Diverticulosis And Diverticulitis

Overview

Diverticulosis means small pouches have formed in the wall of your large bowel (the colon, the last part of your gut). These pouches are called diverticula. Most people with diverticulosis never feel them and don't know they have them. Diverticulitis is when one or more of these pouches becomes inflamed or infected. That can cause real pain, fever, and feeling unwell. So the two words describe the same bowel change at different stages: quiet pouches (diverticulosis) and inflamed pouches (diverticulitis).

Yes, it is very common. In countries where people eat less fibre, more than half of adults over 60 have diverticulosis, and it becomes even more common with age. Only a small share of these people ever go on to have diverticulitis.

It mostly affects adults over 50, but it can happen earlier in life too. It is more likely in people who eat a low-fibre diet, carry extra weight, smoke, or don't move much. It affects men and women about equally. It is rare in children.

Symptoms

Common symptoms

• Diverticulosis: usually no symptoms at all
• Diverticulosis: sometimes mild bloating, cramping, or a change in bowel habits such as constipation
• Diverticulitis: steady pain, often in the lower left side of the belly, that may last for hours or days
• Diverticulitis: tenderness when the belly is pressed
• Diverticulitis: fever, feeling hot or shivery
• Diverticulitis: feeling sick, vomiting, or losing your appetite
• Diverticulitis: constipation or diarrhoea, and sometimes bloating or wind

Symptoms in children

• Diverticulosis and diverticulitis are rare in children
• When it does happen, a child may have vague belly pain, fever, or vomiting rather than clear localised pain
• Any child with lasting or severe belly pain should be checked by a doctor, because many other conditions are more common at this age

Symptoms in older adults

• Symptoms can be less clear-cut. There may be little fever or less obvious pain even when there is a real problem
• New confusion, sudden weakness, or feeling generally unwell can be a sign of infection, especially in frail older adults
• Older adults are more likely to develop complications, so it is worth seeking advice early
• Constipation and changes in bowel habit are common at this age, so a new or worsening pattern deserves a check-up

Causes

Main causes

• Diverticulosis: pouches form where the bowel wall is weaker, usually because of pressure inside the colon, often over many years
• A diet low in fibre is thought to play a major part, because low-fibre stools are smaller and harder, so the bowel must push harder
• Diverticulitis: a pouch becomes inflamed, sometimes because a small amount of stool gets trapped or because the pouch wall becomes irritated or infected

Risk factors

• Getting older, especially over 50
• Eating a diet low in fibre and high in processed foods
• Carrying extra weight, especially around the middle
• Smoking
• Not being physically active
• A family history of diverticular disease
• Long-term constipation
• Regular use of some painkillers and other medicines; ask your pharmacist or doctor if you are unsure about yours

When to see a doctor

See a doctor urgently if:

• New, constant belly pain, especially in the lower left
• Belly pain with a fever
• Pain that keeps you from eating, drinking, or sleeping
• Blood in your stool
• Vomiting that won't stop

Book a routine appointment if:

• A lasting change in your bowel habits, such as new constipation or looser stools
• Ongoing bloating, wind, or mild cramping
• A previous attack of diverticulitis and you want advice on prevention
• You have been told you have diverticulosis and want to know what to eat
• Any new bowel symptoms that worry you, even if they seem mild

Diagnosis

Your doctor will start by asking about your symptoms, your bowel habits, your diet, and your medical history. They will examine your belly, checking for tenderness and signs of infection. Diverticulosis is often found by chance during tests done for other reasons. If diverticulitis is suspected, you may need blood tests and sometimes a scan. After an attack settles, your doctor may suggest a test to look inside the bowel to make sure nothing else is going on.

Tests that may be done

• A physical exam, including feeling your belly
• Blood tests to look for signs of infection or inflammation
• A stool sample to check for infection
• A CT scan of the belly, which is the usual scan for suspected diverticulitis
• An ultrasound scan in some situations
• A colonoscopy (a camera test looking inside the bowel) after you have recovered, to check the bowel and rule out other causes
• A urine test to rule out other causes of pain

What to expect at your appointment

Most of the process is simple and quick. A CT scan is painless and takes only a few minutes. A colonoscopy is done with sedation or pain relief, and you will be given instructions to prepare your bowel beforehand. Your doctor will explain the results and talk through the next steps with you.

