Aliments – Diverticular Disease

Diverticulosis is a condition when pockets (also known as diverticula) develop in the colon, out-pouching through the weak muscle layers in the colon wall. It is a common condition that affects around 19% of Singaporean above the age of 14.

Diverticulitis describes inflammation of these pockets.

Most people with diverticulosis do not experience any symptoms, and even fewer will ever require surgery. Complications that can occur with diverticulosis include infection (diverticulitis) and bleeding (diverticular disease).

Diverticulosis
Most people with diverticulosis do not have any discomfort or symptoms. Some people may experience cramps or discomfort in the lower left abdomen, bloating, and changes in bowel habits (diarrhoea and constipation). Other conditions such as irritable bowel syndrome, stomach ulcers and colorectal cancer can cause similar symptoms, so these symptoms do not always mean a person only has diverticulosis.

Diverticulitis
The most common symptom of diverticulitis is abdominal pain. The most common sign on examination is tenderness in the abdomen. The pain is usually severe and comes on suddenly, but it can also be mild and worsening over several days. The intensity of the pain can fluctuate. A person may also experience cramping, nausea, vomiting, fever, and chills.

Diverticular bleeding
Some people with diverticulosis may experience sudden and massive bleeding from the rectum. This is usually of a large volume, and will require admission for monitoring and possibly blood transfusions. While more than 90% of patients with this condition will stop bleeding without any intervention, a small number of patients may have a life-threatening bleed that results in heart attacks, strokes or even death.

Diverticulitis can lead to intra-abdominal infection and abscesses. Small tears, called perforations may lead to fistula formation. And a tight narrowing in the colon can lead to obstruction. These complications may cause people to experience nausea, vomiting, fever, chills, and severe abdominal pain. Surgical treatment is then required to prevent these symptoms from worsening and causing serious illness.

Research indicates that a low fibre diet over many years may contribute to increased colon pressure. The increased pressure results in the formation of pockets in the colon.

For diverticulitis, treatment includes oral antibiotics, dietary restrictions, bed rest, and pain relief for mild cases. Severe cases of diverticulitis with acute pain and complications will require hospitalisation. Treatment may involve intravenous antibiotics and strict dietary restraints to help the colon rest. In some cases, surgery may be necessary.

Most patients with diverticular bleeding will require admission to the hospital for monitoring, and possibly blood transfusions. Most of these patients will stop bleeding on their own, but a small number may require surgical, or radiological, intervention to stop the bleeding. Patients will also need endoscopic examination of the colon.