Who gets diverticula?
Diverticula are common. They become more common with increasing age. About 1 in 20 people in their 40s, about 1 in 3 people in their 60s, and about half of people in their 80s have diverticula of the colon. Men and women are equally affected.
What causes diverticula?
The reason why diverticula develop is not clear. It is thought to be related to not eating enough fibre. Fibre is the part of food that is not digested.
Your gut moves stools (faeces) along with gentle squeezes of its muscular wall. The stools tend to be drier, smaller, and more difficult to move along if you don't eat much fibre. Your gut muscles have to work harder if there is little fibre in your gut. High pressure may develop in parts of your gut when it squeezes hard stools. The increased pressure may push the inner lining of a small area of your gut through the muscle wall to form a small diverticulum.
What are the symptoms of diverticula?
In most cases diverticula cause no harm or symptoms.
In some cases pain in the abdomen and/or bloating may occur. The pain is usually crampy and tends to come and go. You may get ease from pain and bloating by going to the toilet to pass stools. Some people develop diarrhoea or constipation. It is not clear how diverticula cause these symptoms. If you get symptoms with diverticula, it is called 'diverticular disease'.
Symptoms of diverticular disease are similar to those that occur with a different condition called irritable bowel syndrome (IBS). However, IBS usually affects younger adults and so symptoms that first develop in a younger adult are more likely to be due to IBS. Likewise, symptoms that first develop in older people are more likely to be due to diverticular disease. However, in some cases it is difficult to tell if symptoms are due to diverticular disease or to IBS.
What are the possible complications of diverticula?
Complications are uncommon, and include the following.
Diverticulitis (infection)
About 1 in 10 people with diverticula develop a bout of diverticulitis at some stage. This is when one or more of the diverticula become inflamed and infected. This may occur if some faeces gets trapped and stagnates in a diverticulum. Bacteria (germs) in the trapped faeces may then multiply and cause infection. Symptoms of diverticulitis include:
- A constant pain in the abdomen. It is commonly in the lower left side of the abdomen. This is over the site where diverticula most commonly develop.
- Fever (high temperature).
- Constipation or diarrhoea.
- You may have some blood mixed with your stools.
- You may feel sick or vomit.
An abscess (a ball of infection and pus) may develop if the infection is severe.
Diverticulitis is treated with antibiotics and usually settles within a week or so. Admission to hospital is needed in some cases. Surgery is sometimes needed to drain an abscess or to remove a badly infected part of the colon. Some people have several bouts of diverticulitis in their life.
Bleeding
A diverticulum may occasionally bleed and you may pass some blood with your stools. The bleeding is usually slight, but is sometimes heavy. (However, always report bleeding from the bowel to a doctor. You should not assume bleeding is from a diverticulum. Other more serious conditions such as bowel cancer need to be ruled out.)
Obstruction, fistula, and peritonitis
Infected diverticula occasionally cause a blockage (obstruction) of the colon, or form a channel (fistula) to other organs such as the bladder. A diverticulum may, rarely, burst and cause infection inside the abdomen (peritonitis). Surgery is usually needed to treat these serious but uncommon complications.
What is the treatment for diverticula?
No treatment is needed in most cases as they commonly cause no symptoms. If diverticula cause symptoms, then one or more of the following may be advised by your doctor.
Eat lots of high fibre foods
This is usually advised for everyone, whether you have diverticula or not. Fibre helps to make larger and softer stools. If you have pain due to diverticula, you may find that the pain is eased if you eat a high fibre diet. Also, a high fibre diet may prevent further diverticula forming which may reduce the risk of complications. It also prevents constipation. Many foods are high in fibre, and include the following.
- Fruit, vegetables, and nuts.
- Wholemeal or wholewheat bread, biscuits, and flour (for baking).
- Wholegrain breakfast cereals such as All bran, Weetabix, muesli, etc.
- Brown rice, wholemeal spaghetti, and other wholemeal pasta.
Some experts feel that eating more fibre from fruit and vegetables is probably better than eating more grain based fibre (bread etc) to ease symptoms due to diverticula.
Note: You may have some bloating and extra wind at first when you eat more fibre. This is often temporary and tends to settle in a few weeks as your gut becomes used to the extra fibre. However, some people report that a high fibre diet makes symptoms worse. See your doctor if you think that fibre is making things worse rather than better.
Fibre supplements
These may be advised if a high fibre diet does not prevent constipation. Several types are available at pharmacies, health food shops, or on prescription. The most common (and cheapest) is bran. Some people find bran unpalatable and try other fibre supplements such as ispaghula. A pharmacist will advise.
Note: some people find that bran based products (bran supplements or bran-based cereal products) cause symptoms to become worse for as long as they take them. If your symptoms do not improve after 3-4 weeks of taking bran, then stop or reduce it. You can continue with other fibre supplements.
Fluids
You should have lots to drink when you have a high fibre diet or fibre supplements. Aim to drink at least two litres (about 8-10 cups) per day.
Painkillers
May be needed if you develop abdominal pain.
Antibiotics or surgery
May be needed if you develop a complication such as diverticulitis, etc (described above).
Please note
Tell a doctor if you have a change in the pattern of your toilet habit. For example, a sudden change to regular constipation or diarrhoea, passing blood or mucus, or new pains. A change of symptoms may indicate a new and different gut problem.
©EMIS and PIP 2005 Updated: May 2005 CHIQ Accredited PRODIGY Validated