Treatment

Diverticulosis on its own does not need treatment. The aim is to keep your bowel healthy with a fibre-rich diet, fluids, and regular activity. Diverticulitis needs care, but most people can be looked after at home. Treatment focuses on resting the bowel, easing pain, and watching for any signs that the problem is getting worse.

Self-care at home

• During a flare, rest and drink plenty of fluids, taking small sips often if you feel sick
• Follow your doctor's advice about eating during a flare; some people are advised to have a temporary soft or low-fibre diet, then build fibre back up slowly
• Use simple pain relief only as advised by your doctor or pharmacist
• Avoid straining on the toilet; take your time and don't rush
• Keep a note of your symptoms so you can tell your doctor what changed and when
• Return to normal eating and activity gradually over a few days or weeks

Medical treatments

Your doctor will decide what you need based on how you look and feel. Care may include pain relief, fluids, and a period of resting the bowel. Antibiotics are sometimes used, but not always — your doctor will judge whether they are likely to help. If you are very unwell, dehydrated, or have a complication, you may need a short stay in hospital for fluids and monitoring. If a collection of pus (an abscess) forms, a specialist may drain it using a thin needle guided by a scan. Your doctor will explain each option and why it is being suggested.

When is surgery considered?

Surgery is not needed for most people. It may be considered if you have a serious complication such as a hole in the bowel, a large abscess that can't be drained, a narrowing of the bowel, an abnormal connection between the bowel and another organ, or repeated severe attacks that affect your quality of life. If surgery is suggested, your specialist team will discuss the risks, benefits, and what recovery involves.

Living with this condition

For most people, life carries on much as before. You may want to pay a little more attention to fibre, fluids, and how often you go to the toilet. Some people find that certain foods make them bloated, but there is no single 'diverticulitis diet' that suits everyone. It is fine to notice patterns for yourself and adjust gently rather than cutting out lots of foods.

Lifestyle tips

• Build up fibre slowly over a few weeks rather than all at once, to avoid bloating
• Drink enough fluid — fibre works best when you are well hydrated
• Stay active; a regular walk most days helps the bowel
• If you smoke, getting support to stop is one of the best things you can do for your bowel and your overall health
• Aim for a healthy weight, without crash dieting
• Don't ignore the urge to go to the toilet, and give yourself time
• Ask your pharmacist before starting new medicines, especially painkillers

Diet and exercise

A high-fibre diet means more vegetables, fruit, whole grains, beans, lentils, nuts, and seeds. Increase gradually and drink plenty of water. There is no need to avoid seeds, nuts, or popcorn — that old advice has been dropped. During a flare, your doctor may suggest a softer, lower-fibre diet for a short time, then you can build fibre back up. For exercise, aim for something you enjoy and can keep up, like walking, swimming, or cycling, most days of the week.

Mental health and emotional wellbeing

Belly problems can be worrying, especially when pain comes back or you are waiting for tests. It is normal to feel anxious or fed up. Talking to someone you trust, keeping a simple symptom diary, and asking your doctor to explain anything you don't understand can all help. If worry is affecting your sleep, mood, or daily life, tell your doctor — support is available, and you do not have to cope alone.

Prevention

You can't fully prevent diverticulosis, especially as you get older, but a healthy lifestyle lowers your chances of problems. Eating plenty of fibre, drinking enough fluid, staying active, not smoking, and keeping to a healthy weight all help keep the bowel working well. If you have already had diverticulitis, these steps may also lower the chance of another attack.

Screening programmes

There is no routine screening programme for diverticulosis. It is usually found by chance during tests for other reasons. If you are offered bowel cancer screening in your country, it is still worth doing — it checks for a different problem and can catch things early.

Complications

If left untreated

• An abscess — a pocket of pus forming near the bowel
• A small hole (perforation) in the bowel, which can let bowel contents leak and cause serious infection
• Peritonitis — inflammation of the lining of the belly, which is a medical emergency
• A fistula — an abnormal tunnel between the bowel and another organ, such as the bladder
• A stricture — a narrowing of the bowel that can cause blockage
• Bleeding from a pouch, which can show as blood in the stool
• Sepsis — a severe whole-body reaction to infection

Long-term outlook

The outlook is good for most people. The great majority of people with diverticulosis never have a problem from it. Most attacks of diverticulitis settle with rest and simple care, and many people never have a second attack. If you do have another, your doctor can help you plan ahead. Serious complications are uncommon and can be treated, especially when they are picked up early.

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