Colonic diverticulosis
Overview
This is a disease process that predominantly affects people over the age of 70 years and is more common in developed countries. It is thought to be due to a relative lack of fibre or residue in the diet in middle age. As a consequence of this, the large intestine or colon may have to “squeeze” harder to move (peristalsis) the low volume stool towards the exit or rectum. Over many years the “high pressure” generated may lead to out-pouchings or pockets (diverticula) forming outside the wall of the colon, especially on the lower left side in the sigmoid colon. Many people with colonic diverticulosis are unaware of the condition. It may however lead to constipation, pain or bleeding or occasionally, the diverticulae may get infected (diverticulitis). Diverticulitis usually responds to treatment with antibiotics but sometimes it may be so severe that an abscess (collection of pus) forms or even a hole develops (perforation); these last 2 complications may require urgent surgery. It is important to confirm the diagnosis of colonic diverticulosis as its symptoms may mimic colonic cancer or colitis.
What is it?
Colonic diverticulosis is the condition whereby diverticula, or pockets, form from the lining of the colon. These protrusions of the colon lining occur at sites of weakness in the muscle wall possibly due to increased pressure from muscle contractions.
Diverticulitis is an inflammatory process that causes acute symptoms and may be associated with serious complications.
What may cause it?
Potential risk factors include increasing age; diets low in fibre and high in red meat and refined carbohydrates; obesity.
There is no evidence that seeds or nuts cause diverticulitis.
What are the symptoms?
Diverticulosis is often asymptomatic and found on investigation by colonoscopy or CT scanning. It may be associated with low abdominal cramping, bloating, or constipation. Diverticulitis, due to infection or inflammation of the diverticula, may cause localized lower left sided abdominal pain with either diarrhoea or constipation and fever.
How common is it?
Classically, this is a disease process that predominantly affects people over the age of 70 years and is more common in developed countries. It is however getting more common in younger people possibly related to obesity.
What tests are needed to diagnose it?
It is important to confirm the diagnosis as symptoms of colonic diverticulosis as symptoms may mimic colonic cancer or inflammatory bowel disease.
A colonoscopy enables the gastroenterologist to examine the lining of the colon to confirm diverticulosis and to exclude colon cancer or inflammatory bowel disease.
An abdominal CT scan is a radiological test used to diagnose diverticulitis and to look for complications.
A blood test may be performed to look for any signs of infection within the body.
Treatments & complications
Diverticulitis is usually treated with antibiotics.A recent placebo-controlled trial did not show, in the outpatient setting, that antibiotics were any better than placebo.
Patients with abscess (collection of pus) or perforation (a hole in the colon) require emergency admission to hospital; these last 2 complications may require urgent surgery.
Long-standing severe diverticulosis or following recurrent attacks of diverticulitis the colon may get narrowed (stricture formation) and surgery may be required to avoid obstruction.
At Digestive Health City & Docklands, we work hard to provide our patients with top-class care. You will enjoy friendly, fast and modern treatment by a highly experienced gastroenterologist. We carefully review patient satisfaction and feedback, and at Digestive Health we are continuously making improvements to our services, ensuring the highest level of care possible.
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