Diverticular Disease Of The Colon

Overview

Diverticular disease is a common condition of the large bowel, also called the colon. It happens when small pouches, called diverticula, form in weak spots in the bowel wall. When these pouches are present but not inflamed, it is called diverticulosis. If a pouch becomes inflamed or infected, it is called diverticulitis. Diverticular disease can also cause bleeding from a pouch. Many people have the pouches and never know.

Yes. Diverticular disease is one of the most common bowel conditions in older adults. Many people have diverticula without ever having symptoms.

It is most common in adults over 60, but it can happen at younger ages too. It is more likely in people who eat a low-fiber diet, are overweight, smoke, or are not very active. It is rare in children.

Symptoms

Common symptoms

• Often no symptoms at all.
• Mild cramping or bloating.
• Changes in bowel habits, such as constipation or looser stools.
• Diverticulitis can cause pain, usually in the lower left part of the belly, along with fever and feeling unwell.
• Diverticular bleeding can cause bright red or dark blood in the stool.

Symptoms in children

• Diverticular disease is rare in children.
• If it does happen, a child may have belly pain, fever, or changes in stool.
• Always seek advice from a doctor or pediatrician for belly pain that keeps coming back or comes with fever.

Symptoms in older adults

• Older adults are more likely to have diverticula.
• Symptoms may be milder or less typical, and fever may be less obvious.
• Older adults may have a higher risk of serious complications, so new or worsening belly pain should be checked promptly.

Causes

Main causes

• Small pouches form where the bowel wall is weak.
• Pressure inside the colon may push the inner lining out through weak spots.
• A low-fiber diet over many years is linked to a higher chance of diverticula.
• Constipation and straining may play a role.

Risk factors

• Getting older.
• Eating a diet low in fiber.
• Being overweight.
• Smoking.
• Not being physically active.
• Family history of diverticular disease.
• Some medicines may raise the risk; ask your doctor or pharmacist about your medicines.

When to see a doctor

See a doctor urgently if:

• Severe or worsening belly pain.
• Fever with belly pain.
• Blood in your stool.
• Vomiting and unable to keep fluids down.
• Feeling very weak, dizzy, or unwell.

Book a routine appointment if:

• Ongoing changes in bowel habits.
• Mild cramping or bloating that keeps coming back.
• A history of diverticulitis, so you can plan follow-up care.
• Questions about diet, fiber, or preventing flare-ups.

Diagnosis

A doctor will ask about your symptoms, bowel habits, and medical history, and will examine your belly. They may order tests to look for inflammation or rule out other causes. Diverticular disease is often found by chance during tests done for other reasons.

Tests that may be done

• Blood tests to look for signs of infection or inflammation.
• Stool tests to check for infection or blood.
• Urine tests to rule out other causes of pain.
• Ultrasound or CT scan of the belly to look for inflamed pouches or complications.
• Colonoscopy later, after inflammation has settled, to check the bowel and rule out other problems.

What to expect at your appointment

If your doctor thinks you may have diverticulitis, they may check you carefully and arrange imaging. A colonoscopy is not usually done during an acute episode because the bowel is tender. Most tests are quick, and your doctor will explain the next steps.

Treatment

Treatment depends on whether you have diverticulosis, diverticulitis, or bleeding. Diverticulosis without symptoms usually needs no treatment. Mild diverticulitis can often be managed at home with rest, fluids, and a plan from your doctor. More serious cases may need hospital care.

Self-care at home

• Rest and drink enough fluids.
• Follow your doctor's advice about eating and drinking during a flare-up.
• Return to a normal, high-fiber diet gradually after you recover.
• Avoid straining on the toilet; ask your doctor or pharmacist for help with constipation if needed.
• Keep track of symptoms so you can tell your doctor what changed.

Medical treatments

Your doctor will decide what treatment is right for you. This may include a short period of fluids or a gentle diet, pain relief that is safe for you, and infection-fighting medicines if they think there is an infection. Some people need a stay in hospital for fluids and monitoring. Your care team will also check for complications if you are not improving.

When is surgery considered?

Surgery is not needed for most people. It may be considered if there are serious complications, such as an abscess that needs drainage, a hole in the bowel, a narrow or blocked bowel, an abnormal connection between the bowel and another organ, heavy bleeding that does not stop, or repeated severe episodes. Your specialist will discuss the risks and benefits with you.

Living with this condition

Most people with diverticular disease live full, normal lives. After a flare-up, you can usually go back to your usual activities as you feel better. Pay attention to your body, keep regular meals, and stay in touch with your doctor if symptoms return.

Lifestyle tips

• Eat a balanced diet with plenty of fiber from fruits, vegetables, whole grains, beans, and lentils.
• Drink enough fluids, especially as you increase fiber.
• Stay physically active most days.
• Maintain a healthy weight if you can.
• Do not smoke; ask for support to stop if you smoke.
• You do not usually need to avoid nuts, seeds, or popcorn; ask your doctor if you have been given specific advice.

Diet and exercise

A high-fiber diet and regular movement help keep the bowel working well. Increase fiber slowly so your body can adjust, and drink enough water. Exercise such as walking, swimming, or cycling is good for overall health and may help reduce constipation. During a flare-up, follow your doctor's diet advice and build fiber back up afterward.

Mental health and emotional wellbeing

Belly symptoms can cause worry, especially if you have had a painful flare-up. It is common to feel anxious about when another episode might happen. Talk with your doctor about your concerns and ask what signs to watch for. If worry is affecting your sleep, mood, or daily life, seek mental health support. If you are in crisis or having thoughts of harming yourself, contact your local emergency number or a local crisis service right away.

Prevention

You cannot always prevent diverticular disease, but a healthy lifestyle may lower the chance of problems. Eating enough fiber, drinking fluids, staying active, not smoking, and keeping a healthy weight are all helpful.

Vaccines

There is no vaccine for diverticular disease.

Screening programmes

There is no routine screening test for diverticular disease. Bowel cancer screening is offered at certain ages in some countries, and colonoscopy may be used to check symptoms. Ask your local health service what screening is right for you.

Complications

If left untreated

• An abscess, which is a pocket of pus near the bowel.
• A hole in the bowel, which can cause serious infection.
• A narrow or blocked bowel.
• An abnormal connection between the bowel and another organ.
• Heavy bleeding from a pouch.
• Repeated flare-ups that scar the bowel.

Long-term outlook

The outlook is usually very good. Most people with diverticula never have serious problems, and most mild episodes settle with care. Even if you need hospital treatment or surgery, many people recover well. Your doctor can help you make a plan to lower the chance of future problems.

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