DIVERTICULAR DISEASE

WHAT IS DIVERTICULAR DISEASE?

Diverticular disease (also called diverticulosis) is a benign condition that affects the wall of the large bowel (colon). Small out-pouchings or diverticulae protrude through the wall of the bowel. It tends to mainly involve a section of the large bowel on the left side called the sigmoid colon but can affect the entire colon. The cause is thought to be high pressures within the colon and abnormal peristalsis – it is very common in the Western world but much less common in developing nations.

HOW COMMON IS DIVERTICULAR DISEASE?

Diverticular disease is a very common condition in Australia with about 60% of 60 years olds found to have the condition. It is more common as you get older, but can also be found in those much younger. In fact, the disease appears to be becoming more common in younger patients – our surgeons authored a recent paper demonstrating the increasing incidence of diverticulitis in young patients in South-East Queensland. The paper found one third of patients admitted to hospital with diverticulitis in recent years were younger than 45 years old. Many young patients comment on a family history of diverticulitis at a young age.

Laparoscopic image of sigmoid diverticular disease

WHAT ARE RISK FACTORS FOR DEVELOPING DIVERTICULAR DISEASE?

Low fibre intake is considered the main risk factor for developing diverticular disease. A low fibre diet results in smaller, firm, compacted stool that requires extra pressure from the colon to push through, taking longer time to pass through the bowel. Over time, this extra pressure that is generated within the lumen of the bowel, can lead to ‘blow-outs’ and the formation of diverticulum.

Other potential factors contributing to diverticular disease may be poor defecatory technique or longstanding straining at stool during defecation.

The science on what exactly causes diverticular disease is not clear – at Brisbane Colorectal we take a broad sweep on therapy, including addressing diet, lifestyle and toileting habits.

WHAT ARE THE SYMPTOMS OF DIVERTICULAR DISEASE?

The majority of people who have diverticular disease do not have any discomfort or other symptoms. It is often a harmless, coincidental finding on colonoscopy. In older Australian patients, the majority will have some diverticular disease discovered at colonoscopy.

A proportion (up to one quarter) of people with diverticular disease may develop symptoms or problems related to diverticulae. The most common symptom is diverticulitis, but other problems include sudden rectal bleeding, narrowing of the bowel or a “fistula” occurring where the colon becomes joined to another organ such as the bladder.

WHAT IS DIVERTICULITIS?

Diverticulitis is when there is inflammation/infection in one or more diverticulum. This usually presents with left lower/ lower abdominal pain and fever. Complications of diverticulitis can include abscess formation, and development of a fistula. Repeated attacks can cause scarring in the colon that narrows the lumen and even rarely cause a bowel obstruction. A CT scan is often required to diagnose diverticulitis and look for complications.

HOW IS DIVERTICULITIS TREATED?

Most cases of diverticulitis are treated with oral antibiotics. Severe cases require an admission to hospital for antibiotics through a drip (intravenous) and bowel rest. Mild attacks of diverticulitis can occasionally be managed by resting the bowel with a liquid diet, without requiring antibiotics.

CAN I GET DIVERTICULITIS AGAIN?

Once you have an attack of diverticulitis there is about a 20-25% chance you will have another attack. The risk of getting another attack is increased if you are male, have family history of diverticulitis, are obese, or have high inflammatory markers (blood tests taken on initial presentation).

Some people have persistent pain or continuous symptoms after an attack of diverticulitis. This can be seen in an entity called ‘segmental colitis associated with diverticulitis’. It is important to see a colorectal surgeon to have the correct advice and certainty regarding the diagnosis in this situation.

SHOULD YOU GET A COLONOSCOPY AFTER AN ATTACK OF DIVERTICULITIS?

Most international guidelines recommend a colonoscopy after an attack of diverticulitis, unless one has been done recently. This is done to confirm the diagnosis and to exclude other rare causes of similar symptoms such as colon cancer.

IS SURGERY REQUIRED?

Surgery is not required for those with no symptoms or who have infrequent mild attacks of diverticulitis. Elective surgery may be indicated for those who have had recurrent attacks of diverticulitis, or even after a single attack with complications (abscess, fistula). In this situation the involved segment of sigmoid colon is removed and the 2 ends joined back together. Very rarely, in a severe attack of perforated diverticulitis an emergency operation is required and for safety reasons the bowel is brought out to the skin as a stoma or bag. This is usually temporary, and another operation is performed in the future to join the ends back together. Surgery can generally be performed using minimally invasive surgery – at Brisbane Colorectal we offer this surgery both as laparoscopic or robotic surgery.