Diverticular disease: symptoms, causes and treatment explained
Diverticular disease is a common condition affecting the large bowel, particularly in older adults. While many individuals remain symptom-free, others may develop symptoms or complications requiring medical attention.
Mr Derek Boyle, a consultant colorectal surgeon at Cleveland Clinic London Hospital, outlines what diverticular disease is, its causes, symptoms, and the treatment options available.
What is diverticular disease?
Diverticular disease refers to the formation of small pouches, known as diverticula, within the wall of the colon (large intestine), most commonly in the sigmoid colon.
When these pouches are present without causing symptoms, this is termed diverticulosis, which is very common and usually harmless.
When symptoms such as abdominal pain or altered bowel habits develop, the condition is referred to as diverticular disease.
If the diverticula become inflamed or infected, this leads to diverticulitis, which is a more serious condition.
What causes diverticular disease?
The development of diverticular disease is associated with increased pressure within the bowel and structural changes in the bowel wall.
Key contributing factors
- Low fibre diet: leads to harder stools and greater pressure during bowel movements.
- Ageing: weakening of the bowel wall over time.
- Lifestyle factors: obesity and reduced physical activity.
A low fibre diet remains one of the most significant modifiable risk factors.
Symptoms of diverticular disease and diverticulitis
It is important to distinguish between the symptoms of diverticular disease and diverticulitis.
In diverticulosis, there are typically no symptoms, and the condition is often found incidentally during investigations for other reasons.
In diverticular disease, symptoms are usually milder and long-standing. These commonly include persistent left-sided abdominal pain, bloating, and changes in bowel habits such as constipation or diarrhoea.
In contrast, diverticulitis presents more acutely and with greater severity. Symptoms may include significant abdominal pain, fever, nausea, vomiting, and occasionally rectal bleeding. These features suggest inflammation or infection and require prompt medical assessment.
How is diverticular disease diagnosed?
Diagnosis of diverticular disease is based on clinical assessment supported by investigations.
Common tests
- CT scan: gold standard for diagnosing diverticulitis.
- Colonoscopy: typically performed after resolution of acute inflammation.
- Blood tests: to assess for infection or inflammation.
Treatment options for diverticular disease
Management depends on the severity of symptoms and whether complications are present.
For diverticular disease, treatment is usually conservative and focuses on increasing dietary fibre, improving hydration, and managing symptoms with simple pain relief.
In cases of diverticulitis, treatment may involve antibiotics in selected patients, along with dietary modification and, in more severe cases, hospital admission for observation and supportive care.
Surgery is reserved for complications such as recurrent severe episodes, abscess formation, perforation, or bowel obstruction. When required, surgery is often performed using minimally invasive techniques.
Can diverticular disease be prevented?
Although not entirely preventable, the risk of diverticular disease can be reduced by:
- Maintaining a high fibre diet.
- Ensuring adequate fluid intake.
- Regular physical activity.
- Maintaining a healthy body weight.
Diverticular disease is a common condition that is often manageable with simple lifestyle measures. While many individuals remain asymptomatic, recognising symptoms and seeking timely medical advice is essential to prevent complications and ensure appropriate treatment.