Diverticulum – This literally means an ‘out-pouching’.
Diverticulosis – This term refers to a very common occurrence in the colon most commonly affecting the sigmoid colon. ‘Out-pouches’ occur through weak areas of the bowel wall. In the majority of times, they remain asymptomatic (ie no symptoms).
Diverticular Disease – This is when diverticulosis is associated with symptoms as described below.
Diverticulitis – This is the most common complication of diverticulosis when a diverticula gets inflamed/infected.
In Australia (and other developed countries), the majority of people will develop some diverticulosis as they get older. Only 20% of people however will develop symptoms. It gets more common with age. Historically it was a very rare condition under 45 years but we are seeing more cases in young people (most likely due to poor diets)
Diverticulosis is a western disease that seems to be related to a poor diet that is chronically low in fibre. Low bulk in the stool associated with constipation and straining leads to an increase pressure in the lumen of the bowel. The high pressure pushes out the mucosa (lining) of the bowel through weak areas. Apart from the diverticula, the bowel wall gets thickened and the lumen (channel) can narrow.
As stated, most diverticulosis causes no symptoms. They can cause mild to moderate abdominal pain (usually left sided) and bloating. More serious complications include
Diverticulosis can be readily seen at colonoscopy. The most common investigation for the complications of diverticular disease is a CT scan of the abdomen.
Diverticulosis is managed by improving diet and lifestyle. Increasing exercise, losing weight and increasing fibre in the diet are important. Fibre supplements (Bulking agents) including Psyllium husk, Metamucil and benefiber are helpful. For more significant constipation, laxatives such as movicol or normacol can be used.
Diverticulitis is treated by antibiotics and bowel rest (often in hospital). Bleeding often spontaneously settles but if not, is treated by angiography and embolisation ( a minimally invasive technique to stop bleeding). Recurrent severe diverticulitis, fistulas and obstruction are all treated surgically by colonic resection. The majority of these resections can be performed laparoscopically (keyhole) and the bowel ends can be joined back together (an anastomosis). Occasionally a temporary stoma bag is required.