- Low-Fibre Diet: Inadequate fibre intake leads to harder stools, requiring more effort to pass through the colon. The increased pressure can cause weak spots in the colon wall to bulge outward, forming diverticula.
- Age: The risk increases with age, particularly after 40. As the colon wall weakens over time, it becomes more prone to diverticula formation and inflammation.
- Obesity: Excess body weight adds pressure on the colon and may alter gut bacteria, increasing inflammation risk. A sedentary lifestyle often compounds this effect.
- Sedentary Lifestyle: Lack of physical activity can slow bowel movements, contributing to diverticula formation. Regular movement supports bowel health.
- Smoking: Smoking weakens tissue strength and promotes inflammation throughout the body, including the digestive tract. It may also slow healing during acute episodes.
Diverticulitis
Dr Chong Choon Seng
MBBS | MRCS | Masters in Medicine (Surgery) | FRCS (Edinburgh)
Diverticulitis occurs when small, bulging pouches (diverticula) that form in the digestive tract become inflamed or infected. These pouches most commonly develop in the lower part of the large intestine (colon). The condition can cause severe abdominal pain, fever, nausea, and changes in bowel habits. While mild cases often respond to rest and antibiotics, severe or recurring episodes may require surgery.
Symptoms of Diverticulitis
Diverticulitis symptoms may develop suddenly or progress over several days. These can include:
- Abdominal Pain: The most common symptom, usually felt in the lower left abdomen. The pain is persistent and may last for days or even weeks.
- Fever: A temperature above 38°C may indicate an infection. Fever often develops alongside other symptoms and may be accompanied by chills or general discomfort.
- Changes in Bowel Habits: Constipation is more common, though some may experience diarrhoea. These changes can persist throughout an acute episode and take time to return to normal.
- Nausea and Vomiting: Often occurring with severe abdominal pain, these symptoms may reduce food intake and persist even with minimal eating.
- Bloating: Inflammation in the colon can cause abdominal distension and tenderness, often accompanying bowel habit changes.
Causes and Risk Factors
Several factors contribute to the development of diverticulitis or may trigger acute episodes. These include:
Types of Diverticulitis
Uncomplicated Diverticulitis
Inflammation or infection occurs within the diverticula without leading to severe complications. Most cases respond well to conservative treatment, such as dietary adjustments, oral antibiotics (if prescribed), and rest.
Complicated Diverticulitis
This form involves more serious complications, including abscesses, fistulas, bowel obstruction, or peritonitis. The infection may extend beyond the colon wall, leading to pus collections or abnormal connections between organs. Complicated diverticulitis requires urgent medical attention and may necessitate hospitalisation, drainage procedures, or surgery.
Diagnostic Methods
Physical Examination and Medical History
An abdominal assessment is conducted to check for tenderness and pain, along with a review of symptoms, their duration, and any previous episodes. This evaluation helps determine the need for further tests.
Blood Tests
A blood sample may show elevated white blood cell counts, indicating infection or inflammation. Additional markers help assess overall health and detect possible complications, guiding treatment decisions.
CT Scan
Computed tomography provides detailed images of the colon and surrounding tissues. It helps identify the extent of inflammation, detect complications such as abscesses or fistulas, and assess whether surgery may be required. The scan often involves oral or intravenous contrast for better visualisation.
Colonoscopy
Typically performed 6 to 8 weeks after an acute episode, this procedure uses a flexible tube with a camera to examine the inside of the colon. It assesses the extent of diverticular disease and helps rule out other conditions. Complete bowel preparation is required beforehand.
Treatment Options
Management of diverticulitis depends on severity, complications, and individual health factors, ranging from conservative care to surgical treatment.
Non-Surgical Treatment
- Antibiotics: Oral antibiotics target bacteria associated with diverticular infections. Treatment typically lasts 7–10 days, sometimes combining different antibiotics for broader coverage. Mild cases may resolve without antibiotics.
- Dietary Modifications: A clear liquid diet helps rest the bowel during acute episodes, with a gradual return to solid foods as symptoms improve. The transition depends on symptom resolution and individual tolerance.
- Pain Management: Over-the-counter pain relievers help manage discomfort. Stronger medications may be used short-term for severe pain but are prescribed cautiously to avoid masking complications.
Surgical Treatment
- Bowel Resection: The diseased portion of the colon is removed through open or laparoscopic surgery, depending on inflammation severity and overall health. In most cases, the remaining colon sections are reconnected.
- Emergency Surgery: Life-threatening complications, such as bowel perforation or peritonitis, require urgent surgical intervention. The procedure often involves removing the diseased section of the colon. In some cases, a temporary colostomy is needed to divert waste while the bowel heals, with the possibility of reversal in a later procedure.
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Prevention and Management
A high-fibre diet rich in whole grains, fruits, vegetables, and legumes supports digestion and may lower the risk of diverticulitis. Regular physical activity improves bowel function, while adequate hydration keeps stools soft and easier to pass. After an acute episode, dietary adjustments and activity levels should follow medical guidance, with routine check-ups helping to monitor and refine long-term management.
Frequently Asked Questions
Can diverticulitis recur after treatment?
About 30% of patients experience recurrence after their first episode. Each recurrence increases the likelihood of complications and may influence decisions about long-term management strategies, including surgical intervention.
Does diverticulitis require a permanent change in diet?
After recovery from an acute episode, most patients can return to a normal, high-fibre diet. Individual dietary triggers vary, and keeping a food diary helps identify specific items that may cause symptoms.
How does stress affect diverticulitis?
Stress may affect gut motility and inflammation, potentially triggering symptoms. Regular exercise, sufficient sleep, and relaxation techniques may help reduce flare-ups.
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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 20 years of experience in clinical practice.
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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