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A Discussion On Diverticular Disease With Dr. Makarawo

What is diverticular disease?

Diverticular disease is a disease process where small pockets (diverticula) develop in the wall of the large intestine (colon). The most common site of these pockets is the sigmoid colon.

Diverticular disease is common presenting in 5% of people by age 40 and up to 80% of people by age 80.

Diverticular disease is subdivided into diverticulosis and diverticulitis.

Diverticulosis means the diverticula or pockets are present within the colon without any associated complications or problems.

Diverticulitis means the diverticula have become inflamed usually due to a tiny hole forming within the pocket. This can lead to one of several complications as listed below:

  • Abscess or pus pocket next to the colon which can lead to life-threatening infection and severe illness.
  • Stricture formation which is narrowing of the colon that could lead to complete blockage of the bowel.
  • Rectal bleeding which can be severe enough to be life-threatening.
  • Fistula formation where a tunnel forms between the colon and a nearby organ like the bladder, vagina or uterus.

What causes diverticular disease?

Diverticulosis or pocket formation in the colon is caused by high pressure within the colon. The high pressure in the colon is caused by straining during bowel movements which is most common with people that have a low fiber diet. The high pressure pushes on areas of the bowel wall that are weak causing pockets to form. It is these pockets that can then potentially rupture and lead to diverticulitis.

What are the symptoms of diverticular disease?

Most patients with diverticulosis have no symptoms or complications. If someone has an episode of diverticulitis, they may present with the following symptoms and signs:

  • Left lower abdominal pain
  • Fever
  • Rectal bleeding
  • Poor appetite and generally unwell

In addition, if they have complications of diverticulitis they may also have:

  • Difficult bowel movements associated with nausea and vomiting
  • Bubbles or stool seen when urinating
  • Severe abdominal pain all over the abdomen

How is diverticular disease diagnosed?

Diverticulosis often causes no symptoms. To diagnose it, it is often seen during colonoscopy done by your doctor when it is indicated. To diagnose diverticulitis, you would need to be examined by a physician and may require additional tests including CT scan of the abdomen and pelvis to confirm the diagnosis and ensure there are no complications of it.

How is diverticular disease treated?

Most people live their whole lives with diverticulosis and do not have any problems. To prevent formation of these pockets in the first place, it is recommended to eat a diet high in fiber including fruits and vegetables, and to limit red meat.

If a patient presents with diverticulitis, the treatment is started with antibiotics either in pills or intravenously. Sometimes this may require admission to hospital and treatment with bowel rest and intravenous fluid hydration until the attack subsides.

If a patient presents with complicated diverticulitis, they may need more than just antibiotics. Treatment as follows:

  • Diverticulitis with abscess can be treated with radiological drainage.
  • Recurrent attacks of diverticulitis with constant antibiotic treatment requires surgery.
  • Persistent abscess with peritonitis requires surgery.
  • Fistula formation requires surgery.
  • Stricture formation and obstruction requires surgery.

Surgery is performed using traditional open surgery or laparoscopic and robotic minimally invasive techniques. At the time of evaluation, your colorectal specialist will select the best option for you.