CONDITIONS
Diverticular Disease
Symptoms, causes and treatment of diverticular disease
Diverticular disease of the colon is a common condition that affects around half of Scottish adults by age 60 and is very common by age 80. It develops when the bowel forms small pouches (diverticula), often due to “wear and tear” and raised pressure inside the colon. Most people have no symptoms, but some experience pain, inflammation, altered bowel habit, or complications. Treatment depends on symptoms and ranges from diet changes to antibiotics for diverticulitis. Surgery is rarely needed.
What is diverticular disease?
A diverticulum is a small pouch that bulges out from a hollow structure in the body. When these pouches form in the colon (large intestine), the condition is often called diverticulosis or diverticular disease.
Diverticula are common with ageing. It’s thought that pressure from harder stools passing through an ageing bowel, where the wall has weakened over time, contributes to pouch formation.
What is the difference between diverticulitis and diverticular disease?
Diverticular disease / diverticulosis: diverticula are present (pouches exist).
Diverticulitis: diverticula become inflamed (often painful) — “-itis” usually means inflammation.
How common is diverticular disease?
It is very common in western countries and becomes more common with age. It affects about 50% of Scottish adults by age 60 and is very common by age 80. It appears less common in parts of Africa, possibly related to dietary patterns (especially fibre intake).
What causes diverticular disease?
The exact cause isn’t fully understood, but it is more common in people with a low-fibre diet. Higher pressure inside the colon may push the bowel lining through weak points in the muscle layers, forming diverticula.
Population comparisons suggest diverticular disease is more common with a “western” diet (higher animal protein and lower cereal/vegetable fibre). Lower fibre can reduce stool bulk and increase colonic pressure.
Now that I have diverticular disease, will it ever go away?
Once diverticula form, they are generally considered permanent. However, that doesn’t mean they will cause problems. Most people with diverticular disease have no symptoms throughout life.
Is diverticular disease associated with cancer?
Diverticular disease is not thought to increase the risk of cancer. However, because bowel cancer and diverticular disease can share symptoms, your doctor may recommend tests to rule out other causes (for example, imaging or endoscopy such as sigmoidoscopy/colonoscopy).
What are the symptoms of diverticular disease?
Most patients have no symptoms. When symptoms occur, they may include:
- Change in bowel habit (more constipated or looser than usual)
- Colicky discomfort, often on the left side of the abdomen
- Abdominal distension / bloating
- Pain with inflammation (diverticulitis) — less common
- Blood in the stool — if this is new, tell your doctor so other causes can be excluded
If you have new rectal bleeding, persistent change in bowel habit, fever, worsening abdominal pain, or feel generally unwell, speak to your GP or seek urgent care depending on severity.
How is uncomplicated diverticular disease treated?
For many people, a high-fibre diet helps reduce symptoms and supports more regular bowel function.
- Wholemeal bread
- Brown rice
- Wholemeal pasta
- Fruit and vegetables
- Bran cereals
- Ispaghula husk (e.g., Fybogel / similar)
- Sterculia (e.g., Normacol)
- Methylcellulose (e.g., Celevac / similar)
Some people also benefit from antispasmodics or peppermint oil for cramping and bloating (doctor/pharmacist advice).
What complications may occur?
Complications are uncommon, but include:
- Diverticulitis (infection/inflammation) — often treated with antibiotics
- Perforation with peritonitis — serious, usually needs urgent surgery
- Abscess (local collection of pus) — may need drainage and sometimes surgery
- Fistula (connection to bladder/vagina, etc.) — usually requires surgery
When is surgery necessary?
Surgery is usually reserved for recurrent diverticulitis, complications, severe attacks that don’t respond to treatment, or significant bleeding. Decisions are individual and should balance benefits and risks.
Colectomy
- Open colectomy: larger incision to remove the affected segment
- Laparoscopic colectomy: keyhole surgery using small incisions and a camera
Both approaches can be effective; laparoscopic surgery often has quicker recovery and less post-operative pain, but availability can vary.
Stoma surgery
Sometimes a temporary stoma is needed to allow healing before reconnection, or if reconnection isn’t possible immediately. This may be an ileostomy or colostomy. Many stomas are temporary, but occasionally can be permanent.
What are the results of surgery?
Surgery is often successful, though it may not be a complete cure in all cases. Some people can have recurrence of symptoms afterwards.
Can I be investigated and treated for diverticular disease at the Glasgow Colorectal Centre?
Yes. Specialist colorectal teams can assess symptoms, arrange appropriate investigations where needed, and tailor treatment plans ranging from lifestyle measures to antibiotics or surgery for select cases.
Quick Questions
Does diverticular disease always cause symptoms?
No. Most people with diverticula have no symptoms and may never know they have the condition.
What symptoms suggest diverticulitis rather than uncomplicated diverticular disease?
Worsening abdominal pain (often left-sided), fever, feeling unwell, and sometimes nausea can suggest diverticulitis and should be assessed.
Is a high-fibre diet always appropriate?
Fibre helps many people, but if symptoms are severe or you’re having an acute flare with significant pain/fever, follow medical advice about diet and treatment.