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Bowen Rayner Medicine Ltd
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Dr Charlotte FJ Rayner MD FRCP and Dr E Frances Bowen PhD FRCP
Web site : brmedicine.co.uk
Practice Manager: Tel: 020 8605 2851/Fax: 020 8971 8010
Secretary: [email protected]
Diverticular disease
What is diverticular disease?
Diverticular disease (also known as diverticulosis) is a condition of the large intestine whereby small sacs or pouches
called diverticula form in the wall of the large intestine. These diverticula can become infected, leading to a condition
known as diverticulitis.
What causes diverticular disease and who is at risk?
Diverticular disease is very common in elderly people, being present in up to 80 per cent of elderly individuals in Western
countries. It is rare in people under 20 years of age and in developing countries.
Diverticular disease is thought to be caused by long-standing constipation. The large intestine produces solid stool from
the remains of food after all the nutrients have been absorbed in the small intestine. Constipation increases pressure
within the intestine and over many years this forces small areas of the lining of the intestine to weaken to form the small
sacs or pouches (diverticula).
What are the common symptoms and complications of diverticular disease?
Many people have diverticular disease without knowing, as it does not usually cause symptoms, though occasionally it is
associated with abdominal cramps and flatulence.
Diverticula are prone to becoming blocked and can then become infected (known as 'diverticulitis') or strangulated (ie
their blood supply becomes constricted and so the bowel starts to die as it has no supply of oxygen or nutrients). When
these complications occur the diverticulum may perforate, resulting in an abscess or a life-threatening infection in the
abdomen.
The symptoms of diverticulitis include abdominal pain, vomiting and diarrhoea, and possibly a fever.
How do doctors recognise diverticular disease?
Diverticular disease can be diagnosed by barium enema. Barium is inserted into the intestine through the anus (back
passage) and X-rays are then taken of the abdomen. The barium shows up on the X-ray as a thick white mass and
outlines the structure of the intestine. It can also be diagnosed by colonoscopy in which a long, thin, flexible cable is
inserted through the anus into the intestine and transmits pictures of the inside of the intestine to the doctor's eyepiece or
a monitor.
What is the treatment for diverticular disease?
Self-care action plan
There is much that you can do to help prevent diverticular disease and its complications, simply by following a healthy
diet and lifestyle. Many of these measures involve taking steps to prevent constipation:

stick to a healthy high-fibre, low-fat diet containing plenty of fruit, vegetables, wholemeal bread and whole grain
cereals

avoid constipating foods such as bananas and rice

avoid foods with seeds that might plug diverticula, eg poppy seeds, sesame seeds and strawberry seeds

drink at least two litres of water per day

regular daily exercise is important as it will prevent sluggish circulation, which may aggravate diverticular disease
Bowen Rayner Medicine Limited
Registered Offices – C/o Smith &Williamson, No 1 Bishops Wharf, Walnut Tree Close, Guildford, GU1 4RA
Medicines
Occasionally bulk-forming laxatives (eg bran) are prescribed for people who are unable to take enough fibre in their diet.
Other types of laxative are not helpful and may worsen the situation by causing abdominal cramps. Anti-spasm medicines
may be prescribed for abdominal cramps.
Illustration showing large intestine
Complementary therapy
There is a variety of complementary medical treatments for flatulence and abdominal cramps. However, it is not clear that
any of them are beneficial and do not have harmful effects (eg the use of hypnotherapy and herbal remedies).
Acupuncture and the Alexander technique may help relieve discomfort.
Hospital treatment
Hospital treatment is needed for diverticulitis. No food or fluid is allowed by mouth for a day or so to give the intestine a
chance to recover. Antibiotics, fluids and energy in the form of sugar are given by continuous infusion into a vein (a 'drip').
It may be necessary to put a tube (a nasogastric tube) into the stomach through the nose if there is vomiting. This is
easily 'swallowed' by the patient and guided into the stomach by a nurse. A syringe can then be attached to the free end
of the tube to suck out any stomach contents that might otherwise be vomited.
Once the symptoms have settled, small quantities of fluids and then food can be taken by mouth. These quantities are
gradually increased and if the symptoms do not recur, the antibiotic can also be given by mouth.
Bowen Rayner Medicine Limited
Registered Offices – C/o Smith &Williamson, No 1 Bishops Wharf, Walnut Tree Close, Guildford, GU1 4RA
Surgery
Surgical treatment is needed for strangulation or perforation of a diverticulum and involves cutting out the damaged part
of the intestine. The surgeon may then decide that the two parts of the intestine that remain on either side of the cut
section should not be joined together immediately. This is because the join will not heal until the intestine has completely
recovered from the infection or strangulation. In this situation, a temporary 'colostomy' will be formed. A colostomy is an
opening in the large intestine to the outside of the abdomen. The stools pass through this opening and into a bag fixed
around the colostomy (colostomy bag).
After the operation, the consultant will check that the intestines have started to work and bowel sounds (gurgling sounds
produced by an active intestine) can be heard through a stethoscope before fluids or food can be taken normally. Until
then, fluids are given continuously through a drip, and a nasogastric tube is used to collect fluid that forms in the
stomach. Antibiotics are given by injection. Once bowel sounds can be heard, small quantities of fluids and then food can
be started and then gradually increased. If there is a colostomy, a colostomy nurse will give advice and answer questions
about how to look after it.
Discharge home is arranged once pain and discomfort resulting from the operation have settled, fluid and foods can be
taken freely, and the temporary colostomy is working well. The temporary colostomy is removed by a second operation a
month or two later and the intestine is joined up again. Just occasionally, the diverticular disease is so severe that it is
decided that the colostomy should be permanent.
What is the outcome of diverticular disease?
The symptoms and risk of complications of diverticular disease can usually be controlled by good self-care. Operations
for complications such as strangulation or perforation, should they occur, are relatively straightforward and have a high
success rate.
Further information

Digestive Disorders Foundation
020 7486 0341
www.digestivedisorders.org.uk
Bowen Rayner Medicine Limited
Registered Offices – C/o Smith &Williamson, No 1 Bishops Wharf, Walnut Tree Close, Guildford, GU1 4RA