Diverticular disease is a medical term that includes three conditions: diverticulosis, diverticular bleeding, and diverticular infection/diverticulitis. Diverticulosis is the presence of diverticula (plural), saclike protrusions of the wall of the large bowel.

The high rate of hospitalization and surgery makes diverticular disease one of the five most expensive digestive diseases ahead of irritable bowel syndrome and inflammatory bowel diseases. Direct costs associated with diverticular disease are $88.6 million per year. The risk for symptomatic diverticular disease is negligible for 35 year olds or younger. However, at age 55 the risk increases by a factor of 10 and at 75 years the risk has increased to 40. 50% of Canadians over the age of 80 years develop diverticular disease. At present, there are no known risk factors other than advanced age.

What is Diverticulosis?

Diverticulosis is the presence of diverticula (plural), sac-like protrusions of the wall of the large bowel. A diverticulum is when the inner lining of the large bowel (colon) is pushed out through weak spots in the muscle causing a pouch or sac.

What is Diverticulitis?

Diverticulitis is a result of the infection and or inflammation of the small sacs that line the walls of your intestines. This complication occurs in a few patients who already have diverticulosis. Men and women are affected equally. The resulting infection can be mild, leading only to abdominal pain; or severe, with diffuse infection or sometimes the development of an abscess (a pocket of pus). There is usually fever and an elevated white cell count in the blood. With healing there can be scarring, leading to bowel narrowing and obstruction. Fortunately, severe episodes account for less than one-quarter of all episodes of diverticulitis. A diagnosis of diverticulitis is based on the symptoms and examination, with tests that help confirm the diagnosis. In ill patients, a CT scan is the safest and most-cost-effective method of diagnosis

What is Diverticular Bleeding?

Bleeding occurs less often than diverticulitis and is not related to episodes of diverticulitis. Often patients do not have symptoms before bleeding occurs. There may be fresh red blood or altered darker blood. Pain is not frequent but cramps can occur. All patients with bleeding need to be investigated to rule out other causes of bleeding. Patients with major bleeding or those who feel light-headed should go to the emergency department. Bleeding often stops on its own but still should be investigated. Most patients do not have further bleeding but in some it may recur. Patients with, recurrent episodes often require surgery.

How Can I Prevent Diverticular Disease?

In general, increasing the amount of fibre in the diet is recommended with adequate fluid intake. While this will not cause the diverticula present to become smaller or go away, the high fibre diet may reduce the formation of other diverticula. There is no evidence that avoiding foods such as popcorn or those with small seeds such as strawberries or tomatoes is useful, although this has been recommended in the past.

Most people with diverticulosis have no symptoms and never develop complications. Without a complication, symptoms may be related to the low fibre diet rather than the diverticula themselves. Abdominal pain, cramps or irregular bowel habits are common symptoms and many doctors would say that these are due to irritable bowel syndrome (IBS) rather than to diverticulosis.

Signs and symptoms of diverticulitis

• abdominal pain
• infection
• development of an abscess (a pocket of pus)
• fever
• elevated white cell count
• Intestinal scarring
• bowel narrowing and/or obstruction.

Risks associated with Diverticular Disease

Patients with repeated episodes or a severe attack may need surgery. Surgery is usually not necessary but is sometimes performed in patients with severe or frequent complications. Often the bowel can be joined together immediately. If there is an infection a temporary connection between the bowel and the skin (colostomy) is formed to avoid connecting infected bowel. This surgery can be reversed at a later operation when the bowel is reconnected. The long term outlook is good.

Risk of developing diverticular disease increases with age. At age 55 the risk increases by a factor of 10 and at 75 years the risk has increased to 40. 50% of Canadians over the age of 80 years develop diverticular disease.

Testing for Diverticular Diseases

A diagnosis of diseases is based on the symptoms and examination, with tests that help confirm the diagnosis. In ill patients, a CT scan is the safest and most-cost-effective method of diagnosis.

Treating Diverticular Diseases

Surgery is usually not necessary but is sometimes performed in patients with severe or frequent complications. Often the bowel can be joined together immediately. If there is an infection a temporary connection between the bowel and the skin (colostomy) is formed to avoid connecting infected bowel. This surgery can be reversed at a later operation when the bowel is reconnected. The long term outlook is good.

