Colorectal - Diverticulosis/Diverticular Disease

What is diverticulosis?

A diverticulum is a small pouch that protrudes from the wall of the colon. Diverticula means more than one diverticulum. They usually develop in the section of large bowel (colon) towards the back passage (anus) where stools become more solid. Diverticula are extremely common especially as we get older.

The reason why they develop is largely related to a lack of fibre in our food. Fibre is an indigestible material that helps to soften and bulk up our stools (faeces) making it easier for the muscular wall of the colon to squeeze it along and pass through. If you do not eat enough fibre the muscles have to work harder which puts pressure on parts of the colon. The increased pressure pushes the lining of a small area through the muscle wall to form a diverticulum.

In most cases this condition will be unknown as there are no symptoms and it is only detected during a colonoscopy or sigmoidoscopy (flexible telescope into the anus) which is carried out for other reasons. As diverticulosis means diverticula without symptoms there is no need for treatment; however, a high fibre diet is usually advised to prevent constipation.

High Fibre foods

• Wholegrain cereals such as all bran and bran flakes
• Whole meal and whole wheat bread and flour
• Brown rice and pasta
• Beans, pulses and legumes
• Fruit and vegetables
• Aim to drink 8-10 cups of fluid (mainly water) a day

Diverticular disease

This is a term used when the disease causes crampy abdominal pain or bloating. The pain tends to be on the left side and comes and goes. Some people may develop diarrhoea or constipation. These symptoms can be similar to those of bowel cancer, so it is important to have a colonoscopy to rule this out and confirm diverticular disease.

Diverticulitis

This term is used when one or more diverticulum become inflamed and infected. This happens when bacteria from trapped faeces multiplies and causes infection. During a flare up of diverticulitis you will usually require a course of antibiotics and strong pain killers. Symptoms should settle with this treatment if they are not too severe.

Symptoms of diverticulitis include:

• Constant severe abdominal pain
• High temperature (fever)
• Constipation and/or diarrhoea
• Blood mixed with stools
• Feeling sick (nausea) or being sick (vomiting)
• Bleeding from the back passage

Always report bleeding from the back passage as bowel cancer needs to be ruled out.

To prevent further irritation, avoid high fibre foods including seeds, nuts, raw vegetables and dried fruits for a short time.

Foods to eat during a flare up of diverticulitis

• White bread, pasta rice and noodles
• Plain crackers
• Potatoes without the skin
• Milk and dairy products
• Chicken and fish
• Eggs
• Low fibre cereals such as Rice Crispies and Cornflakes

If symptoms are severe, a clear fluid diet for a couple of days may be advised to rest the colon.

These include:

• Water
• Clear juices
• Teas and coffee without milk
• Ice lollies and jelly

As symptoms improve,eat low fibre foods, gradually re- introducing high fibre foods once you feel better.

An infected diverticulum (diverticulitis) can sometimes lead to serious complications and include:

• Bleeding caused by a burst blood vessel
• Blockage (obstruction) of the colon
• Collection of pus (abscesses)
• A channel (fistula) that connects organs together such as the bladder and bowel
• A hole (perforation) in the wall of the colon that can lead to infection in the abdomen (peritonitis)

If symptoms are severe or prolonged you may need to be admitted to hospital for treatment.