Diverticular Disease

What is Diverticular Disease?

Diverticular disease is an increasingly common health problem in Singapore, affecting residents over 40 years of age. It is characterized by small pouches of inflamed tissue (diverticula) in the wall of the large intestine. Though it may sound alarming, diverticular disease is most often asymptomatic and can be managed with a healthy diet and lifestyle. 

The condition has a variety of causes. Sometimes, diverticular disease occurs due to a lack of fiber in the diet, which can cause stool to become hardened and form blockages in the intestine. In other cases, the condition may be caused by an imbalance in the microbiome of the digestive tract, leading to inflammation and subsequent formation of diverticula. 

Additionally, diverticular disease may be caused by a bacterial infection in the intestine.  Though diverticular disease is often asymptomatic, it can lead to painful and uncomfortable symptoms. Common symptoms of diverticular disease include abdominal pain, bloating, and frequent constipation or diarrhea. 

Additionally, individuals with diverticular disease may see traces of blood in their stool, accompanied by abdominal cramps. The treatment for diverticular disease varies depending on the severity of the condition. In most cases, dietary and lifestyle changes can help manage symptoms and prevent complications. 

This may include increasing fiber intake, reducing alcohol consumption, quitting smoking, maintaining a healthy weight, and managing stress. Additionally, avoiding foods that are high in fat and sugar can help reduce symptoms and prevent flare-ups. In more severe cases, medication may be necessary to reduce inflammation and manage symptoms. 

Antibiotics may also be prescribed to treat any underlying bacterial infection. In very rare cases, surgery may be necessary to correct the condition. However, surgery is only recommended when other treatments have been unsuccessful. Though it can be a challenging condition to manage, diverticular disease is usually not life-threatening. 

The key is to make lifestyle changes, such as increasing fiber intake, to reduce the risk of flare-ups. With the right treatment, individuals with diverticular disease can lead a healthy and comfortable life. In general, diverticular disease do not require surgery, however, when they present as emergencies, then surgery might be needed to overcome the immediate danger.

What are the Common Symptoms of Diverticular Disease?

Generally, diverticula exhibit no symptoms and can remain undiscovered without medical intervention. However, when symptoms do appear due to complications of diverticular disease, they can range from mild to severe. The most common symptom of diverticular disease is abdominal pain. 

This pain is often intermittent, localized to the lower left abdomen and can range from a mild ache to a sharp, stabbing sensation. Other symptoms of diverticular disease include bloating, constipation, diarrhea and blood in the stool. Some patients may also experience nausea, vomiting and rectal bleeding.

In addition to these symptoms, diverticular disease can lead to further complications such as diverticulitis, which is a severe inflammation of the diverticula, and perforation of the colon. Perforation can be life-threatening and requires immediate medical attention. If you are experiencing any of the above symptoms, it is important to seek medical attention. 

Your doctor will be able to diagnose and treat your condition, as well as advise you on how to prevent further complications. Treatment options may include lifestyle changes such as increasing your fiber intake and exercising regularly, as well as medications and in some cases, surgery.

To reduce your risk of developing diverticular disease and its associated complications, it is important to adopt a healthy lifestyle. This includes making sure to get enough exercise, eating a balanced and high-fiber diet and drinking plenty of fluids. Regular check-ups with your doctor can also help to identify any issues early on and ensure that any issues are managed and treated promptly.

What is the Difference Between Diverticular Disease and Diverticulitis?

Diverticular disease and diverticulitis may sound similar, but they are actually two very distinct conditions. Diverticular disease is a condition in which small pouches or sacs form in the lining of the large intestine. These pouches, also known as diverticula, can cause abdominal pain, bloating and nausea. Diverticulitis is a more serious and advanced condition of diverticular disease, which is caused by inflammation of the diverticula.

Diverticular disease consists of two stages. The first stage is the initial formation of diverticula, which can cause mild abdominal pain, bloating and changes in bowel habits. The second stage is when the diverticula becomes infected, leading to diverticulitis. Symptoms of diverticulitis include intense abdominal pain, fever, nausea, vomiting and changes in bowel habits. In severe cases, abscesses or fistulas may develop as a result of the infection.

The primary difference between diverticular disease and diverticulitis is the severity and intensity of the symptoms. While diverticular disease may cause mild abdominal pain, bloating and nausea, diverticulitis is associated with more intense and severe symptoms such as fever and intense pain. It is important for patients to recognise these symptoms early on, so that they can seek timely and appropriate treatment at colorectal clinics. 

This will help prevent the condition from worsening and leading to a significant decline in one’s quality of health. If left untreated, diverticulitis can cause serious complications such as a perforation of the colon, an abdominal abscess and a fistula. These conditions can be life-threatening, so it is critical that patients recognise the symptoms of diverticular disease and diverticulitis, and seek timely medical attention.

What are Some Possible Complications of Diverticulitis?

While diverticulosis (the presence of these sacs) is typically asymptomatic, diverticulitis occurs when the sacs become inflamed, leading to symptoms such as fever and abdominal pain. Though diverticulitis is rarely life-threatening, it can lead to complications which require medical attention.

