Diverticular disease and diverticulitis

Diverticula are small bulges that can develop in the lining of the intestine. They don’t always cause symptoms but when they do, it’s called diverticular disease. When diverticula become infected, it’s called diverticulitis.

  1. Complication of diverticular disease
  2. Symptoms include fever, bloating and stomach pain 
  3. Treated with antibiotics

You should seek medical advice right away if you have been diagnosed with diverticular disease and suspect you may have diverticulitis. If you’re experiencing general symptoms such as stomach pain or constipation, and want to speak to a doctor, our video GP service is available to help.  

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What is diverticular disease and diverticulitis?

Diverticular disease is a condition where diverticula (small pockets in the large colon) cause symptoms such as irregular bowel habits, small harder stools (or pellets) and bloating. Diverticulitis is the condition that results when these pockets become infected. The infection causes a fever, pain in the lower left side of the abdomen, and very occasionally rectal bleeding. Complicated diverticulitis can cause a range of complications, such as abscesses and perforation. 

What causes diverticular disease?

Low fibre diets are thought to play a role in the development of diverticular disease. Fibre performs an important function in making stools larger and softer, which in turn helps muscles in the large intestine to expel them without applying too much pressure. If someone doesn’t eat enough fibre, this can cause their stools to become smaller, harder and more dense. In such cases, the muscles in the bowel need to exert themselves more. 

This can lead to certain parts of the bowel wall becoming weaker, resulting in mucosal tissue pushing through to the outside of the bowel. When this happens, small empty pockets develop. 

What symptoms do diverticular disease and diverticulitis cause?

When stool gets trapped in these pockets, it can cause inflammation and sometimes an infection (diverticulitis). Someone experiencing inflamed diverticula may develop pain and discomfort in the lower left side of the abdomen, and pass small, pellet-like stools. When someone has an infection, they may get these symptoms in addition to a fever, nausea and vomiting.

It is thought that the prevalence of diverticulitis is increasing in developing countries, but around 75% of people who have diverticula will not experience any symptoms. The presence of diverticula before the age of 40 is quite rare; it’s more common for people to develop them when they’re older. 

What complications can diverticulitis lead to?

There are many issues that can arise from diverticulitis, and they vary in severity. Bleeding is one of the more common effects of diverticulitis, and can happen when the bowel wall is weakened. The formation of abscesses is a possible complication of diverticulitis. These are pus-filled lumps that appear on the outside of the colon. 

Fistulas are another complication of diverticulitis, where small tunnels develop in bowel tissue. These can allow the passing of harmful bacteria from the intestine to other parts of the body and cause further infection. Rarely, diverticula that become infected can split, which leads to an infection of the stomach lining, known as peritonitis. Both fistulas and peritonitis often require surgery.

How is diverticular disease and diverticulitis managed?

How the condition is treated depends on how serious the effects are. For example, someone with diverticular disease may be able to alleviate symptoms through dietary changes alone. Diverticulitis usually needs to be treated with antibiotics, but doesn’t require hospital admission in milder cases. However, you may need to go to hospital if your symptoms are serious, or if your doctor thinks you are at risk of developing other problems.

You can talk to a doctor online about diverticular disease and diverticulitis, or any other symptoms you may be concerned about, through our video consultation service. Click below to make an appointment at a suitable time. Our doctors are available at a convenient time for you.

Page last reviewed:  15/06/2020
Diagnosis and treatment

What are the causes of diverticulitis and diverticular disease?

Diverticula are small pockets which can develop on the exterior of the large bowel. When someone has diverticula, it is known as diverticulosis. When diverticula cause symptoms of discomfort, it’s called diverticular disease.

It is not fully understood why some people develop the disease, although a lack of dietary fibre is thought to be a contributing factor. Fibre in the diet produces bigger and softer stools, and this makes it easier for them to pass. If someone doesn’t eat enough fibre, their stools tend to be smaller and harder, and this causes the bowel to strain. This then leads to the development of weaker points within the bowel wall, and inner tissue (mucosa) pushes through to the outside, creating pockets (diverticula).

Around a quarter of people with diverticular disease go on to develop diverticulitis. This is when diverticula become infected.

How are the conditions diagnosed?

Diverticular disease causes symptoms that are similar to other conditions, such as IBS and coeliac disease. If your GP rules out other illnesses and suspects you may have diverticular disease, they may suggest you have tests to help them make a diagnosis.

In people who already have diverticular disease, a doctor can usually determine the presence of diverticulitis by conducting a physical exam. 

Will I need tests?

To diagnose the presence of diverticula, you will need to have tests. A colonoscopy (a small camera inserted into the rectum) and CT scans (X-rays) are typically used in such cases.

Diverticulitis can usually be confirmed in people with a history of diverticular disease through a blood test.

How are diverticular disease and diverticulitis treated?

Milder cases can be treated at home. Eating a high fibre diet can help to reduce the symptoms of diverticular disease - usually within a few days or weeks. If rectal bleeding occurs in someone with diverticular disease, a doctor may need to monitor them more closely.

Uncomplicated diverticulitis can be treated with antibiotics at home. They will not always be necessary, and a doctor may simply suggest a low-residue diet. However, in the event that they are, a doctor can prescribe co-amoxiclav. 

A doctor will advise you to consume clear liquids only, and to refrain from eating solids for the first two days of treatment. If the symptoms of diverticulitis are severe, however,  hospitalisation may be necessary, as the risk of complications is higher.

Page last reviewed:  15/06/2020
Questions and Answers

How are diverticular disease and diverticulitis treated?

Diverticular disease can sometimes be helped by making adjustments to your diet. This includes eating more fibre, so that the bowel doesn’t have to strain as much to pass harder stools.

For an uncomplicated case of diverticulitis, where an infection is present but symptoms are otherwise mild, a course of antibiotics will often be prescribed. It is also recommended that you drink clear liquids only, and slowly reintroduce solid foods to your diet over the course of treatment. 

If bowel perforation, abscesses or other complications are suspected, hospitalisation is required.

How long will it take for me to recover?

It can vary, depending on how serious the condition is. Mild diverticulitis will take between 1-2 weeks to fully recover having taken antibiotics. The recovery time is longer for people who have had surgery, and may take at least a month.

Can I consult a doctor about diverticular disease and diverticulitis online?

Yes. However, if your symptoms are serious and you are experiencing severe pain, being sick and can’t keep fluids down, you should speak to a medical professional urgently and go to your nearest hospital.

Our doctors are available to help if you are experiencing milder symptoms, seeking expert input, or looking to establish what the cause may be. We work with GMC-registered doctors, who can issue treatment where appropriate, or refer you for further investigations where needed. Our service allows you to choose an appointment at a time that suits you.

Page last reviewed:  15/06/2020

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