Think you may have diverticular disease or diverticulitis? Discover how to identify the symptoms & get to know the causes & treatment options
It’s estimated that between one in three, with an expected increase to one in two people, will be affected by diverticular disease during their lifetime. But what is it and how can it be treated?
Take note as we delve into the symptoms to watch out for, as well as the causes, tests and treatment options to help relieve discomfort.
What is diverticular disease & diverticulitis?
Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (bowel).
Diverticular disease occurs when one (diverticulum) or multiple small bulges or pockets (diverticula) develop in the large intestine and cause symptoms such as tummy pain and constipation. However, diverticula doesn’t always cause symptoms – this is known as diverticulosis.
Sometimes, the diverticular can become inflamed or infected when bacteria gets trapped inside one of the bulges. This is called diverticulitis and it can cause more severe symptoms, which we’ll go into next.
What are the symptoms of diverticular disease & diverticulitis?
Symptoms of diverticular disease can include:
• Tummy pain in the lower left side – this can come and go and generally gets worse during or shortly after eating (pooing or passing wind may help relieve this)
• A change in bowel habits such as constipation, diarrhoea or both
• Having blood in your stool
Diverticulitis symptoms can come on suddenly following an infection or inflammation of diverticula. These include:
• Constant, more severe tummy pain
• A high temperature
• Diarrhoea or constipation
• Having mucus or blood in your poo, or rectal bleeding (bleeding from your bottom)
If you notice any of the above symptoms for diverticular disease or diverticulitis, speak to your GP as soon as possible.
What causes diverticular disease & diverticulitis?
While the exact reason for diverticular disease developing is unclear, what we do know is that diverticulitis is caused by an infection of one or more of the diverticula. This infection can be triggered when hard stool or undigested food becomes trapped in one of the pouches, giving bacteria the chance to spread. Both conditions are also thought to be linked to age, genetics, diet and lifestyle.
Age
As you get older, particularly from 40 onwards, it’s estimated that two out of three people will develop diverticula (the small bulges or pockets) during their lifetime, with most people having had it by time they’re 80 years old.
This is due to the walls of your large intestine gradually becoming weaker, meaning that the pressure from passing hard stools through the intestine can cause diverticula to form.
Genetics
If you have a close relative with diverticular disease or diverticulitis, especially if they had it before 50 years old, you’re more likely to develop diverticula at some point in your lifetime.
Diet
There’s no exact reason why diverticula develop, but it’s thought to be associated with not eating enough fibre.
Eating a diet rich in fibre can help with digestion, prevent constipation and make stools softer and larger, putting less pressure on the walls of your intestine and making them easier to pass through.
However, if your diet is lacking fibre (adults should have around 30g per day), this can cause smaller and harder pieces of stool to pass through the large intestine. These smaller pieces can create weak spots on the outside layer of muscle, allowing the inner layer (mucosa) to squeeze through, creating diverticula.
Lifestyle
A couple of lifestyle factors can also put you at greater risk of developing diverticular disease and diverticulitis, including:
• Smoking
• Being overweight or obese
• Having a history of constipation
• Having long-term and regular use of painkillers such as aspirin or ibuprofen
If any of the above relate to you, there’s a couple of things you can do to help which we’ll get into soon.
How are diverticular disease & diverticulitis diagnosed?
Sometimes, diagnosing diverticular disease and diverticulitis can be difficult as they share similar symptoms with other conditions, such as irritable bowel syndrome (IBS), coeliac disease and bowel cancer. However, during your appointment, your GP will examine your symptoms and ask about your family history to rule out any of the above conditions and any other possible causes.
Your GP may suggest doing a blood test and if necessary, you may be offered one or more of the following tests where you’ll be given a laxative beforehand to clear out the bowels.
• Colonoscopy – where a thin tube with a camera (a colonoscope) is inserted into your rectum and guided up to your bowel. Your doctor will look for diverticula or signs of diverticulitis
• CT scan – where an X-ray and computer create images of the inside of your body to detect diverticular
• CT colonography or virtual colonography –where a tube is inserted into the rectum to pump air into it. This may be used in combination with a CT scan
What treatment is available for diverticular disease & diverticulitis?
