Diverticular Disease

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

Diverticular disease occurs when small pouches, called diverticula, form in the walls of the large intestine (colon). This condition, known as diverticulosis, is common in older adults and is usually harmless. However, when these pouches become inflamed or infected, it leads to diverticulitis, which may cause abdominal pain, fever, and changes in bowel habits. While diverticulosis typically does not cause symptoms, diverticulitis often requires medical attention to manage symptoms and prevent complications.

Types of Diverticular Disease

There are two main forms of diverticular disease: diverticulosis and diverticulitis.

Diverticulosis

Diverticulosis refers to the formation of small pouches (diverticula) in the colon. It usually does not cause symptoms and is often discovered during routine medical examinations, such as a colonoscopy. Most individuals with diverticulosis are asymptomatic.

Diverticulitis

Diverticulitis occurs when the diverticula becomes inflamed or infected. This condition may cause abdominal pain, fever, and bowel changes such as constipation or diarrhoea. In more serious cases, complications such as abscesses or blockages may develop, requiring medical treatment.

Causes of Diverticular Disease

The exact cause of diverticular disease is not well understood, but certain factors are thought to contribute to its development, such as:

Low-Fibre Diet

Fibre helps soften stools, making them easier to pass. Insufficient fibre intake can lead to harder stools and increased pressure on the colon, resulting in the formation of diverticula.

Ageing

The risk of developing diverticular disease increases with age, as the walls of the intestines may weaken over time, making it easier for diverticula to form.

Constipation

Chronic constipation, often caused by inadequate fibre intake or insufficient hydration, increases pressure in the colon, contributing to diverticula formation.

Obesity

Excess body weight is associated with an increased risk of developing diverticulitis. Obesity can elevate pressure on the intestines, contributing to inflammation or infection of the diverticula.

Symptoms of Diverticular Disease

The symptoms of diverticular disease vary depending on whether an individual has diverticulosis or diverticulitis.

Diverticulosis

Most individuals with diverticulosis do not experience any symptoms and may only discover the condition during a medical examination for unrelated issues.

Diverticulitis

When diverticula become inflamed or infected, individuals may experience several symptoms, including:

Abdominal Pain

Pain related to diverticular disease is often persistent, can range from mild to severe, and may worsen with movement or bowel movements. It occurs when the inflamed pouches irritate surrounding tissues in the colon.

Fever

Fever occurs as the body responds to the infection or inflammation in the diverticula. A high fever may indicate a more serious infection, such as an abscess.

Nausea or Vomiting

Nausea or vomiting can occur when diverticulitis disrupts normal digestive processes. Inflammation may slow down food movement through the intestines, leading to nausea, while more severe cases can result in vomiting.

Changes in Bowel Habits

Diverticulitis can cause constipation or diarrhoea due to inflammation interfering with normal bowel movements. Constipation may result from swelling in the colon that slows the passage of stools. Diarrhoea may occur if the irritation causes the contents to move faster through the intestines.

Bloating

Bloating occurs when inflammation causes swelling in the colon, leading to a feeling of fullness or tightness in the abdomen. Increased gas production in the irritated area can worsen this sensation.

Diagnosis of Diverticular Disease

Diverticular disease is diagnosed using a variety of methods, depending on the symptoms and severity.

Imaging Tests

A CT scan provides detailed images of the colon, allowing doctors to visualise inflamed or infected diverticula. This test helps confirm the presence and extent of inflammation, detect complications such as abscesses or perforations, and rule out other conditions with similar symptoms, such as appendicitis.

Blood Tests

Blood tests can detect elevated white blood cell counts, which indicate that the body is responding to infection or inflammation. An increase in white blood cells suggests that the immune system is actively fighting off a potential bacterial infection in the diverticula. Blood tests can also help assess the severity of the inflammation.

Colonoscopy

A colonoscopy involves inserting a flexible tube with a camera into the colon to directly view the intestinal walls and detect diverticula. This procedure is particularly effective for diagnosing diverticulosis (the presence of diverticula) in asymptomatic patients or those with mild symptoms. However, it is typically avoided during an active episode of diverticulitis due to the risk of further irritating inflamed tissues and potentially increasing the risk of perforation.

Treatment of Diverticular Disease

Treatment for diverticular disease varies based on the severity of the condition and whether the individual has diverticulosis or diverticulitis.

Non-Surgical Treatment

For mild cases of diverticulitis, non-surgical treatments are typically recommended to alleviate symptoms and prevent complications.

Antibiotics

Antibiotics are commonly prescribed to treat infections associated with diverticulitis, which help to reduce inflammation and limit the spread of bacteria. Completing the full course of antibiotics helps ensure the infection is completely cleared and reduces the risk of recurrence.

Pain Management

Over-the-counter pain relievers such as paracetamol are often used to manage discomfort associated with diverticulitis.

Surgical Treatment

In more severe cases of diverticulitis or when complications like perforation, abscesses, or obstruction occur, surgery may be required to prevent further issues and restore normal bowel function.

Bowel Resection

A bowel resection involves surgically removing the affected portion of the colon where the diverticulum is inflamed. This procedure reduces the risk of recurring diverticulitis and complications. The healthy parts of the colon are then reconnected to restore normal digestive function.

Colostomy

In more serious cases, where the colon requires time to heal after surgery or infection, a temporary colostomy may be performed. This procedure redirects waste through an opening in the abdomen into an external bag, allowing the colon to recover before it is reconnected later.

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Preventing Diverticular Disease

Lifestyle changes can help lower the risk of developing diverticular disease and prevent complications if diverticula are already present. A high-fibre diet rich in fruits, vegetables, and whole grains promotes softer stools and reduces pressure on the colon, while staying hydrated helps to prevent constipation.

Regular physical activity and maintaining a healthy weight support overall bowel health. Avoiding excessive straining during bowel movements minimises stress on the colon, reducing the likelihood of diverticular problems.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Can diverticular disease be completely cured?

    Diverticular disease, particularly diverticulosis, cannot be completely cured as the pouches (diverticula) that form in the colon typically remain. However, lifestyle changes such as a high-fibre diet, regular exercise, and proper hydration can help manage the condition and reduce the risk of diverticulitis.

    Can diverticular disease affect younger people?

    While diverticular disease is more common in older adults, it can affect younger individuals, particularly those with risk factors such as a low-fibre diet, chronic constipation, or obesity. Early lifestyle changes can help reduce the likelihood of developing the condition.

    How long does it take to recover from diverticulitis without surgery?

    For mild cases of diverticulitis, recovery usually takes about a week with antibiotics, rest, and dietary adjustments such as a low-fibre or liquid diet. More severe cases may take longer and require closer monitoring by a specialist.

    Can diverticular disease lead to long-term bowel issues?

    Recurrent diverticulitis or complications such as scarring may lead to long-term bowel issues, like chronic constipation or partial bowel obstruction. Regular follow-ups with a specialist, along with appropriate treatment, are necessary to manage these long-term effects and maintain bowel health.

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