Diverticular disease

Overview

Diverticular disease is a condition where small bulges or pouches develop in the lining of your large intestine (colon). These pouches are called diverticula. When these pouches become inflamed or infected, it's called diverticulitis.

Yes, it is very common. About 50% of people over 60 have diverticula. Many never have problems, but some develop symptoms or complications.

Diverticular disease most often affects older adults, especially those over 50. It is less common in people under 40. It can affect both men and women.

Symptoms

Common symptoms

• No symptoms at all (diverticulosis)
• Pain in the lower left side of your belly
• Bloating or feeling full after meals
• Changes in bowel habits, like constipation or diarrhea

Symptoms in children

• Diverticular disease is rare in children, but if it occurs, symptoms may include belly pain, nausea, and changes in bowel movements.

Symptoms in older adults

• Same symptoms as adults, but older adults may have more severe pain or complications. They are also more likely to have diverticulitis or bleeding.

Causes

Main causes

• The exact cause is unknown, but diverticula form when weak spots in the colon wall give way under pressure.
• A diet low in fiber may increase pressure in the colon, leading to pouch formation.

Risk factors

• Being over 50
• A diet low in fiber and high in processed foods
• Not getting enough physical activity
• Being overweight or obese
• Smoking
• Certain medications like steroids or nonsteroidal anti-inflammatory drugs (NSAIDs)

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe belly pain, high fever, or blood in your stool, seek emergency care right away.

Book a routine appointment if:

• If you have ongoing mild belly pain, bloating, or changes in bowel habits that last more than a week or two.
• If you notice blood in your stool after a bowel movement (but not emergency symptoms).

Diagnosis

Your doctor will ask about your symptoms, examine your belly, and may order tests to look at your colon.

Tests that may be done

• CT scan of your belly—this is the most common test to diagnose diverticulitis.
• Colonoscopy—a camera on a flexible tube to look inside your colon, but this is usually done after inflammation has settled.
• Blood tests to check for signs of infection or inflammation.
• Stool tests to rule out other causes of your symptoms.

What to expect at your appointment

If you have symptoms, your doctor will examine you and ask questions. For diverticulitis, you may need a CT scan. This involves lying still while a machine takes pictures. It is painless. If you need a colonoscopy, you will be given sedation to help you relax.

Treatment

Treatment depends on whether you have symptoms and how severe they are. If you have diverticulosis with no symptoms, no treatment is needed. For diverticulitis, treatment may include rest, diet changes, and sometimes medication.

Self-care at home

• For mild diverticulitis: rest, drink clear liquids like water or broth, and gradually add low-fiber foods as you feel better.
• Apply a heat pack to your belly to ease pain.
• Use over-the-counter pain relievers like paracetamol (acetaminophen) — but avoid NSAIDs like ibuprofen unless your doctor says it's safe.
• Once symptoms improve, slowly increase fiber in your diet.

Medical treatments

For diverticulitis, your doctor may prescribe antibiotics to treat infection. Pain relief may be offered. In some cases, you may need to be hospitalized for IV fluids and stronger pain medications. Treatment is tailored to how serious your infection is.

When is surgery considered?

Surgery is rarely needed. It may be considered if you have repeated severe attacks, a complication like an abscess or fistula, or if the condition does not improve after medical treatment.

Living with this condition

Most people with diverticular disease live normally. If you have had diverticulitis, you may need to adjust your diet for a while. After recovery, you can return to your usual activities.

Lifestyle tips

• Eat a high-fiber diet with plenty of fruits, vegetables, whole grains, and legumes.
• Drink plenty of water to help fiber work properly.
• Get regular exercise, like walking for 30 minutes a day.
• Maintain a healthy weight.
• Avoid smoking and limit alcohol.

Diet and exercise

Fiber is key—aim for 25 to 30 grams per day from foods like oats, beans, apples, and leafy greens. Increase fiber slowly to avoid bloating. Drink 8–10 cups of water daily. Exercise helps keep your bowels regular and may reduce pressure in the colon.

Mental health and emotional wellbeing

Living with a digestive condition can be worrying, especially if you have had a severe attack. It is normal to feel anxious. Talk to your doctor if you feel down. Support from family or friends can also help.

Prevention

You can lower your risk of developing diverticula or having an attack by eating a high-fiber diet, staying active, drinking enough water, and not smoking. It may not be completely preventable, but these steps can help.

Screening programmes

There is no specific screening test for diverticular disease. If you have symptoms, your doctor will investigate. Routine colon cancer screening (like colonoscopy) may incidentally find diverticula, which is harmless.

Complications

If left untreated

• Abscess (a pocket of pus) in the belly
• Perforation (a hole in the colon) leading to a serious infection called peritonitis
• Fistula (an abnormal connection between the colon and another organ like the bladder)
• Intestinal blockage
• Bleeding from the diverticula

Long-term outlook

With proper treatment, most people recover fully from diverticulitis. Even if you have a complication, doctors can usually treat it successfully. Many people live for years without any further problems. Eating well and staying healthy can help prevent future attacks.

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