Diverticular Disease

Written by A/Prof Viraj Kariyawasam, Gastroenterologist

1. What is Diverticular Disease?

Diverticular disease refers to a condition where small pouches, called diverticula, form in the wall of the large bowel (colon). These pouches are common, particularly with increasing age, and are often found incidentally during colonoscopy or imaging.

Many people with diverticula have no symptoms (diverticulosis). Diverticular disease is the term used when diverticula cause symptoms or complications such as inflammation, infection, bleeding, or pain.

2. Causes & Risk Factors

Diverticula are thought to develop due to increased pressure within the colon over time. Dietary and lifestyle factors play an important role.

Risk factors include increasing age, a low-fibre diet, chronic constipation, physical inactivity, obesity, and smoking. Certain medications, such as non-steroidal anti-inflammatory drugs, may increase the risk of complications.

3. Symptoms & How It May Present

Many people with diverticulosis have no symptoms. When symptoms occur, they may include intermittent abdominal pain, bloating, or changes in bowel habits.

Diverticulitis occurs when a diverticulum becomes inflamed or infected and usually causes more severe symptoms such as persistent abdominal pain (often on the lower left side), fever, nausea, and changes in bowel habits. Diverticular bleeding can cause sudden, painless rectal bleeding.

4. How Is It Diagnosed?

Diagnosis depends on symptoms and clinical assessment. Blood tests may show signs of infection or inflammation in cases of diverticulitis.

CT scanning is the preferred test for suspected acute diverticulitis. Colonoscopy is often performed after recovery to assess the colon and exclude other conditions. Imaging or colonoscopy may also identify diverticula incidentally.

5. Treatment & Management Options

Management depends on the severity of symptoms and whether complications are present. Uncomplicated diverticulosis often requires no specific treatment.

For symptomatic diverticular disease, increasing dietary fibre and managing bowel habits are key strategies. Acute diverticulitis may require antibiotics, bowel rest, or hospital admission in more severe cases. Surgery is reserved for recurrent or complicated disease.

6. Living With / Managing Diverticular Disease

Most people with diverticular disease live normal lives with appropriate lifestyle management.

A high-fibre diet, adequate fluid intake, regular exercise, and avoidance of smoking can reduce symptoms and lower the risk of future episodes. Regular follow-up may be recommended after complicated diverticulitis.

7. Prevention & Risk Reduction

Eating a fibre-rich diet, maintaining a healthy weight, and staying physically active reduce the risk of developing diverticular complications.

There is no need to routinely avoid nuts, seeds, or popcorn, as these foods do not increase the risk of diverticulitis.

8. When to Seek Medical Advice

Medical review is recommended for persistent or recurrent abdominal pain, changes in bowel habits, or unexplained rectal bleeding.

Urgent medical attention is required for severe abdominal pain, fever, vomiting, or significant bleeding, as these may indicate diverticulitis or complications.