Diverticular Disease: Understanding risks and management

Diverticulosis is the result of pouches forming on the intestinal wall. The small pouches that form are called diverticula and they protrude from the outer wall of the colon. The most common risk factors that lead to diverticular disease are age and diet. Why someone develops diverticular disease is unclear, but could possible involve a lack of fibre in the diet and genetics. Complications can be serious. 

What is Diverticulosis

Diverticulosis is the result of pouches forming on the intestinal wall. The small pouches that form are called diverticula and they protrude from the outer wall of the colon. When these pouches become inflamed, it is known as diverticulitis. Diverticular disease affects the bowel lining of the large intestine or the colon wall

Only about 25% of people that have diverticula will develop symptoms of diverticulosis.

Risk Factors

The most common risk factors that lead to diverticular disease are age and diet. As a matter of fact, close to 50% of all adults over seventy suffer from this common condition, while it is much less common in people under the age of fifty. However, most of these people are not aware that they have the disease. 

Because research indicates that diverticulosis was less common prior to the twentieth century and occurs more frequently in the western nations of Australia, Europe and the United States than it does in Africa and Asia, there is a theory that eating a low-fibre diet may lead to the condition. In addition, the condition is not as common among vegetarian, which supports this theory. Researches do not yet understand just how a low-fibre diet causes the disease. Another theory is that the disease is caused by genetics.

One interesting fact is that while people in Asian countries develop the condition in the first section of the colon, people in western countries tend to develop it in the last third of the colon. Even though people of Japanese descent who live in Hawaii are at a higher risk for diverticulosis than those that reside in Japan, they still develop it in the first third of the colon.

Possible complications 

There are a number of possible complications associated with diverticular disease, such as:

Abscess – If diverticulitis is left untreated, it can lead to abscess in the form of a pus ball

Cancer – A person with diverticulosis is at risk of developing cancer.

Haemorrhage – Haemorrhaging can be caused by diverticula. However, it is crucial to rule out other causes of the bleeding.

Perforation – Rupture may occur of a weakened bowel pocket. When this occurs, the bowel contents could seep into the abdomen. Symptoms of a perforated bowel, which is a serious medical emergency, include chills, high fever and pain.

Peritonitis – A perforation may cause peritonitis, which is when the membranes that line the abdominal organs and cavity become infected. This is a serious complication and could potentially be life threatening.

Management of diverticular disease

For someone with diverticular disease, or diverticulosis, there is no known way to prevent new diverticula from forming. Instead, it is important to manage the symptoms of the condition.

• Fibre. Gradual changes in diet to include more foods that contain soluble fibre, such as oat bran and green vegetables, as well as fibre supplements like psyllium, will help with mild symptoms and improve bowel habits.
• Avoid. It is important to avoid foods that can worsen the symptoms, such as pips, seeds, nuts, legumes and sweet corn.
• Laxatives. Using laxatives on a short-term basis to prevent and treat constipation is advised in some cases.
• Surgery. In rare instances, elective surgery can be performed to remove bowel segments that have been seriously affected if the symptoms have become disabling.
• Water. Drink plenty of water and other fluids to keep stool moist and soft, which will be easier to pass.
• Exercise. Regular exercise is also a good way to encourage proper bowel function.

If you think that you may be suffering from diverticular disease, talk with your doctor or a gastroenterologist to find out how to effectively treat your symptoms.

References

1. Gastro.net, Diseases and Conditions, Diverticulosis and Diverticulitis
2. Centre for Digestive Diseases, Disease Information, Diverticulosis & Diverticulitis
3. Mayo Clinic, Patient Care & Health Info, Diseases and Conditions, Diverticulitis
4. U.S. Department of Health and Human Services, National Digestive Diseases Information Clearinghouse, Diverticular Disease
5. Touzios JG, Dozois EJ; Gastroenterology Clinics of North America; Volume 38, Issue 3, Pages 513 – 525; Diverticulosis and Acute Diverticulitis; 2009
6. Jacobs DO, The New England Journal of Medicine; Clinical Practice Diverticulitis; 2007
7. Better Health Channel, Conditions and Treatments, Digestive System – Large Intestine, Diverticulosis and Diverticulitis
8. Dieticians Association of Australia, For the Public, Smart Eating for You, Nutrition Information A-Z, Diverticulitis
9. Gastroenterology Society of Australia; Facts about Diverticular Disease; Fourth Edition; 2009
10. myDr for a healthy Australia, Gastrointestinal Health, Diverticular disease and diverticulitis
11. Therapeutic Guidelines, Antibiotic, Gastrointestinal Tract Infections, Diverticular Disease
12. The Australian Women’s Weekly, Diet & Health, Expert Q & A; Diet for diverticular disease; 2008
13. Colorectal Surgical Society of Australia and New Zealand, Patients & Public, Diverticular Disease