Diverticular Disease

Diverticula (singular, diverticulum) are outpouchings of the bowel wall, which do not possess the capability to empty themselves. As a result of this lack of an active emptying function, these outpouchings are prone to filling with fecal deposits. This may result in inflammation as bacteria penetrate the bowel wall.

This inflammation, called diverticulitis, can recur and have a wide range of severity. It is not clear at present what causes diverticula to form, but it is known that people living in Western industrialized nations develop diverticula and their complications more frequently than persons living in the developing world. This has led some researchers to suspect that diet may play a role. It is known that people in the industrialized world consume a diet that is much poorer in dietary fibre. The simple presence of non-symptomatic diverticula (diverticulosis) does not require any treatment.

Symptoms and Disease Course

The most frequently reported symptom of diverticulis is pain in the left lower abdomen. Inflammation of these bowel segments may lead to disturbances of bowel movements and patients often experience a long period of constipation. In some cases patients report diarrhoea, bloating or increased flatulence (passing wind). Other complications may occur later in the course of the inflammation. The situation is more dangerous if after treatment pain does not subside and patients develop fever or the abdomen becomes hard.

Making the Diagnosis

Diverticulosis (the presence of diverticula) is often a coincidental finding at colonoscopy or radiographic examinations of the abdomen. The diagnostic work-up is completed with an ultrasound examination and a radiographic (x-ray) examination of the abdomen.

Forms of Therapy

The goal of therapy in patients with diverticulosis not reporting any symptoms is to regulate bowel movements and prevent complications. Patients are advised to consume a diet rich in dietary fibre or to supplement their diets with bulking agents, such as psyllium.  The first flare of acute diverticulitis is usually treated conservatively: based on severity, the physician may recommend measures such as bed rest, avoidance of oral food intake, fluids by infusion and antibiotics. If there is inadequate response to conservative therapy or when patients frequently relapse, surgery may be required.