Diverticulitis
Diverticulitis is the most severe form of diverticular disease.
Diverticular disease develops when small pouches form in the wall of your digestive tract, typically in your colon (large intestine). These arise when weak spots in the intestinal wall balloon outward and they tend to occur as a result of age although there may also be genetic factors involved.
These pouches are known as diverticulae (singular = diverticulum) and tend to be multiple, a condition known as diverticulosis.
The majority of people with diverticulosis (around 75%) do not experience any symptoms or associated problems.
When diverticulae cause symptoms, such as tummy pain or bloating, it’s known as diverticular disease.
Diverticulosis and diverticular disease do NOT increase your risk of developing bowel cancer.
If the diverticulae become inflamed or infected, causing more severe symptoms (severe abdominal pain, fever & diarrhoea), it’s called diverticulitis.
It’s estimated that 5% of people have diverticulae by the time they are 40 years old, and at least 50% of people have them by the time they are 80 years old. Men and women are equally affected.
You’re more likely to get diverticular disease and diverticulitis if you do not get enough fibre in your diet.
Symptoms
Diverticulosis:
Most people never know they have diverticulae and have no symptoms.
Diverticular Disease:
Some people experience bloating and/ or crampy pain in the abdomen which is eased by going to the toilet. This tends to come and go and gets worse during or shortly after eating. The symptoms of diverticular disease may also include diarrhoea, constipation or even blood in your poo.
Diverticulitis:
If faeces (poo) gets trapped in the diverticulae then bacteria can multiply and cause infection. The symptoms of diverticulitis include more severe, constant pain in the abdomen (usually left sided), fever, constipation or diarrhoea and/or blood & mucus mixed in with your stool. You may also experience nausea and vomiting together with feeling tired and generally unwell.
If the infection is severe, an abscess may form.
Read more about the symptoms of diverticular disease and diverticulitis.
Causes
Diverticular disease is one of the most common digestive conditions.
There’s no single known cause of diverticular disease. Instead, experts believe that multiple genetic and environmental factors likely contribute to its development.
You’re more likely to develop diverticulae if you have a close relative with diverticular disease, especially if they developed it before they were 50.
Both sexes are equally affected by diverticular disease and diverticulitis, although the condition is more likely to appear at a younger age (under 50) in men than in women. Overall, symptoms of diverticulitis are most likely to occur in people over 70 years old.
Diverticular disease is often described as a “Western disease” because the rates are high in European and North American countries, and low in African and Asian countries. A combination of genetics and diet is thought to be the reason for this and the fact that people in Western countries tend to eat less fibre (dietary fibre helps to make your stools softer and larger so they put less pressure on the walls of your intestines).
Some other things that seem to increase your risk include:
- smoking
- being overweight
- having a history of constipation
- long-term regular use of painkillers such as ibuprofen or aspirin
Self-care
If you’ve already been diagnosed with diverticular disease, you usually do not need to contact a GP – the symptoms can be treated at home.
Eating a high-fibre diet may help ease the symptoms of diverticular disease and stop you developing diverticulitis. Generally, adults should aim to eat 30g of fibre a day. Good sources of fibre include fresh and dried fruits, vegetables, beans and pulses, nuts, cereals and starchy foods.
Fibre supplements, usually in the form of sachets of powder that you mix with water, are available from pharmacists and health food shops.
Gradually increasing your fibre intake over a few weeks and drinking plenty of fluids can help prevent side effects associated with a high-fibre diet, such as bloating and farting.
People aged 50-70 who eat a high-fibre diet (25g a day) have a 40% lower chance of admission to hospital with complications of diverticular disease – compared to others in their age range with the lowest amount of dietary fibre.
Paracetamol can be used to relieve abdominal pain associated with diverticular disease. Painkillers such as aspirin and ibuprofen should not be taken regularly as they can cause stomach problems. A pharmacist can give you more advice about this. If paracetamol alone is not working, then you should consult your GP.
When to seek medical advice
You should contact a GP as soon as possible if you are experiencing symptoms suggestive of diverticular disease or diverticulitis for the first time.
If you’ve already been diagnosed with diverticular disease, you usually do not need to contact a GP – the symptoms can be treated at home unless they are worsening or are associated with bleeding from the back passage or fever.
