Diverticular Disease And Diverticulitis

Overview

Diverticular disease is a common condition of the bowel. Small pouches, like little pockets or bulges, form in the wall of the large bowel (colon). These pouches are called diverticula. Many people have them and never feel anything at all. When the pouches cause mild tummy symptoms, doctors call it diverticular disease. Diverticulitis is different: it means one or more of these pouches have become inflamed or infected. It is usually more painful and needs medical advice.

Yes, it is very common. In the UK and other Western countries, more than half of people over the age of 60 have these pouches in their bowel. Only a small number of them ever get problems such as diverticulitis.

It becomes more common with age and is rare in people under 40. It affects men and women about equally. It is more common in people who eat a low-fibre diet, who are overweight, who smoke, or who are not very active. Younger people can get it too, but this is less usual.

Symptoms

Common symptoms

• No symptoms at all — this is the most common situation
• Mild crampy pain in the lower tummy, often on the left side
• Bloating and wind
• Constipation, or sometimes loose stools
• A change in how often you go to the toilet
• If a pouch becomes inflamed (diverticulitis): stronger, more constant tummy pain, fever, feeling sick, and feeling generally unwell

Symptoms in children

• This condition is rare in children, so tummy pain in a child usually has other causes.
• If it does happen, a child may have tummy pain, fever, and vomiting.
• Any child with lasting tummy pain and a fever should be checked by a doctor.

Symptoms in older adults

• Older adults may have fewer obvious signs even when they are quite unwell.
• Confusion or sudden drowsiness can be a warning sign of infection in an older person.
• Pain may be less severe than expected, so it is wise to get checked early.
• The risk of complications is higher, so do not wait if symptoms are getting worse.

Causes

Main causes

• The pouches form when pressure inside the bowel pushes through weak spots in the bowel wall.
• A diet low in fibre is strongly linked: less fibre means harder, smaller stools and more pressure in the bowel.
• Ageing makes the bowel wall weaker, which is why the pouches are more common in later life.
• Diverticulitis happens when a pouch becomes inflamed or infected, sometimes because a small hard piece of stool gets trapped in it.

Risk factors

• Getting older
• A diet low in fibre and low in fruit and vegetables
• Being overweight
• Not being physically active
• Smoking
• Long-term use of certain medicines, including some painkillers and steroid tablets — ask your doctor or pharmacist about your own medicines
• A family history of diverticular disease

When to see a doctor

See a doctor urgently if:

• Tummy pain with a fever or chills
• Pain that is severe or getting worse
• Blood in your stool
• Vomiting and unable to keep fluids down
• A change in bowel habit that lasts more than a few weeks

Book a routine appointment if:

• Ongoing bloating, wind, or mild tummy discomfort
• Constipation that does not improve with diet changes
• Questions about fibre, diet, or how to reduce your risk
• Any new bowel symptoms you are unsure about

Diagnosis

A doctor will start by asking about your symptoms, your bowel habits, and your medical history, and will examine your tummy. Many people are diagnosed by chance when they have tests for another reason. If your doctor thinks you may have diverticulitis, they may arrange blood tests and a scan to look at the bowel more closely.

Tests that may be done

• A physical examination of your tummy
• Blood tests to look for signs of infection or inflammation
• A stool sample to rule out infection
• A CT scan, which takes detailed pictures of the bowel and shows inflammation clearly
• An ultrasound scan in some cases
• A colonoscopy (a camera test of the bowel) later on, usually after things have settled, to check the bowel and rule out other conditions

What to expect at your appointment

Most tests are quick and painless, though a colonoscopy needs some preparation to clear the bowel beforehand. Your doctor will explain what each test involves and how to prepare. Results usually come back within a few days to a couple of weeks, and your doctor will talk them through with you.

Treatment

Treatment depends on how mild or severe your symptoms are. Many people with pouches and mild symptoms need no treatment beyond healthy eating. A mild bout of diverticulitis can often be managed at home with rest, fluids, and pain relief, while more serious cases need hospital care.

