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Diverticulosis and Diverticulitis

Posted Tuesday, 15 September 2020

Date issued: July 2024

For review: July 2026

Ref: A-285/AC/Colorectal/Diverticulosis and Diverticulitis v4

PDF: Diverticulosis and Diverticulitis v4.pdf [pdf] 235KB

Diverticulosis occurs when small defects in the muscle of the wall of the large bowel (colon) allow small pockets or pouches (diverticula) to form. Diverticulitis is infection or inflammation of these abnormal pouches. Together, these conditions are called diverticular disease.

Diverticular disease is not associated with more serious conditions, such as bowel cancer, despite some similar symptoms.

Causes of diverticulosis:

Diverticulosis is extremely common. Getting older and diet may be the most common risk factors. More than half of all adults over the age of 70 have the condition and most are unaware that they have diverticulosis. It is less common in people under the age of 50. One possible contributing factor is a low fibre diet and there may be genetic causes.

Symptoms:

Diverticulosis

Diverticulosis is usually asymptomatic (has no symptoms). When many diverticula (pouches) are present, the normal smooth working of the bowel can be affected. This may cause a range of symptoms including:

Pain in the left lower side of your tummy, a small number of people may have it on the right side
Tummy pain that may get worse after you eat and gets better if you poo or pass wind
Constipation and / or diarrhoea
Blood in the poo
Bloating / wind

Many of these symptoms are like those of bowel cancer. However, diverticulosis is much more common, so these symptoms may be more likely to be due to diverticulosis than cancer. However, a specialist will usually assess these symptoms.

Diverticulitis

Diverticulitis seems to occur when inflammation develops in the diverticular wall. This causes a small infection to develop, which could form an abscess.

Symptoms include:

Sharp pain, often located at a specific point, like in the lower left half of the tummy.
High temperature
Bloating of the tummy
Nausea and vomiting
Bleeding and / or mucous (Slime) from the bottom

Treatment options for diverticulitis:

Mild symptoms can be treated at home with a low fibre diet during a flare up, and returning to a higher fibre diet when the inflammation has settled. If your symptoms are worsening, please see your GP as sometimes it’s necessary for antibiotics to be prescribed. Diverticulitis occasionally requires admission to hospital, particularly if the pain is not settling and you remain unwell.

Diagnosis methods:

Since diverticulosis is often asymptomatic, it tends to be discovered during examinations for other conditions, such as suspected colorectal cancer. However, diverticulitis is usually diagnosed during an acute attack.

Together diverticulosis and diverticulitis are known as diverticular disease. Tests to confirm the diagnosis of diverticular disease may include:

Medical history: including dietary habits.
Physical examination: including rectal examination (finger inserted into the bottom)
Colonoscopy: a slender flexible tube is inserted into the bottom, to allow the doctor to look at the entire length of the Large bowel (colon).
Virtual colonoscopy: (CT colonoscopy) a small tube is used to gently inflate the large bowel (colon) and a CT scan is then taken of the tummy, outlining the colon.
CT scan: to detect abscesses outside the bowel lining.
Blood tests: to check for signs of infection.
Stool test: to check for the presence of blood in the poo or an infection, which may mimic the symptoms of diverticulosis and diverticulitis.

Treatment and self-care options for diverticulosis:

For people with diverticulosis, there is no proven way to prevent the formation of new diverticula. Treatment revolves around the settling of symptoms, and may include:

A gradual increase in the amount of fibre in your diet over a period of several weeks, which usually leads to an improvement in bowel habit. Doing it slowly reduces the side effects associated with a high fibre diet, such as bloating of the tummy and wind. Some people may find a diet high in fibre can make their symptoms worse. Examples of fibre include broccoli, oat bran, whole meal or wholegrain bread, whole grain cereals, brown or wild rice, whole wheat pasta and fibre supplements, such as ispaghula husk (Fybogel)
Drink plenty of fluids, at least 8 glasses (2-3 litres) of water a day.
Avoid excessive amounts of sugar, sweets, or fatty foods.
Increase your daily intake of green vegetables.
Exercise regularly to encourage bowel function and peristalsis (wave like contractions, which moves the poo through the bowel).
Short term use of laxatives to treat and prevent constipation.
Surgery, very rarely required, but elective surgery may be indicated to remove seriously affected bowel segments when symptoms are disabling.

Where to get help:

Your doctor, specialist nurse, dietitian

Tips for increasing fibre

Don’t underestimate the relevance of what you eat and drink and how it impacts on your bowels.

Swap white bread for whole meal or whole grain bread.
Swap refined cereals such as Rice Krispies® or Cornflakes® to wholegrain versions, such as porridge/Bran Flakes®/Weetabix®/Shredded Wheat®.
Add unprocessed bran to the diet, either in a dry state or mixed with other foods.
Swap white rice and pasta to brown/whole wheat varieties
Add extra vegetables to mince, casseroles, soups, stews, curry, or chilli.
Add beans and pulses to mince, casseroles, soups, stews, curry, or chilli.
5 portions of fresh fruit and vegetables
Try new fruit and vegetables that you’ve not had before.
Snack on a piece of fruit or vegetable sticks.
You can use fresh, frozen, or tinned fruit and vegetables.
Sprinkle seeds (e.g., pumpkin seeds, golden linseeds, sunflower seeds) over soups, salads, or yoghurts.
Choose foods labelled with 'high-fibre'.
Keep the skins on fruit and vegetables when possible. Some skins of some fruits are often rich in fibre e.g., pears, tomatoes, and potatoes.