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Diverticulosis and diverticulitis

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Diverticulosisoccurswhensmalldefectsinthemuscleofthewallofthelargeintestineorcolon
allowsmallpocketsorpouches(diverticula)toform.Diverticulitisisinfectionorinflammationof
theseabnormalpouches.Together,theseconditionsarecalleddiverticulardisease.
Despitehavingsomesymptomsincommon,diverticulardiseaseisntassociatedwithmoreserious
conditions,suchasbowelcancer.However,diverticulitisisoftenamedicalemergency,requiring
immediatemedicalattentionand,frequently,admissiontohospital.Mildattackscanbetreatedat
home,butshouldalwaysbeassessedpromptly.

Causes of diverticular disease

Diverticulosisisextremelycommon.Oldageanddietmaybethemostimportantriskfactors.More
thanhalfofalladultsovertheageof70havethecondition.Mostofthesepeopleareunawarethat
theyhavediverticulosis.
Diverticulosisislesscommoninpeopleunder50.Studiesappeartoshowthatdiverticulosis
becamemorecommoninthe20thcentury.ItisalsomorecommoninWesternnationsincluding
NorthAmerica,EuropeandAustralia.ItislesscommoninAsiaandveryuncommoninAfrica.
Discoveryofthesefactsledtothetheorythatthelow-fibredietcommoninWesternnationsmay
beimportant.Animalstudiesshowthatthistheoryispossible.Ithasalsobeenshownthat
vegetarianslesscommonlydevelopdiverticulosis.Exactlyhowalow-fibredietmaycause
diverticulosisisnotknown.
Theremayalsobegeneticcauses.ItisinterestingthatWesternpeopledevelopdiverticulosisinthe
lastthirdofthecolon,whilepeopleinAsiancountriessuchasJapan,TaiwanandSingapore
generallydevelopdiverticulosisinthefirstsectionofthecolon.IntheJapanesepopulationlivingin
Hawaii,theriskofdiverticulosisishigherthanthoselivinginJapan.However,whendiverticulosis
developsinthesepeople,itisstillintheJapaneselocationthefirstthirdofthecolon.
Diverticulitisseemstooccurwhenasmallpuncturedevelopsinthediverticularwall.Thiscausesa
smallinfectiontodevelop,oftenforminganabscess.

Symptoms of diverticulosis
Diverticulosisisusuallyasymptomatic(hasnosymptoms).However,whenmanydiverticula
(pouches)arepresent,thenormalsmoothworkingofthebowelcanbeaffected.Thismaycausea
rangeofsymptomsincluding:

abdominalpainandbloating
constipationanddiarrhoea
flatulence
bloodinthefaecesthisisusuallyminor,butbleedingcansometimesbeheavyifa
diverticulumgetsinflamedorisnearabloodvessel
anaemiafromrepeatedbleedingmayoccur.

Manyofthesesymptomsaresimilartothoseofbowelcancer.Diverticulosisismorecommon,so
thesesymptomsmaybemorelikelytobeduetodiverticulosisthancancer.However,aspecialist
willusuallyassessthesesymptomsyourdoctorwillreferyou.

Symptoms of diverticulitis
Symptomsofdiverticulitisinclude:

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sharppain,oftenlocatedataspecificpointforexample,inthelowerlefthalfofthe
abdomen
fever
distension(bloating)oftheabdomen
nauseaandvomiting.

Complications of diverticular disease

Someofthepossiblecomplicationsofdiverticulardiseaseinclude:

Abscessuntreated,diverticulitismayleadtoanabscess(aballofpus).
Perforationaweakenedpocketofbowelwallmayrupture.Thecontentsofthebowelcan
thenseepintotheabdominalcavity.Symptomsincludepain,highfeverandchills.A
perforatedbowelisamedicalemergency.
Peritonitisperforationcanleadtoperitonitis(infectionofthemembranesthatlinethe
abdominalcavityandabdominalorgans).Thiscomplicationispotentiallylifethreatening.
Haemorrhagediverticulacanbethesourceofhaemorrhage.Whenbleedingoccurs,itis
importanttoexcludeothercauses.Apersonwithdiverticulosiscanalsogetcancer.