  • Abscesses: When the diverticula become infected, they can fill with pus, leading to an abscess. The abscess can cause vomiting and diarrhea, and typically requires treatment with antibiotics. If the abscess is large, it may need to be drained surgically.
  • Blockages: If the sacs become inflamed and scarred, this can lead to a blockage, or strictures, in the bowel. This can cause nausea, vomiting, and constipation, and can require surgical intervention to relieve the obstruction.
  • Fistulas: An abnormal connection, or fistula, may form between sections of bowel or between the bowel and other organs, such as the bladder or vagina. This can cause pain and drainage, and may need to be surgically repaired.
  • Peritonitis: In severe cases of diverticulitis, the infected or inflamed pouch can rupture, spilling contents into the abdominal cavity, leading to a serious condition called peritonitis. This is a surgical emergency and requires immediate medical attention, typically including antibiotics and possibly surgery.

Complications of diverticulitis can be serious, but they are often avoidable by eating a high-fiber diet and seeing your doctor if you experience any symptoms such as fever, abdominal pain, or changes in bowel habits. If you are diagnosed with diverticulitis, it’s important to follow your doctor’s treatment plan and take steps to prevent recurrence.

What are the Treatment Options for Diverticulitis?

Diverticulitis can be a debilitating condition, so it’s important to be aware of the available treatment options. Though some cases may be mild and managed with simple at-home treatments, other cases may require hospitalization and surgery. Here are some of the treatment options for diverticulitis.

Medical Treatment

In mild cases, a high-fiber diet, simple painkillers, and oral antibiotics can help. If the diverticulitis is more severe, hospitalization may be necessary to receive intravenous fluids and antibiotics with stronger painkillers.


In rare cases, surgery may be needed to treat serious complications of diverticulitis. Surgery usually involves removing the affected section of the large intestine, which is called a colectomy. This is the treatment for rare complications such as fistulas, peritonitis, or a blockage in the intestines.

Lifestyle Modifications

Along with medical and surgical treatment, making lifestyle modifications can help manage diverticulitis. Eating a high-fiber diet, drinking enough water, exercising regularly, and managing stress can all help to reduce symptoms and prevent future flare-ups.

Alternative Treatments

In some cases, alternative treatments may be helpful in relieving symptoms and improving quality of life. This includes probiotics, homeopathy, acupuncture, yoga, and massage therapy.

Diverticulitis is a potentially serious condition, and it is important to seek treatment as soon as possible to avoid more serious complications. There are a variety of treatment options available, so be sure to discuss them with your doctor to find the best one for you. With the right treatment and lifestyle modifications, it is possible to control diverticulitis and live a healthy life.

Frequently Asked Questions

  • What is diverticular disease?

    This refers to the presence of diverticula in the colon. It is common in patients over 40 years of age. There are also some differences in the prevalence between Asians and Americans. While right sided diverticulitis is common amongst Asians, it is very rare amongst Americans. 

    Almost invariably, diverticulitis occurs in the sigmoid (colon on the left side) in the Western population and the root cause is usually attributed to that of hyperperistalsis or increase in pressure in the colon. 

    Amongst Asians, right sided diverticulitis though less frequent than less sided diverticulitis, is a common mimicker of appendicitis and other causes of right sided abdominal pain. There is no proven theory of why this is the case, but the current understanding is that of genetic predisposition and interaction with microbiomes. 

  • Is diverticular disease serious?

    Symptomatic diverticular disease almost always resolves without any medication. The important thing to do is a colonoscopy to exclude other causes of similar symptoms like colitis or cancer. 

    When infected, i.e. diverticulitis, antibiotics are successful in treating it more than 80% of the time. Thus the role of surgery is limited to those who fail conservative treatment or develop other complications as mentioned in the above section. 

    For those patients who have a severe diverticulitis, it is important to be managed with appropriate measures and be monitored closely for any signs of severe sepsis. In such cases, it can lead to severe consequences and surgery is often performed as an emergency.

  • Should I worry about diverticular disease?

    No. As mentioned, it is very common and there is no need for any surgery in most cases. This condition itself is also not related to colon cancer and most patients remain well and asymptomatic throughout their entire life.

  • Can diverticular disease become cancerous?

    No. Diverticular disease does not become cancerous. In recurrent diverticulitis, stricture may form and sometimes in these cases, it is hard to exclude a concomitant cancer as the endoscopy is unable to reach beyond the narrow part of the colon. 

    This does not imply that diverticular disease causes the cancer, but rather any patient with diverticular disease should have a colonoscopy done at least once to exclude a cancer which can mimic the signs and symptoms of diverticular disease.

  • Can I still live a normal life with diverticular disease?

    Certainly, anyone can live a normal life with diverticular disease. Many people don’t even require any changes to be done. The only necessary thing to do is to have a colonoscopy done if not done before to exclude colorectal cancer. 

    In terms of lifestyle, there are different suggestions mentioned under the section of treatment options. These advice add to the overall wellbeing and can improve symptoms for those patients who have symptomatic diverticular disease.

  • Can diverticular disease go away on its own without medical intervention?

    Diverticular disease being an outpouching that has developed in the colon is an anatomical anomaly that remains unchanged and will not go away. That being said, it usually does not lead to any serious consequences and most patients remain well and asymptomatic. 

    The only way to remove them is through surgery which is only indicated in severe disease or complications. (See above section under complications of diverticulitis) Endoscopic measures to invaginate these outpouches are not indicated and ill-advised as these can lead to severe complications like perforations of the colon.

  • What is the best treatment for diverticulitis?

    Antibiotics are the mainstay for most patients with diverticulitis. In the Netherlands and Sweden, large scale studies have also shown that patients with mild diverticulitis can be safely treated with any need for antibiotics. (AVOD and DIABOLO trials) This is selected for patients with early or mild diverticulitis. Other than medications, most treatments include supportive measures like intravenous hydration and gut rest.