If you experience any bleeding, severe pain or fever then you should seek immediate medical advice.
Mild diverticulitis can usually be treated at home with antibiotics prescribed by your GP. More serious cases may need hospital treatment to prevent and treat complications.
In the first instance you should contact your GP or, if this is not possible, call NHS 111 or your local out-of-hours service.
Diagnosis & Treatment
Diagnosis
Diverticular disease
Diverticular disease can be difficult to diagnose from the symptoms alone because there are other conditions that cause similar symptoms, such as irritable bowel syndrome (IBS), coeliac disease or bowel cancer.
As a first step, your GP may recommend blood tests to exclude some of these other conditions although there is no single blood test to identify diverticular disease specifically.
To make sure there is not a more serious cause of your symptoms, your GP may refer you for a colonoscopy, a CT scan, or sometimes both. These allow a more detailed examination of the bowel and both procedures are usually performed on an outpatient basis. Sometimes the two procedures are combined into what is called a CT colonography or virtual colonoscopy. Cancer Research UK has more information about a CT colonography. For a CT colonoscopy, the scan is done after you’ve had the laxative.
Diverticulitis
If you have had a previous history of diverticular disease, your GP will usually be able to diagnose diverticulitis from your symptoms and a physical examination.
A blood test may be taken, because a high number of white blood cells indicates infection.
Further tests will be needed if you have no previous history of diverticular disease.
If you are unwell, your GP may refer you to hospital for blood tests and investigations. This is to look for complications of diverticulitis and to rule out other possible conditions, such as gallstones or a hernia.
Treatment
Diverticular Disease:
Most cases of diverticular disease can be treated at home.
The over-the-counter painkiller paracetamol is recommended to help relieve your symptoms.
Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are not recommended because they may upset your stomach and increase your risk of internal bleeding.
Eating a high-fibre diet may initially help to control your symptoms.
Some people will notice an improvement after a few days, although it can take around a month to feel the benefits fully.
If you have constipation, you may be given a bulk-forming laxative. These can cause flatulence (wind) and bloating. Drink plenty of fluids to prevent any obstruction in your digestive system.
Diverticulitis:
Mild diverticulitis can often be treated at home. Your GP may prescribe antibiotics for the infection and you should take paracetamol for the pain. It’s important that you finish the complete course of antibiotics, even if you are feeling better.
Some types of antibiotics used to treat diverticulitis can cause side effects in some people, including vomiting and diarrhoea.
Your GP may recommend that you stick to a fluid-only diet for a few days until your symptoms improve. This is because trying to digest solid foods may make your symptoms worse. You can gradually introduce solid foods over the next 2 or 3 days.
For the 3 to 4 days of recovery, a low-fibre diet is suggested, until you return to the preventative high-fibre diet. This is to reduce the amount of faeces (poo) your large bowel has to deal with while it is inflamed.
Torbay and South Devon NHS Trust has produced a helpful leaflet on a low residue diet – Click here to view.
Further tests will be needed if you have no previous history of diverticular disease.
If you have more severe diverticulitis, you may need to go to hospital, particularly if:
- your pain cannot be controlled using paracetamol.
- you are unable to drink enough fluids to keep yourself hydrated.
- you are unable to take antibiotics by mouth.
- your general state of health is poor.
- you have a weakened immune system.
- your GP suspects complications.
- your symptoms fail to improve after two days of treatment at home.
If you are admitted to hospital for treatment, you are likely to receive injections of antibiotics and be kept hydrated and nourished using an intravenous drip (a tube directly connected to your vein).
Most people start to improve within 2 to 3 days.
Surgery:
In rare cases, surgery may be needed to treat serious complications of diverticulitis.
The most common complication of diverticulitis is the formation of an abscess. Abscesses are usually treated with a technique known as percutaneous drainage, which is done by a radiologist.
More serious complications may require removal of the affected section of your large intestine. This is known as a colectomy. This is the treatment for rare complications such as fistulas, peritonitis or a blockage in your intestines.
Such complications are extremely rare.
Videos about Diverticulitis
What is diverticulitis? Causes, symptoms, treatment & more | Top Doctors UK
Top Doctors UK | Published: 25 Mar 2020
Diverticular Disease & Diverticulitis | Gastrointestinal Society
GI Society | Published: 1 Nov 2016
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