A diverticulum is a protrusion of the lining of the bowel through an area of weakness in the muscle wall of the bowel. This results in the formation of a small pouch or pocket. If there is more than one pocket these are they are known as diverticulae. Diverticulosis describes the presence of these pockets. Diverticulitis is the term we use to describe inlammation or infection of diverticulae.
Some people are born with a diverticulum or diverticulae. Most diverticulum or diverticulae develop during life and become more common with age. About half the people in the UK have diverticulae by the age of 50 and nearly three quarters by the age of 80.
The cause of diverticulae isn’t precisely known, but it is believed to be linked to diet. It is thought that eating a diet which lacks fibre over a number of years causes the muscle of the bowel to work harder. This creates an increased pressure inside the bowel and results in these little pockets being ‘blown out’.
Symptoms of Diverticular Disease
Diverticulae are common. For most people they don’t cause any symptoms and no treatment is required.
Some patients can experience pain in the left lower abdomen. This is not usually severe and tends to be crampy in nature.
Diverticulitis occurs when a diverticulum or diverticulae become iinflammed or nfected. Pain and tenderness may develop, usually in the left lower abdomen. This can be associated with feeling unwell and a fever and it is not uncommon to experience some change in bowel habit.
Sometimes the infection causing diverticulitis can lead to an abscess forming next to the bowel. This may result in more pain and tenderness, a high fever and chills.
Occasionally bleeding can occur from a diverticulum. There can be quite a lot of blood and this tends to be slightly darker in colour.
Diverticulitis can occasionally lead to more serious complications when an inflamed pocket or an abscess ruptures causing peritonitis within the abdomen. This is usually associated with more severe pain affecting the whole of the abdomen, it hurts to move, and the pain is often accompanied by vomiting.
How Diverticular Disease is Investigated
Diverticulae are frequently found during examinations for other colorectal problems, e.g. changes in bowel habit or bleeding. In this situation no treatment is usually required. In patients who present with suspected diverticulitis blood tests and a CT scan are usually the first investigations performed. These tests will give information on the extent and severity of the inflammation. A colonoscopy is often performed once the acute inflammation has settled down to confirm the diagnosis and rule out any other causes.
Once formed diverticlua will not disappear on their own.
Diverticular Disease Treatment
Diverticulitis normally requires treatment with antibiotics and in some cases this treatment needs to be in hospital. These attacks will normally settle down quite quickly but people may feel some ongoig discomfort for several weeks after.
Some patients who have frequent episodes of diverticulitis may be advised to have a planned operation to remove the affected part of the bowel.
When an abscess develops a CT scan is usually required to make the diagnosis. Usually the abscess can be drained from the outside without an operation and antibiotics are given.
When diverticulae cause bleeding a CT scan can be very useful to cofirm the diagnosis and also the site of bleeding. Bleeding from the bowel cause by diverticulae normally stops without any treatment. Sometimes a blood transfusion is required. If bleeding doesn't stop an angiogram with placement of coils at the bleeding point may be performed. Only very rarely is an operation required.
Although rare, if peritonitis develops an emergency operation to remove the affected part of the bowel is usually required.
Surgical procedures that can be performed for diverticular disease can include:
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What are the next steps?
If you think you have this condition or any of these symptoms you will need to seek medical advice.
For more information or to make an appointment:
If you have private medical care or wish to pay to see a consultant:
Take this factsheet along to your own GP and request a referral to one of our consultants.