Diverticulitis

What is Diverticulitis?

Diverticula are small, bulging sacs that can develop in the wall of the digestive tract. The condition known as diverticulosis occurs when these pouches appear. Diverticulitis occurs when one or more of these pouches become inflamed or infected. Diverticulosis affects approximately 10% of individuals over the age of 45, and around 65% of those over 70. Of these, about 25% will develop diverticulitis.

Symptoms of Diverticulosis and Diverticulitis

Diverticulosis is characterized by the formation of these bulging pouches without any inflammation, while diverticulitis is marked by inflammation or infection of these pouches. The symptoms of these two conditions can differ.

Symptoms of Diverticulosis

Most people with diverticulosis do not experience any symptoms. However, approximately 15%-20% of individuals with the condition will have symptoms unrelated to inflammation or infection. These symptoms may resemble those seen in bowel cancer and can include:

• Abdominal bloating and discomfort
• Diarrhoea or constipation
• Excessive gas (flatulence)
• Blood in stools
• Anaemia due to frequent bleeding

Symptoms of Diverticulitis

When the diverticula become inflamed or infected, the condition is called diverticulitis. Symptoms of diverticulitis may include:

• Abdominal pain, which can vary from mild to severe, typically on the lower left side
• Nausea or vomiting
• Fever
• Swollen abdomen
• Changes in bowel movements, including diarrhoea or constipation
• Presence of blood or mucus in the stool

Causes of Diverticulosis and Diverticulitis

A diet low in fibre combined with a high intake of animal fats may contribute to constipation, which leads to a buildup of waste in the colon. This excess pressure on the walls of the colon can cause small pouches or pockets to form. Diverticulitis develops when these pockets become inflamed or infected, often due to bacteria from food or stool becoming trapped inside these bulges.

Risk Factors for Diverticulitis

Although there is no single cause for diverticulosis, certain risk factors increase the likelihood of developing this condition. These include:

• Age, The risk rises with age, becoming more common in individuals over 40.
• Gender, Men are more likely to develop the condition than women.
• Obesity
• Smoking
• A diet that is low in fibre and high in animal fats
• Sedentary lifestyle (lack of exercise)
• Some medications, such as steroids, opioids, and NSAIDs (non-steroidal anti-inflammatory drugs)

How is Diverticulitis Diagnosed?

Diverticulosis is often discovered during tests for other conditions, such as bowel cancer. However, diverticulitis is typically diagnosed during an active episode. The diagnosis of diverticulitis generally involves several steps, which may include:

• A review of medical history, including lifestyle and dietary habits
• A physical exam, which may include a rectal examination
• Blood tests
• Stool samples to detect signs of infection or blood
• Colonoscopy, A procedure to examine the large intestine (colon) and rectum for abnormalities
• Barium enema, A special imaging test to identify issues in the colon
• A CT scan to check for abscesses or complications

Complications of Diverticulitis

Diverticulitis can lead to various serious complications, including:

• Abscesses (pus-filled sacs within the bowel)
• Bowel obstruction
• Formation of a fistula, an abnormal connection between sections of the bowel or between the bowel and other organs, created when an ulcer breaches the full thickness of the bowel wall
• Perforation of the bowel, where contents leak into the abdominal cavity
• Peritonitis, a life-threatening infection of the abdominal cavity and organs
• Severe bleeding (haemorrhage)

Treatment for Diverticulitis

For mild cases, the treatment typically focuses on allowing the bowel to heal, often by following a liquid-only diet or a low-fibre diet. During recovery, antibiotics and/or pain relief medication may be prescribed. Severe cases often require hospitalization, where intravenous antibiotics and fluids are administered, along with stronger pain management if necessary. Most of the time, this treatment is effective, but surgery might be needed in some situations. Surgery may be required if you have:

• Complications such as:

1. An abscess in the bowel 2. A fistula 3. Bowel obstruction 4. Perforation of the bowel wall

• Multiple episodes of uncomplicated diverticulitis
• A weakened immune system

Surgical procedures may include the removal of diseased portions of the intestine, followed by the reconnection of healthy segments, allowing for normal bowel movements. In cases of extensive damage to the colon where reconnection is not possible, a bowel resection with colostomy may be necessary. This involves creating an opening (stoma) in the abdominal wall, connecting it to a healthy section of the bowel. Waste is then collected in a bag worn outside the body.

When to Consult a Doctor

If you experience any changes in your bowel habits, it is important to consult a doctor, as they may indicate diverticular disease or even bowel cancer. Seek immediate medical attention if you experience any of the following symptoms:

• Severe abdominal pain
• Fever
• Vomiting
• Blood in your stool

Can Diverticulitis Be Prevented?

Although the exact cause of diverticular disease remains unclear, diverticulitis is often linked to a sedentary lifestyle and a low-fibre diet. The following steps may help reduce your risk of developing this condition:

• Consuming a fibre-rich diet, particularly by increasing your intake of green vegetables
• Using fibre supplements if necessary
• Drinking plenty of fluids to make bowel movements easier
• Regular exercise to promote healthy bowel function