Diverticular disease

Also called Diverticulitis, Diverticulosis

Small pouches in the bowel wall. Usually harmless, occasionally an emergency.

What it is

Small pouches called diverticula form in the wall of the large bowel. By 70, most people in the UK have some, and the majority never know.

Diverticulosis means having them. Diverticular disease means having symptoms. Diverticulitis means one has become inflamed or infected, and that is where it gets serious.

The old advice to avoid nuts, seeds and popcorn has been studied and found unnecessary. People have avoided them for decades on the basis of a theory that did not hold up.

Signs you might notice

Often nothing at all.

Diverticular disease: intermittent lower abdominal pain, usually on the left, bloating, and a change in bowel habit.

Diverticulitis: constant, more severe pain in the lower left abdomen, fever, feeling unwell, and often a change in bowel habit.

Rectal bleeding, which can be sudden and heavy.

Severe pain with a rigid abdomen suggests perforation and is an emergency.

How it can affect day-to-day life

The risk in older people, and particularly in those who cannot describe pain, is that diverticulitis presents as confusion or as being off their food and gets missed until perforation.

Recurrent episodes affect quality of life considerably and sometimes lead to surgery.

Long-term constipation contributes to the formation of diverticula, so constipation management is prevention here as well as comfort.

Supporting someone well

Get fibre and fluid up between episodes. This is the main preventive measure, and it needs to be built up gradually.

Do not restrict nuts, seeds or popcorn without a specific reason.

During an acute episode, follow the medical advice on diet, which usually means resting the bowel briefly rather than pushing fibre.

Treat constipation actively.

In an older person or somebody who cannot describe symptoms, take abdominal tenderness, fever or new confusion seriously and get it assessed.

Where to get help

A GP manages most cases. Severe pain, fever, or heavy rectal bleeding needs urgent assessment or A and E.

Guts UK provide clear patient information.

Any change in bowel habit over 50, or bleeding, needs investigating rather than being attributed to known diverticula.