids and avoiding solid food may help during flare-ups

Some people experience ongoing discomfort for several weeks after an attack.

Treatment for recurrent diverticulitis

• If you have frequent episodes, your doctor may recommend surgery to remove the affected section of the bowel

Treatment for abscesses and severe infection

• CT-guided drainage – A minimally invasive procedure where an abscess is drained through the skin

• Emergency surgery – Required if an abscess ruptures or peritonitis develops

Treatment for diverticular bleeding

• CT scan – Used to confirm the site of bleeding

• Blood transfusion – May be needed if there is significant blood loss

• Angiogram with coil placement – If bleeding persists, a minimally invasive procedure can stop the bleeding

• Surgery (rare cases) – Only performed if other treatments fail

Surgical treatment for diverticular disease

Surgery is only required in severe cases, such as repeated episodes of diverticulitis, uncontrolled bleeding, or complications like peritonitis or bowel obstruction. Procedures include:

• Sigmoid colectomy – Removal of the sigmoid colon

• Left hemicolectomy – Removal of the left side of the colon

• Anterior resection – Removal of the sigmoid colon and upper rectum.

• Hartmann’s procedure – Usually performed as an emergency operation for complications such as peritonitis or obstruction. This involveed removing the affected part of the bowel and creating a colostomy.

Why choose the Midlands Bowel Clinic?

• Expert colorectal surgeons experienced in managing diverticular disease

• State-of-the-art diagnostic tools for accurate assessment

• Advanced surgical techniques, including minimally invasive procedures for diverticular disease

Contact us

If you have symptoms of diverticular disease or diverticulitis, or need expert advice, contact us today. Early diagnosis and appropriate treatment can help prevent complications and improve your quality of life.