Diverticulitis
What is diverticulitis?
Diverticula are small, bulging pouches that can form in the lining of the digestive system. Diverticulosis occurs when these pouches (diverticula) develop in the digestive tract. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.
Diverticulosis affects around 10% of people over the age of 45 and 65% of people over the age of 70, with about a quarter of these developing diverticulitis.
What are the symptoms of diverticulosis and diverticulitis?
Diverticulosis is when small, bulging pouches form in the lining of the digestive system (with no inflammation), and diverticulitis is when these pouches become inflamed.
Symptoms of both can be different.
Diverticulosis
Most people with diverticulosis experience no symptoms at all. However, between 15%-20% of people with the condition will experience some symptoms, that are not due to inflammation or infection. These can be similar to those related to bowel cancer and may include:
abdominal bloating and pain
diarrhoea or constipation
flatulence (farting)
blood in your faeces (poo)
anaemia due to repeated bleeding
Diverticulitis
Symptoms associated with diverticulitis (inflammation or infection) may include:
pain which can range from mild to severe, usually on the lower left-hand side of your abdomen
nausea or vomiting
fever
a distended abdomen
a change in bowel habits such as diarrhoea or constipation
blood or mucous in your faeces
What causes diverticulosis and diverticulitis?
A low fibre diet in combination with a high intake of animal fat may increase the risk of constipation (a build-up of waste products in the colon). This puts extra strain on the walls of the colon and this pressure causes these pockets or pouches to form.
Diverticulitis occurs when these areas become inflamed or infected, usually as a result of bacteria from food or faeces becoming trapped in one of these bulges.
Risk factors for diverticulitis
There is no one cause of diverticulosis, but there are risk factors that increase your risk of developing the condition. These include:
age — the incidence increases with age and is more common over the age of 40
gender — men are at higher risk than women
obesity
smoking
a diet low in dietary fibre and high in animal fat
lack of exercise
some medications including steroids, opioids and non-steroidal anti-inflammatories (NSAIDs)
How is diverticulitis diagnosed?
Diverticulosis is usually diagnosed during investigations for other conditions such as bowel cancer. However, diverticulitis is commonly diagnosed during an attack. Diagnosing diverticulitis will usually involve several steps which may include:
conducting a medical history, including lifestyle and dietary habits
physical examination, including a rectal examination
blood tests
stool (poo) samples to check for signs of blood or infection
colonoscopy — an examination used to detect changes or abnormalities in the large intestine (colon) and rectum
barium enema — a special imaging procedure to look for abnormalities in the colon
CT scan to check for abscesses
What are the complications of diverticulitis?
Diverticulitis can result in some serious complications which may include:
abscesses (balls of pus in the bowel)
blockage of the bowel
the development of a fistula (an abnormal passageway when an ulcer extends through the entire thickness of the bowel wall) between parts of the bowel, or between the bowel and other organs
perforation of the bowel where contents of the bowel leak into the abdominal cavity
peritonitis, a life-threatening complication where the membranes of the abdominal cavity and abdominal organs become infected
heavy bleeding (haemorrhage)
How is diverticulitis treated?
For mild attacks of diverticulitis, treatment will usually involve giving your bowel time to heal by having a fluid-only diet, or one with low fibre. You may also need antibiotics and/or pain relief medication while you recover.
Severe cases of diverticulitis often require hospitalisation where you can be given antibiotics and fluids via a drip, along with stronger pain relief if required. Most of the time treatment is effective. However, in some cases, surgery may be required. This is usually the case if you have:
a complication such as:
an abscess in the bowel
fistulao obstruction in the bowel
perforation or puncture in the bowel wall
had multiple episodes of uncomplicated diverticulitis
a weak immune system
Surgery may involve removing diseased parts of your intestine and connecting the healthy segments, so you can continue to have normal bowel movements.
If there has been severe damage to your colon and it’s not possible to reconnect the colon to the rectum, then a procedure called a bowel resection with colostomy may be necessary. This is where an opening (stoma) is created in the abdominal wall and is connected to a healthy part of the bowel. Waste passes through the opening into a bag which is worn on the outside of the body.
When to see your doctor
Any changes to your bowel habits should be investigated by your doctor as they may be symptoms of diverticular disease or even bowel cancer. However, you should seek urgent medical attention if you feel very unwell or have:
very severe abdominal pain
a fever
vomiting
blood in your faeces
Can you prevent diverticulitis?
While the exact cause of diverticular disease is unknown, diverticulitis is associated with a sedentary lifestyle and a low-fibre diet. The following steps may be beneficial in reducing the risk of developing the condition:
eating a diet rich in fibre, especially by increasing your daily intake of green vegetables
using a fibre supplement, if appropriate
drinking plenty of fluids to ensure your stools are easy to pass
exercising regularly to aid regular bowel function
Your local MediADVICE pharmacist is available to help you manage your health and we can recommend a range of products to assist in the management and treatment of diverticulitis symptoms. Speak to your MediADVICE pharmacist about your symptoms so we can recommend products and medications that may be suitable for you.
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