DIVERTICULOSIS

What is Diverticulosis?

Diverticulosis is the presence of outpouchings on the wall of the colon. While this is a very common condition (present in 1/3 of people older than 60 and 1/2 of people over 70), only a minority (~20%) will ever develop symptoms or problems as a result. This condition usually affects the large bowel (colon) - the sigmoid colon is the most commonly involved area, but the entire colon can be involved. If affected, you often require a colonoscopy, and may need further treatment depending on your symptoms and the problems caused.

Why do I have diverticulosis?

You are more likely to develop diverticulosis as you get older, and many patients will have family members who are also sufferers. In most patients, these are their only risk factors, although there are others such as connective tissue diseases.

What is diverticulitis?

When a diverticulum becomes inflamed, this is called acute diverticulitis. This usually occurs suddenly and without warning, commonly causing abdominal pain, feeling feverish and unwell and irregular bowel habit. This usually settles with time and antibiotics. While many patients are able to be treated at home with oral antibiotics, you might require admission to hospital depending on the severity of the attack. You will usually be able to eat relatively normally during treatment of such an episode.

In approximately 10-20% of cases of diverticulitis, secondary problems occur - called ‘complicated diverticulitis’. Such secondary problems include an abscess in your abdomen near the area of affected colon, or more significantly a bowel perforation. Such attacks usually require more intensive treatment. This might include a longer course of antibiotics, a longer stay in hospital, drainage of the abscess under CT scan guidance. Acute surgery can usually be avoided, but is sometimes necessary if an attack of diverticulitis is particularly severe, or won’t resolve with the other treatments mentioned above.

Aside from diverticulitis, what other problems can diverticulosis cause?

Bleeding: bleeding from diverticulosis usually occurs suddenly and without warning. It can be quite heavy in some cases, needing urgent assessment and management in hospital. The bleeding ceases on its own in most cases, but a procedure (such as a colonoscopy or an x-ray guided procedure i.e. “embolisation”) might be required. Observation in hospital, including dietary restriction, is usually required while the bleeding resolves

Stricture: In some case, a fixed narrowing of the colon occurs as a result of diverticular disease. This might be detected at the time of colonoscopy, or if the narrowing leads to an obstruction of the bowel. This usually requires surgery to resect the affect part of the bowel

Fistula: rarely, if inflammation from diverticulitis continues for an extended period, the bowel can erode through into adjacent organs such as the urinary bladder, the vagina, or another portion of the bowel. This can lead to significant problems, such as recurrent infections or the passage of bowel content from the urinary system or vagina. Surgery is usually required in such instances.

I have had an episode of acute diverticulitis. What happens now?

It may be necessary for your diet to be modified for several weeks after an episode of diverticulitis, and Jayson will discuss this with you. You may also require a follow up colonoscopy, particularly if you have never had one (or it has been some time since your last one), you have had other preceding bowel symptoms, or if it was a particularly severe episode.

No further treatment is warranted in the majority of cases, and any subsequent episodes are treated as they arise. In some instance, surgery can help reduce the risk of further episodes. This is not suited to everyone, but rather depends on the frequency and severity of episodes of diverticulitis, balanced against the risks of surgery. This decision needs to be tailored to each individual patient, and Jayson can discuss this in detail with you.

Am I likely to have further attacks? How can I reduce my risk?

Somewhere between 10-30% of patients who have a further episode at some stage. Some people have recurrent symptoms or episodes of diverticulitis that significantly impact their quality of life. There are risk factors for recurrent episodes, and addressing these will reduce your risk. These include cigarette smoking and obesity.

Despite what you may hear or read, there is no strong evidence to suggest that changing your diet, using preventative (prophylactic) antibiotics, or taking pre- or probiotics will lower your risk.