Considering the role of gut health in overall health and wellbeing, it’s unsurprising that many of us want to know more about it. And, while conditions like irritable bowel syndrome (IBS) and Crohn’s disease are widely recognised, others, like diverticular disease and diverticulitis, remain lesser-known.
Yet, according to the NHS, diverticular disease is one of the most common digestive conditions around.
So what exactly is diverticular disease and diverticulitis, and how can you reduce your risk? We’ll cover this and more.
What are diverticular disease and diverticulitis?
Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (colon).
- Diverticular disease causes small bulges or pockets (called diverticula) to develop in the lining of the intestine.
- Diverticulitis happens when these pockets become inflamed or infected.
What are the symptoms of diverticular disease and diverticulitis?
Symptoms of diverticular disease and diverticulitis vary depending on the stage and severity of the condition. For example, you can have diverticula present in your large intestine without experiencing symptoms of diverticular disease or diverticulitis.
We’ll explore this in more detail below.
Diverticula
Diverticula is the medical term used to describe small bulges that stick out of the side of the large intestine.
Diverticulosis
If diverticula have been discovered in your large intestine, you may be worried about what this means. However, diverticula are common, particularly with age, and for many people, they cause no symptoms.
For example, the NHS estimates that 5% of people have diverticula by age 40, and by age 80, at least 50%. If you have diverticula but haven’t previously suffered with consistent abdominal pain or bouts of diarrhoea, there’s a 70% to 80% chance you won’t experience symptoms in future. This state is known as diverticulosis.
Diverticular disease
According to the NHS, one in four people with diverticula will experience symptoms, such as bloating, lower abdominal pain, and a change in normal bowel habits. Having symptoms associated with diverticula is known as diverticular disease.
Symptoms of diverticular disease may appear similar to those caused by irritable bowel syndrome (IBS).
Diverticulitis
Diverticulitis happens when bacteria become trapped inside diverticula, causing inflammation and infection. Diverticulitis shares many of the same symptoms as diverticular disease, but tends to be most severe and constant. According to the NHS, this can include…
- More severe abdominal pain, particularly on the left side (the pain typically starts below the lower belly button, before moving to the lower left-hand side of the abdomen)
- High temperature (fever) of 38C or above
- Diarrhoea or frequent bowel movements
- A general feeling of being tired and unwell
- Feeling nauseous or being sick
Note: According to the NHS, Asian people may experience pain in the lower right-hand side of the abdomen. This is because East Asian people tend to develop diverticula in a different area of their colon for genetic reasons.
Can diverticulitis and diverticular disease lead to complications?
According to the NHS, around one in five people experience complications of diverticular disease and diverticulitis, such as bleeding, urinary issues, fistula, and abscesses. Being over 50 increases your risk of complications. However, having diverticula doesn’t increase the risk of cancer.
You can read more about potential complications of diverticular disease and diverticulitis on the NHS website.
What can cause diverticular disease and diverticulitis?
Experts are currently unsure exactly why diverticula initially develop. However, it’s thought that they’re closely related to not eating enough fibre.
Among other things, fibre is essential for digestion because it’s needed to soften and bulk out stools, making them easier to pass. A lack of fibre means the pressure of moving small, hard pieces of stool through the large intestine can cause weak spots to develop in the outer muscle layer. If, under pressure, the inner muscle layer (mucosa) squeezes through these weak spots, it causes diverticula to develop.
Why only some people with diverticula go on to experience symptoms of diverticular disease and diverticulitis is also unknown. That said, the NHS has identified several factors that appear to increase your risk. These include…
- Smoking
- Being overweight or obese
- Having a family history of constipation
- Frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) painkillers, such as ibuprofen
- Having a close relative with diverticular disease, particularly if they developed it before the age of 50
That said, while these factors are thought to play a role in the development of diverticular disease, experts are currently unsure exactly why.
The reason why diverticula are more common later in life is likely because the large intestine naturally becomes weaker over time. This, paired with the pressure of hard stools passing through, may increase the likelihood of bulges forming.
Note: It’s important to note that there’s currently no clinical evidence to confirm the link between fibre and diverticula. However, the NHS believe it’s very likely to play a role because diverticular disease and diverticulitis are both much more common in Western countries, where many people don’t eat enough fibre.
How is diverticular disease and diverticulitis diagnosed?
