Diverticula. Surgical Directorate. What are Diverticula? Who gets Diverticula? What causes Diverticula? 0137/03/Oct 2009

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1 Diverticula Diverticula of the colon are common in older people. They usually cause no symptoms, and no treatment is usually needed. Pain, or complications which need treatment, are uncommon. What are Diverticula? A diverticulum is a small pouch with a narrow neck that protrudes from the wall of the gut. Diverticula means more than one diverticulum. They can develop on any part of the gut, but usually occur in the colon (large intestine). They most commonly develop in the section of the colon leading towards the rectum, where the stools (sometimes called faeces or motions) are becoming more solid. (This is on the left hand side of the abdomen). Several diverticula, and sometimes many, may develop over time. Who gets Diverticula? They become more common with increasing age. About one in 20 people in their 40s, about one in three people in their 60s, and about half of people in their 80s have diverticula of the colon. Men and women are equally affected. What causes Diverticula? The reason why diverticula develop is not clear. It is thought to be related to not eating enough fibre. Fibre is the part of food that is not digested. Your gut moves stools (faeces) along with gentle squeezes of its muscular wall. The stools tend to be drier, smaller, and more difficult to move along if you don't eat much fibre. Your gut muscles have to work harder if there is little fibre in your gut. High pressure may develop in parts of your gut when it squeezes hard stools. The increased pressure may push the inner lining of a small area of your gut through the muscle wall to form a small diverticulum. East Sussex Hospitals NHS Trust Page 1 of 5

2 What are the symptoms of Diverticula? Diverticula usually cause no harm or symptoms. In some cases, pain in the abdomen and/or bloating may occur. The pain is usually 'crampy' and tends to come and go. You may get ease from any pain and bloating by going to the toilet to pass stools. Some people develop diarrhoea or constipation. However, it is not clear whether diverticula actually cause these symptoms. They may be due to other conditions such as irritable bowel syndrome in people who just happen to have diverticula. What are the possible complications of Diverticula? Complications are uncommon, and include the following. Diverticulitis (infection) About one in 10 people with diverticula develop a bout of diverticulitis at some stage. This is when one or more of the diverticula become inflamed and infected. This may occur if some faeces gets trapped and stagnates in a diverticulum. Bacteria (bugs) in the trapped faeces may then multiply and cause infection. Symptoms of diverticulitis include: A constant pain, usually in the lower left side of the abdomen. This is over the site where diverticula commonly develop. Fever (high temperature). Constipation or diarrhoea. You may have some blood mixed with your stools. You may feel sick or vomit. An abscess (a ball of infection and pus) may develop if the infection is severe. Diverticulitis is treated with antibiotics and usually settles within a week or so. Admission to hospital is needed in some cases. Surgery is sometimes needed to drain an abscess or to remove a badly infected part of the gut. Some people have several bouts of diverticulitis in their life. Bleeding A diverticulum may occasionally bleed and you may pass some blood with your stools. The bleeding is usually slight, but is sometimes heavy. Obstruction, fistula, and peritonitis Infected diverticula occasionally cause a blockage (obstruction) of the gut, or form a channel (fistula) to other organs such as the bladder. A diverticulum may, rarely, burst and cause infection inside the abdomen (peritonitis). Surgery is usually needed to treat these serious but uncommon complications. About one in 100 people with diverticula need surgery at some stage for a complication. East Sussex Hospitals NHS Trust Page 2 of 5

3 What is the treatment for diverticula? Be reassured - Diverticula are common in older people, and can be thought of as a normal part of ageing. No treatment is needed in most cases as they usually cause no symptoms. Eat lots of high fibre foods - (This is usually advised for everyone, whether you have diverticula or not.) Fibre helps to make larger and softer stools. If you have pain due to diverticula, you may find that the pain is eased if you eat a high fibre diet. Also, a high fibre diet may prevent further diverticula forming which may reduce the risk of complications. It also prevents constipation. Many foods are high in fibre, and include the following: o Fruit, vegetables and nuts. o Wholemeal or wholewheat bread, biscuits, and flour (for baking). o Wholegrain breakfast cereals such as All Bran, Weetabix, muesli, etc. o Brown rice, wholemeal spaghetti, and other wholemeal pasta. You may have some bloating and extra wind at first when you eat more fibre. This is often temporary and tends to settle in a few weeks as your gut becomes used to the extra fibre. Some experts feel that eating more fibre from fruit and vegetables is probably better than eating more grain based fibre (bread etc) to ease symptoms due to diverticula. Fibre supplements may be advised if a high fibre diet does not prevent constipation. Several are available at pharmacies, health food shops, or on prescription. The most common (and cheapest) is bran. Some people find bran unpalatable and try other fibre supplements such as ispaghula. A pharmacist will advise. Note: Some people find that bran based products (bran supplements or bran-based cereal products) cause symptoms to become worse for as long as they take them. If your symptoms do not improve after three or four weeks of taking bran, then stop or reduce it. You can continue with other fibre supplements. Have lots to drink when you have a high fibre diet or fibre supplements. Aim to drink at least two litres (about eight to 10 cups) per day. Painkillers may be needed if you develop abdominal pain. You may be prescribed a medicine to ease gut spasm if you have crampy abdominal pains. Antibiotics or surgery may be needed if you develop a complication (described above). Please note Tell a doctor if you have a change in the pattern of your toilet habit; for example, a sudden change to regular constipation or diarrhoea, passing blood or mucus, or new pains. A change of symptoms may indicate a new and different gut problem. East Sussex Hospitals NHS Trust Page 3 of 5

4 Legal Disclaimer This information has been taken from the website The Trust accepts no responsibility for the content of this website. Please remember that this leaflet is intended for general information only. Please check any specific concerns with your doctor. East Sussex Hospitals NHS Trust Other sources of information Royal College of Anaesthetists - The Royal College of Surgeons - Your GP NHS Direct Telephone: Important information Please remember that this leaflet is intended as general information only. It is not definitive. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please, therefore, always check specific advice on the procedure or any concerns you may have with your doctor. Hand Hygiene In the interests of our patients the trust is committed to maintaining a clean, safe environment. Hand hygiene is a very important factor in controlling infection. Alcohol gel is widely available throughout our hospitals at the patient bedside for staff to use and also at the entrance of each clinical area for visitors to clean their hands before and after entering. Other formats If you require this leaflet in any other format such as larger print, audio tape, Braille or an alternative language, please ask at one of our PALS offices. If you require interpreting services during your hospital visit please ask a member of staff who will be able to organise this for you via the appropriate department. After reading this information are there any questions you would like to ask? Please list below and ask your nurse or doctor. East Sussex Hospitals NHS Trust Page 4 of 5

5 Reference The following clinicians have been consulted and agreed this patient information: Clinical Matrons Mrs E Fellows Mrs J Kinch Senior Sisters Linda Budd Gillian Churchill Trish Shult Nicola Booth Date Agreed: October 2009 Review Date: October 2011 Responsible Clinicians: Mrs E Fellows and Mrs J Kinch - Clinical Matrons East Sussex Hospitals NHS Trust Page 5 of 5