Diverticular Disease: Symptoms, Causes, and Treatment

Diverticular disease occurs when small pouches, known as diverticula, form in the wall of the large intestine, most commonly in the sigmoid colon. These pouches often develop due to increased pressure in the colon, usually linked to diet and lifestyle factors. In many cases, diverticula cause no symptoms (a condition known as diverticulosis). However, if these pouches become inflamed or infected, the condition progresses to diverticulitis, which can cause abdominal pain, fever, digestive disturbances, and complications requiring medical attention.

This article explores the symptoms, causes, complications, and treatment options for diverticular disease, along with ways to manage and prevent flare-ups.

Recognising the Symptoms

Symptoms of diverticular disease vary depending on whether a person has diverticulosis (harmless diverticula) or diverticulitis (inflamed or infected diverticula).

Diverticulosis: Few or No Symptoms

Diverticulosis is usually discovered incidentally during medical tests such as a colonoscopy or CT scan. Most individuals experience no symptoms, but some may notice mild digestive discomfort, including:

Abdominal discomfort: A dull, persistent ache, usually in the lower left abdomen, that may come and go. The discomfort may be more noticeable after meals or when bloating occurs.

Bloating and gas: A sensation of fullness or increased gas production, which can cause mild cramping or distension.

Changes in bowel habits: Some individuals experience fluctuations between constipation and diarrhoea, sometimes with the need to strain during bowel movements.

Mild tenderness: Gentle pressure on the lower abdomen may reveal slight tenderness, though this is not usually painful.

Diverticulitis: Inflammation and Infection

When diverticula become inflamed or infected, the symptoms become more pronounced and require medical attention. These may include:

Persistent abdominal pain: A continuous, often sharp pain that typically occurs in the lower left abdomen. The pain may worsen over time and can be aggravated by movement, eating, or pressure on the area.

Fever and chills: A sign of infection, often accompanied by sweating, fatigue, or an overall feeling of being unwell.

Nausea and vomiting: Can occur alongside significant pain and digestive distress, particularly if the infection affects bowel movement.

Bowel irregularities: Constipation is common, though some individuals may experience diarrhoea. Stools may contain mucus or appear looser than usual.

Loss of appetite: A general lack of interest in food, often due to nausea, pain, or bloating.

Abdominal tenderness: The affected area may feel sensitive to touch, with pain intensifying when pressure is applied.

What Causes Diverticular Disease?

The development of diverticular disease is influenced by multiple factors, including age, diet, lifestyle, and genetics.

Ageing: Over time, the walls of the colon lose elasticity and become more susceptible to pressure changes, increasing the likelihood of diverticula formation. The condition is more common after the age of 40 and becomes increasingly prevalent with age.

Low-fibre diet: Fibre adds bulk to stools and helps them pass through the intestines with less strain. Diets low in fibre can lead to harder stools, increasing pressure in the colon and contributing to diverticula development.

Chronic constipation and straining: Repeated straining during bowel movements can place excessive pressure on the colon walls, leading to the formation of diverticula.

Physical inactivity: A sedentary lifestyle is associated with slower digestion and a higher likelihood of constipation, both of which can increase the risk of diverticular disease.

Obesity: Higher body weight, particularly around the abdomen, has been linked to a greater risk of diverticulitis and its complications.

Genetic factors: Individuals with a family history of diverticular disease may be more likely to develop the condition, suggesting a hereditary component.

Smoking: Some studies suggest that smoking may contribute to an increased risk of diverticulitis and more severe complications.

Complications of Diverticulitis 

If left untreated, diverticulitis can lead to complications that require medical intervention. These complications can range from mild infections to more severe conditions affecting the digestive system.

Abscess formation: When an infected diverticulum develops into a pocket of pus, an abscess may form. While smaller abscesses can often be treated with antibiotics, larger ones may require drainage through a minimally invasive procedure.

Perforation and peritonitis: In severe cases, a diverticulum may rupture, allowing bowel contents to leak into the abdominal cavity. This can lead to peritonitis, a widespread infection that requires immediate medical treatment, often including surgery.

Bowel obstruction (stricture formation): Repeated inflammation can cause scar tissue to form, leading to narrowing of the colon. This can result in difficulty passing stools, persistent bloating, and cramping.

Fistula formation: A fistula is an abnormal connection between the colon and another organ, such as the bladder or vagina. This can cause chronic infections, unusual discharge, or bowel-related symptoms.

Rectal bleeding: In some cases, diverticula may rupture, leading to bleeding in the digestive tract. While mild cases may resolve on their own, significant blood loss may require medical attention.

Managing Diverticular Disease

Lifestyle and Conservative Management: For individuals diagnosed with diverticulosis, lifestyle and dietary modifications are key to managing the condition and reducing the likelihood of complications. A high-fibre diet, including fruits, vegetables, legumes, and whole grains, helps maintain regular bowel movements and reduces strain on the colon. Hydration is also necessary, as adequate fluid intake helps prevent constipation. Engaging in regular physical activity supports digestion and overall gut health. Avoiding excessive straining and adopting healthy bathroom habits may further help reduce the risk of complications. 

Medical Treatment for Diverticulitis: For mild cases of diverticulitis, treatment typically includes antibiotics to control infection and pain relievers to manage discomfort. A temporary low-fibre or liquid diet may be recommended to allow the colon to rest. If symptoms do not improve within a few days, additional medical evaluation may be required to check for complications such as abscesses or obstruction.

Elective Surgery: Elective surgery may be recommended for individuals who experience frequent or severe episodes of diverticulitis. The procedure, known as a colectomy, involves removing the affected portion of the colon to prevent further flare-ups. Surgery is generally considered when complications such as strictures, fistulas, or recurrent infections develop. Since elective surgery is planned, it allows for thorough preparation and recovery.

Emergency Surgery: In cases where diverticulitis leads to a perforation, severe infection, or an abscess that cannot be managed with antibiotics, emergency surgery is necessary. The procedure may involve removing the affected section of the colon, and in some cases, a temporary colostomy may be required to allow healing. Emergency surgery carries a longer recovery time than elective procedures.

Preventing Diverticular Disease and Its Complications

Maintaining a high-fibre diet, drinking enough water, engaging in regular physical activity, and managing weight can help reduce the risk of diverticular disease and its complications. A diet rich in fibre supports bowel regularity and lowers pressure in the colon, while hydration ensures that stools remain soft and easy to pass. Exercise contributes to digestive health and may help prevent constipation. Avoiding excessive straining and establishing healthy bowel habits may further support gut function.

When to Seek Medical Attention

Medical evaluation is recommended if symptoms such as persistent abdominal pain, fever, nausea, vomiting, or changes in bowel habits occur. Blood in the stool, increasing discomfort, or signs of infection may indicate complications that require urgent treatment. Seeking medical advice early can help manage symptoms effectively and reduce the risk of further issues.

Conclusion

Diverticular disease is common, particularly in older adults. While many people with diverticulosis experience no symptoms, diverticulitis can lead to pain and complications. Dietary and lifestyle changes help manage the condition, while medical or surgical interventions may be required for more severe cases. Taking proactive steps can help individuals maintain digestive health and reduce the risk of future flare-ups.

If you’re experiencing symptoms of diverticular disease or have concerns about your digestive health, schedule an appointment today for a thorough evaluation and personalised care.