Diagnosis of diverticular disease

Sincediverticulosisisoftenasymptomatic(withoutsymptoms),ittendstobediscoveredduring
examinationsforotherconditionssuchascolorectalcancer.Diverticulitisisusuallydiagnosed
duringanacuteattack.
Teststoconfirmthediagnosisofdiverticulardiseaseinclude:

medicalhistoryincludingdietaryhabits
physicalexaminationincludingrectalexamination
colonoscopyaslenderflexibletubeinsertedintotheanussothatthedoctorcanlookat
theentirelengthofthelargeintestine
bariumenemaaspecialcontrastingdyeflushedintothebowelviatheanusandx-rays
aretaken
CTscantodetectabscessesoutsidethebowellining
bloodteststocheckforsignsofinfection
stoolteststocheckforthepresenceofbloodinthefaecesorthepresenceofinfections,
whichmaymimicthesymptomsofdiverticulosisanddiverticulitis.

Treatment for diverticulosis

Forapersonwithdiverticulosis,thereisnoprovenwaytopreventtheformationofnewdiverticula.
Treatmentrevolvesaroundthesettlingofsymptoms.

Agradualswitchtoadietwithincreasedsolublefibre(greenvegetables,oatbranandfibre
supplementssuchaspsyllium)usuallyleadstoanimprovementinbowelhabitandmild
symptoms.
Somefoodsmaymakesymptomsworseorevenleadtodiverticulitis.Nuts,seedsandpips
arebestavoided,whilesomepeoplefindavoidinglegumes(peasandbeans)andsweet
cornalsohelps.
Short-termuseoflaxativestotreatandpreventconstipationmaybeadvised.
Rarely,electivesurgeryisperformedtoremoveseriouslyaffectedbowelsegmentswhen
symptomsaredisabling.

Treatment for diverticulitis

Diverticulitisisoftenamedicalemergency,requiringimmediatemedicalattentionand,frequently,
admissiontohospital.Mildattackscanbetreatedathome,butshouldalwaysbeassessed
promptly.Treatmentmayinclude:

noeatingordrinkingintravenousfluidsaregiventorestthebowel

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antibiotics
pain-relievingmedication
surgeryiftheweakenedsectionsofbowelwallhaverupturedorbecomeobstructed,orif
theattackofinfectionfailstosettle
colostomyifitisntpossibletorejointhehealthysectionsofbowel,acolostomybagwill
befitted.Thisismorecommonifthesurgeryisperformedasanemergency.Theuseofa
colostomyisgenerallytemporaryandthebowelcanberejoinedaftersixto12months,if
healthpermits
thelong-termuseofamildantibioticthisisoftennecessarytopreventfurtherattacks.

Self-care suggestions
Suggestionsinclude:

Increaseyourdailyintakeofgreenvegetables.Introducefibregraduallytoavoid
unpleasantsymptomssuchasflatulence.
Considerusingafibresupplement(suchaspsyllium).
Drinkplentyoffluidstoensureyourstoolsaresoft,moistandeasytopass.
Exerciseregularlytoencouragebowelfunctionandperistalsis.

Where to get help

Yourdoctor
Gastroenterologistorspecialistsurgeon

Things to remember

Diverticulosisistheformationofabnormalpouchesinthebowelwall.
Diverticulitisisinflammationorinfectionoftheseabnormalpouches.
Together,theseconditionsareknownasdiverticulardisease.
Treatmentoptionsincludeachangeofdiet,antibioticsand(rarely)surgery.

This page has been produced in consultation with, and approved by:

CanberraHospital-GastroenterologyUnit
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