If you suspect you may have diverticular disease or diverticulitis, it’s important to speak to your GP.
It can be difficult to diagnose diverticular disease and diverticulitis because they cause symptoms similar to other conditions. For this reason, your GP may first recommend blood tests to rule out other conditions, including irritable bowel syndrome (IBS), coeliac disease, and bowel cancer.
Other methods of diagnosing diverticular disease and diverticulitis include colonoscopy and CT pneumocolon or colonography, which you can read more about on the NHS website.
If you’ve previously been diagnosed with diverticular disease, your GP will usually be able to diagnose diverticulitis based on your symptoms and a physical examination. However, in some cases, they may refer you for further blood tests and investigations to check for complications and rule out other potential conditions, such as gallstones.
How is diverticular disease and diverticulitis treated?
Treatment for diverticular disease and diverticulitis will depend on the severity of your symptoms.
We’ll cover some of the options below. For a more in-depth guide to treatment for diverticular disease or diverticulitis, head over to the NHS website.
Treatment for diverticular disease
Many people with diverticular disease find that they’re able to manage symptoms at home.
Paracetamol can help relieve pain and discomfort. However, painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, aren’t recommended because they can cause stomach upsets and increase the risk of internal bleeding.
Increasing your fibre intake can also help improve symptoms of diverticular disease. And if you struggle with constipation, your GP may prescribe you a bulk-forming laxative.
According to the NHS, around one in 20 people with diverticular disease experience heavy or constant rectal bleeding. While this is usually painless, it can be serious if too much blood is lost. For this reason, rectal bleeding sometimes requires treatment with a blood transfusion.
Treatment for diverticulitis
Mild cases of diverticulitis can often be treated at home, often through a combination of antibiotics to address the infection and paracetamol for pain management.
Certain types of antibiotics used to treat diverticulitis can cause side effects in some people, including diarrhoea and vomiting. Your GP will be able to advise you on how to navigate these.
According to the NHS, you may need hospital treatment if pain can’t be managed with paracetamol, you’re unable to drink enough fluids to stay hydrated, or you have a weakened immune system.
Hospital treatment for diverticulitis typically involves antibiotic injections and an intravenous drip to keep you hydrated. Most people find that symptoms start to improve within two to three days of these treatments.
In the past, surgery was recommended as a preventative measure for people who’d had two episodes of diverticulitis as a method of preventing complications. However, this is no longer the case, as studies have found that, in most cases, the risk of serious complications (estimated to be around one in 100) outweighs the benefits.
That said, there are some exceptions – including for those with a history of serious complications from diverticulitis or who have a weakened immune system and are more vulnerable to infections.
You can read more about treatment for diverticulitis on the NHS website.
How can I reduce my risk of diverticular disease and diverticulitis?
Statistics show that over 90% of UK adults don’t eat enough fibre. In fact, most of us eat just 60% of the NHS daily recommended intake of 30g. As a result, the NHS says that the best thing you can do to reduce your risk of diverticular disease and diverticulitis and improve symptoms is to eat a high-fibre diet.
Alongside its role in gut health, studies have consistently linked high-fibre diets with a reduced risk of several conditions – including stroke, heart disease, bowel cancer, and type 2 diabetes.
Some of the best sources of fibre include beans, lentils, fruit and vegetables like raspberries, pears, and avocados, and whole grains like oats, quinoa, and brown rice. Check out our article, 10 easy ways to add more fibre to your diet, to learn more.
That said, experts recommend increasing your fibre intake gradually, over a few weeks. This should help to reduce the impact of side effects linked with high-fibre diets, including bloating and gas.
Other useful steps you can take to help reduce your risk of diverticular disease and diverticulitis include quitting smoking, maintaining a healthy weight, and addressing constipation.
Final thoughts…
Despite being one of the most common digestive conditions around, we tend to hear less about diverticular disease and diverticulitis than other gut conditions like IBS and coeliac disease.
However, while research into its causes is ongoing, experts believe that fibre has a key role to play. Plus, aside from reducing your risk of diverticulitis and diverticular disease, eating more fibre is one of the best things you can do for your overall health.
For further reading on how to boost your gut health, head over to our gut health section. Here, you’ll find information on everything from common food intolerances to foods to help improve digestion.
Do you have any experience with diverticulitis and diverticular disease that you’d like to share? We’d be interested to hear from you in the comments below.