Self-care at home

• Drink plenty of fluids, especially water, during a flare-up
• Eat a gentle, low-fibre diet for a few days while symptoms are bad, then build fibre back up slowly
• Use simple pain relief as advised by your pharmacist or doctor
• Rest and avoid heavy meals until you feel better
• Keep gently active when you can — short walks help the bowel
• Keep a note of what you ate and how you felt, so you can spot patterns

Medical treatments

Your doctor may prescribe antibiotics if they think a pouch is infected. They may also suggest pain relief and, if you are very unwell, fluids through a drip in hospital. If a pocket of pus (an abscess) forms, it can sometimes be drained by a specialist using a thin needle guided by a scan. Your doctor will explain the options and choose the approach that suits you. Always follow their advice and finish any course of treatment as directed.

When is surgery considered?

Surgery is only needed for a small number of people. It may be considered if you have repeated severe attacks, a serious complication such as a hole in the bowel, a blockage, an abscess that cannot be drained, or a connection that forms between the bowel and another organ. Your specialist team would discuss this carefully with you.

Living with this condition

Most people with diverticular disease get on with normal life. You may find it helpful to build a steady routine around fibre, fluids, and gentle activity, and to learn your own early warning signs so you can act quickly if a flare-up starts.

Lifestyle tips

• Eat a varied diet with plenty of fruit, vegetables, whole grains, and pulses
• Increase fibre slowly so your body can adjust, and drink more fluid as you do
• Stay active — regular walking and other gentle exercise help the bowel
• Aim for a healthy weight
• If you smoke, ask for help to stop
• Go to the toilet when you need to, and do not strain or hold on
• Keep a simple diary of symptoms if you find it helps you spot triggers

Diet and exercise

A high-fibre diet is the mainstay of bowel health. Fibre adds bulk and softness to stools, so the bowel does not have to push so hard. Good sources include wholegrain bread and cereals, oats, beans, lentils, vegetables, and fruit. Increase fibre gradually over a few weeks and drink plenty of water. During a flare-up, some people find a softer, lower-fibre diet easier for a few days, then build back up. Regular movement, such as a daily walk, helps keep the bowel working well. If you are unsure what to eat, ask your doctor or a dietitian for advice.

Mental health and emotional wellbeing

Tummy problems can be worrying, and fear of a flare-up can affect your mood, sleep, and confidence. That is very common and nothing to feel ashamed of. Talking to someone you trust, or to your doctor, often helps. If low mood or anxiety is affecting your daily life, tell your doctor — support is available.

Prevention

You cannot always prevent the pouches from forming, but you can lower your chance of problems. A high-fibre diet, plenty of fluids, regular activity, a healthy weight, and not smoking are all linked to fewer flare-ups and better bowel health.

Vaccines

There is no vaccine for this condition. Keep up with any routine vaccinations your doctor recommends for your general health.

Screening programmes

There is no routine screening test for diverticular disease. If you have had diverticulitis, your doctor may suggest a colonoscopy afterwards to check the bowel and rule out other conditions. Bowel cancer screening programmes also exist in many countries for people in a certain age range — ask your local health service whether you are due for screening.

Complications

If left untreated

• An abscess — a collection of pus near the bowel
• A hole in the bowel wall, which can let infection spread inside the tummy (this is serious and needs emergency care)
• Peritonitis — inflammation of the lining of the tummy, causing severe pain and illness
• A narrowing of the bowel that can cause a blockage
• A fistula — an abnormal connection between the bowel and another organ such as the bladder
• Bleeding from the bowel, which may show as blood in the stool

Long-term outlook

For most people the outlook is good. The great majority never develop serious problems, and mild flare-ups usually settle with simple care. Even if you need hospital treatment or, rarely, surgery, most people recover well and return to normal life. Learning your early warning signs and getting advice promptly makes a real difference.

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