- Low-Fibre Diet: A diet low in fibre results in harder stools, requiring more pressure during bowel movements, which can lead to the formation of diverticula.
- Age: The likelihood of developing diverticular disease increases after age 40, with the highest prevalence in individuals over 60.
- Obesity: Excess body weight increases pressure on the colon wall and may alter the balance of gut bacteria.
- Sedentary Lifestyle: Lack of physical activity slows bowel motility and raises the risk of constipation, contributing to diverticula formation.
- Genetic Factors: Some individuals may have a family history that increases their risk of developing diverticula.
- Medications: Regular use of certain drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), has been linked to a higher risk of diverticular disease.
Diverticular Disease
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Diverticular disease occurs when small pouches, called diverticula, form in the wall of the large intestine, most often in the lower part (sigmoid colon). These pouches are common, especially as people get older, and usually do not cause problems. However, if they become inflamed or infected – a condition known as diverticulitis – they can lead to symptoms such as belly pain, changes in bowel habits, and sometimes fever. Diverticular disease is increasingly common and can often be managed with lifestyle changes, medication, or, in some cases, surgery.
Symptoms of Diverticular Disease
Diverticular disease symptoms can vary from mild discomfort to serious complications, depending on the stage of the condition.
- Abdominal Pain: Pain is usually felt on the lower left side of the abdomen and may worsen during meals but ease after passing stool or gas.
- Changes in Bowel Habits: Constipation and diarrhoea may alternate, with these changes often lasting from several days to weeks.
- Bloating: The abdomen can feel swollen or tender, particularly after eating or during flare-ups.
- Nausea: Mild to moderate nausea is common, especially during episodes of acute inflammation.
- Fever: A temperature above 38°C may occur if an infection develops in the diverticula.
- Rectal Bleeding: Bright red blood in the stool may appear, which requires urgent medical attention.
Causes and Risk Factors
Several factors contribute to the development of diverticular disease. Common causes and risk factors include:
Forms of Diverticular Disease
Diverticular disease manifests in various forms, each with different levels of severity and required treatment.
Diverticulosis
This refers to the presence of diverticula without any inflammation or noticeable symptoms. Most individuals with diverticulosis remain symptom-free, and the condition is often detected during routine screenings. These pouches can persist without causing issues, though regular monitoring and dietary adjustments may help prevent progression.
Acute Diverticulitis
This occurs when the diverticula become inflamed or infected, leading to noticeable symptoms such as severe abdominal pain, fever, and changes in bowel habits. Immediate medical attention is often necessary, as complications like abscess formation or perforation can arise without proper treatment.
Chronic Diverticulitis
This involves recurring or prolonged episodes of inflammation. Patients may experience intermittent flare-ups with varying symptom severity. Over time, this form can cause thickening and narrowing of the bowel wall, potentially disrupting normal intestinal function. Long-term management and monitoring are usually required.
Diagnostic Methods
Physical Examination
The doctor performs a thorough abdominal examination to check for tenderness and masses. This initial assessment helps determine the location and severity of pain. The examination may also include checking vital signs and reviewing medical history.
CT Scan
Computed tomography provides detailed images of the bowel wall and surrounding tissues. This test can identify inflamed diverticula, abscesses, or other complications. The scan typically requires oral or intravenous contrast material for better visualisation.
Colonoscopy
A flexible tube with a camera examines the entire colon, but this test is usually performed after inflammation has resolved. The procedure allows direct visualisation of diverticula and rules out other conditions. Preparation involves complete bowel cleansing the day before.
Blood Tests
Laboratory analysis checks for signs of infection and inflammation. These tests measure white blood cell count, C-reactive protein levels, and other markers that may indicate active disease. Results help guide treatment decisions.
Treatment Options
Treatment approaches vary based on the type and severity of diverticular disease, ranging from conservative management to surgical intervention.
Non-Surgical Treatment
- Dietary Modifications: A high-fibre diet helps prevent constipation and reduce pressure on the colon wall. This approach includes gradually increasing fibre intake along with adequate fluid consumption. Regular monitoring and adjustment of fibre intake may be necessary.
- Antibiotics: Antibiotics may be prescribed for acute diverticulitis to treat bacterial infection. The course typically lasts 7-14 days, with the specific antibiotic choice based on severity and patient factors. Some cases may require intravenous administration in a hospital setting.
- Pain Management: Over-the-counter pain relievers help control discomfort during flare-ups. Acetaminophen is often recommended over NSAIDs, as the latter may increase complication risks. The duration of pain medication use depends on symptom severity.
Surgical Treatment
- Bowel Resection: This involves surgically removing the affected part of the colon when non-surgical treatments are unsuccessful. The procedure can be done using minimally invasive laparoscopic techniques or traditional open surgery, depending on the patient’s condition. Recovery usually takes 4 to 6 weeks.
- Emergency Surgery: Immediate surgery is required for serious complications such as perforation or abscess formation. In many cases, this involves creating a temporary colostomy to allow the bowel to heal. A follow-up surgery is often performed later to reverse the colostomy and restore normal bowel function.
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Prevention and Management
The prevention and management of diverticular disease focus on promoting bowel health and alleviating symptoms. A fibre-rich diet with 2–3 litres of daily water intake supports regularity, while regular exercise, weight management, and smoking cessation lower the risk of complications. Keeping a food diary helps identify triggers, and consistent eating habits aid digestion. During flare-ups, following temporary dietary restrictions as advised can minimise symptoms. Regular medical check-ups ensure proper monitoring and adjustments to the treatment plan.
Frequently Asked Questions
Can diverticular disease occur in younger people?
Although diverticular disease is more common in individuals over 40, it can also develop in younger people, especially those with risk factors such as obesity, a low-fibre diet, or a sedentary lifestyle.
Are there any long-term dietary restrictions after recovering from diverticulitis?
Most people can gradually reintroduce high-fibre foods into their diet after recovery. However, specific trigger foods should be avoided if they cause symptoms, and any dietary changes should be made under medical guidance.
How often should I have follow-up screenings for diverticular disease?
Follow-up screenings are typically recommended every 1–3 years for individuals with a history of diverticulitis or complications, depending on their symptoms, risk factors, and age. Those with no ongoing symptoms or risk factors may only need periodic screenings as part of routine health check-ups, as advised by their doctor.
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Dr Chong Choon Seng
MBBS (NUS)
MRCS (Edinburgh)
Masters in Medicine (Surgery)(NUS)
FRCS (Edinburgh)
Dr Chong is the former Program Director of General Surgery Residency at NUHS, and has more than 10 years of experience as a colorectal and general surgeon.
As an esteemed professional in minimally invasive surgery, Dr. Chong remains committed to achieving optimal outcomes for all surgical conditions, from piles to cancer treatment.
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