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Common Ailments ~ Diverticular Disease

Diverticular Disease

Age: More common over the age of 50

Lifestyle: a low-fibre diet is a risk factor

In Diverticular disease, pea- or grape-sized pouches protrude from the wall of the intestine, normally from the part of the colon closest to the rectum. The pouches form when parts of the wall of the intestine bulge outwards through weakened areas, often close to an artery. In many cases the bulging of the intestinal wall is associated with persistent constipation and occurs when the pressure in the intestine increases as the person strains to defaecate. Sometimes, one or more pouches become inflamed, a condition known as diverticulitis.

About 1 in 3 people between the age of 50 and 60 has Diverticular disease, and the disorder becomes increasingly common after the age of 60. However, most affected people have no symptoms. The disease is strongly associated with a low fibre diet, which can lead to constipation. The disease is very rare in developing countries, where fibre comprises a large part of the diet.

What are the symptoms?

More than three-quarters of all people with Diverticular disease are unaware of the condition because they have no symptoms. If symptoms present, they may include the following:

  • Episodes of abdominal pain, especially in the lower left abdomen, that are relieved by a bowel movement or a release of intestinal wind.
  • Intermittent episodes of constipation and diarrhoea
  • Occasional bright red bleeding from the rectum, which may be painless.

Diverticular disease is sometimes difficult to distinguish from irritable bowel syndrome, which has similar symptoms. If diverticulitis develops, the symptoms may become worse and be accompanied by:

  • Severe abdominal pain and tenderness in the abdomen
  • Fever
  • Nausea and vomiting

If you notice any change in your bowel habits or you have rectal bleeding, you should consult your doctor immediately because these symptoms may indicate a more serious underlying disease, such as colorectal cancer.

Are there complications?

If an inflamed diverticulum bursts, faeces and bacteria can spill into the abdominal cavity. As a result, an abscess may form next to the colon or peritonitis, an inflammation of the membrane that lines the abdominal cavity, may develop. Peritonitis is a potentially life threatening condition

An abnormal channel called a fistula may develop between a diverticulum and the bladder, resulting in pain, a more frequent urge to pass urine, or recurrent bladder infections. In some women, a fistula may develop between a diverticulum and the vagina, causing faecal material to be discharged through the vagina. An inflamed diverticulum may also cause intestinal obstruction.

How is it medically diagnosed?

If your doctor suspects that you have Diverticular disease, he or she may arrange for you to have a contrast X-ray in which a barium enema is used to highlight the shape of the intestines. If your symptoms include rectal bleeding, a colonoscopy may be carried out to examine the colon and exclude colorectal cancer. Sometimes, Diverticular disease is found during an investigation for another disease.

If your symptoms develop suddenly, you may be admitted to hospital for investigative tests. You may have X-rays and a colonoscopy. In addition, CT scanning or ultrasound scanning may be performed.

What is the medical treatment?

Often, a high-fibre diet with plenty of fluids is the only treatment needed for Diverticular disease, together with anti-spasmodic drugs if you have abdominal pain.

If you develop severe diverticulitis, you will be admitted to hospital and given intravenous fluids and antibiotics to treat bacterial infection. These measures produce improvements in most cases, and no further treatment is needed. However, surgery is sometimes necessary if you have severe rectal bleeding or if an abscess or a fistula develops. Anyone who has two or three attacks of diverticulitis within a few years is also likely to need surgery. The most common operation is a partial colectomy, in which the diseased part of the colon is removed and the healthy ends of the intestine are rejoined. At the same time, a temporary colostomy may be performed.

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