If your test results come back positive for diverticular disease or diverticulitis, your GP will advise you on the next steps and treatment options available to you.
Treatment for diverticular disease
Diet
Eating a high-fibre diet can help relieve symptoms and discomfort caused by diverticular disease. Foods rich in fibre include:
• Fresh and dried fruits
• Vegetables – these can be added as a side to a meal or in soups, sauces and stews
• Pulses such as beans, lentils and chickpeas
• Nuts – particularly almonds, pecans, chestnuts and hazelnuts
• Cereals – this includes porridge oats as well as wholegrain and wholewheat cereals such as Weetabix and Shredded Wheat
• Starchy foods such as granary breads, potatoes and wholemeal pasta
Typically, adults consume 20g of fibre a day, however the NHS recommends 30g per day. If you’re not sure where to start or how to incorporate more fibre into your diet, you can find more information on the NHS guide.
Alternatively, you may want to consider taking fibre supplements, if suitable for you. They often come in powder format in a sachet, like the Boots Good Gut Daily Fibre Sachets. These can be mixed with water to help you reach your daily recommended fibre intake.
Gradually altering your diet over a few weeks and drinking plenty of fluids can help prevent the symptoms of diverticular disease associated with a high-fibre diet, such as bloating and flatulence.
Medicine
If you’ve been diagnosed with diverticular disease, your GP may recommend taking paracetamol to help relieve any pain and discomfort. If you find that paracetamol alone isn’t working, speak to your GP for further advice.
It’s important to note that painkillers including aspirin and ibuprofen should not be taken for pain relief of diverticular disease symptoms as these can cause stomach upsets. Speak to your GP or pharmacist for more advice on this if you’re unsure.
They may also suggest you take bulk-forming laxatives to help with the constipation and diarrhoea, if you’re experiencing these symptoms.
Treatment for diverticulitis
Diet
Unlike diverticular disease, the diet for helping ease the symptoms associated with diverticulitis involves eating a very low-fibre diet to help your digestive system rest.
Depending on the severity of your symptoms, your GP may recommended a fluid-only diet until you see an improvement. However, once your symptoms have gone, you can gradually go back to a high-fibre diet.
Medicine
Your GP may prescribe a course of antibiotics to help treat the symptoms of diverticulitis. You can still take paracetamol for pain relief but speak to your GP before taking these alongside antibiotics or if you find paracetamol alone isn’t helping.
For the most part, diverticular disease and diverticulitis can be treated at home. However, in some cases there may be complications, meaning you may need to be treated in hospital where you’re likely to receive:
• Injections of antibiotics
• A tube directly connected to your vein (intravenous drip) to keep you hydrated and nourished
• A stronger prescription of painkillers if paracetamol isn’t helping
Surgery
One of the most common complications of diverticulitis is forming an abscess. These can be treated via a technique called percutaneous drainage, which is carried out by a radiologist.
If there’s serious complications of diverticulitis, surgery may be needed. If this is the case, your doctor will discuss the benefits and risk factors beforehand as well as answering any questions you may have. We’d recommend bringing a friend or family member with you to take notes.
The surgeon will then carry out a colectomy which involves removing the infected section of your large intestine. Following the colectomy, you may have a temporary or permanent colostomy where one end of your bowel is directed through an opening in your stomach.
In rare cases, the surgeon may decide that your large intestine either needs to heal before it can be reattached or if too much of it has been removed to be reattached. If this happens, then stoma surgery will be required. Stoma surgery (known as ‘having a bag’) enables waste materials from your body to be removed without using all of your large intestine, collecting faeces (poo) into a bag that’s stuck to the skin on your belly.
When to see your GP
Speak to your GP as soon as possible if you notice symptoms of diverticular disease or develop symptoms of diverticulitis.
If, after being diagnosed, you have severe pain or you experience bleeding, seek immediate help from your GP. If this is not possible, call NHS 111 or your local out-of-hours service.
Find more information for a range of digestive problems in our digestion and gut health hub.