Treating Diverticulitis

Mild episodes usually respond to antibiotics. Many episodes do not recur. Patients with repeated episodes or a severe attack may need surgery.

Living Positively with Diverticular Disease

Managing diverticular diseases

Through several life style changes, it is possible to manage diverticular disease and even prevent it from worsening. Try to make the following changes to help you keep living your life your way:

Increase Your Fibre Intake

Stock pile your diet with tons of fibrous fruits and vegetables. Things like bran and oats are also a great idea. If you’re really struggling, you can also use a fibre supplement to help you easily increase your intake. However, always make sure to talk to your doctor before adding any new supplements to your diet.Also, be sure to add more fibre to your diet gradually. Too much fibre too fast can lead to things like bloating and excessive gas.

Drink More Water

Drinking lots of water will help you to avoid becoming constipated, and will increase the fluidity of stool, helping you to pass your stool more easily.

Exercise

It’s important to keep things moving! Regular exercise is important for good digestive health and helps to reduce stress. Although stress is not a cause of diverticular disease, stress can aggravate symptoms or make them feel more noticeable.

• A diverticulum is when the inner lining of the large bowel (colon) is pushed out through weak spots in the muscle causing a pouch or sac. Diverticulosis is the presence of diverticula (plural), saclike protrusions of the wall of the large bowel.
• While most patients with diverticulosis are asymptomatic, about 25% will develop symptoms, and about 5% will develop an episode of acute diverticulitis (inflammation of diverticula). (Strate et al. 2015; Tursi 2012)
• It is estimated that over 130,000 Canadians have diverticular disease. (Canadian Digestive Health Foundation 2009)
• The prevalence of diverticular disease increases markedly with age. Among Canadians over age 80, about half develop the disease. (Canadian Digestive Health Foundation 2009)
• Every year, more than 400 Canadians die due to complications associated with diverticular disease. (Canadian Digestive Health Foundation 2009)
• Each year 3,309 Canadians require life-saving surgical intervention to treat their diverticular disease. (Canadian Digestive Health Foundation 2009)
• Diverticular disease incurs direct costs of $88.6 million per year in Canada. (Canadian Digestive Health Foundation 2009)

_Citations:

_{Canadian Digestive Health Foundation. 2009. Establishing digestive health as a priority for Canadians. The Canadian Digestive Health Foundation – National Digestive Disorders Prevalence & Impact Study Report.}

_{Strate LL et al. American Gastroenterological Association Institute Technical review on the management of acute diverticulitis. Gastroenterology. 2015 Dec;149(7):1950-76.}

_{Tursi A. Advances in the management of colonic diverticulitis. CMAJ. 2012 Sep 18;184(13):1470-6.}

My mom is 65. I heard that she is at increased risk of developing diverticular disease. Is this true?

The risk for symptomatic diverticular disease is negligible for 35 year olds or younger. However, at age 55 the risk increases by a factor of 10 and at 75 years the risk increases to 40%. 50% of Canadians over the age of 80 years develop diverticular disease. At present, there are no known risk factors other than advanced age.

What is diverticular bleeding?

Bleeding occurs less often than diverticulitis and is not related to episodes of diverticulitis. Often patients do not have symptoms before bleeding occurs. There may be fresh red blood or altered darker blood. Pain is not frequent but cramps can occur. All patients with bleeding need to be investigated to rule out other causes of bleeding. Patients with major bleeding or those who feel light-headed should go to the emergency department. Bleeding often stops on its own but still should be investigated. Most patients do not have further bleeding but in some it may recur. Patients with, recurrent episodes often require surgery.

What is diverticulitis?

Diverticulitis is an infection in the diverticulum. This complication occurs in a few patients with diverticulosis. Men and women are affected equally. The resulting infection can be mild, leading only to abdominal pain; or severe, with diffuse infection or sometimes the development of an abscess (a pocket of pus). There is usually fever and an elevated white cell count in the blood. With healing there can be scarring, leading to bowel narrowing and obstruction. Fortunately, severe episodes account for less than one-quarter of all episodes of diverticulitis.

What is the cause of diverticulosis?

It is thought that lack of fibre in the diet may cause small stool size and high pressure contractions inside the colon. The inner lining then is pushed out through weak spots in the muscle, causing a pouch or a sac (diverticulum).