Diverticular Disease

• Cramping pain in the lower tummy, usually on the left side, often eased by passing wind or stool
• Bloating and excess wind
• A change in bowel habit, with constipation, diarrhoea or both
• Tenderness over the lower abdomen during a flare-up
• Fever and feeling generally unwell when the diverticula become infected (diverticulitis)
• Bleeding from the back passage, which can sometimes be brisk
• Mucus in the stool

Diverticula are thought to form when raised pressure inside the bowel pushes the inner lining outwards through weaker points in the muscular wall, creating small pouches. A diet low in fibre is strongly linked to the condition, as low-fibre stools are harder and require more pressure to move along, and rates of diverticular disease are much higher in Western countries where fibre intake tends to be lower. Age is a major factor, with diverticula becoming increasingly common from middle age onwards.

Other factors that may increase the risk include being overweight, smoking, lack of physical activity, and certain medications such as non-steroidal anti-inflammatory painkillers (NSAIDs). Genetics also appears to play a part. Diverticulitis occurs when one or more of these pockets becomes inflamed or infected, sometimes when a small piece of hard stool becomes trapped, which can lead to localised infection and, less commonly, complications such as an abscess.

Diverticulosis is often discovered incidentally during a colonoscopy or CT scan performed for another reason. Where symptoms are present, the diagnosis is usually confirmed with a colonoscopy, which allows the bowel lining to be inspected directly, or with a CT colonography. These investigations are also important to rule out other causes of the symptoms, including bowel cancer, which can sometimes present in similar ways.

When acute diverticulitis is suspected, a CT scan of the abdomen and pelvis is the most useful test. It confirms the diagnosis, shows how severe the inflammation is, and identifies complications such as an abscess, perforation or fistula that may change the treatment plan. Blood tests are used to check for signs of infection and inflammation. Colonoscopy is usually deferred until an acute attack has settled, then performed a few weeks later to inspect the bowel fully.

Diverticulosis is often found by chance during a scan or colonoscopy done for another reason and needs no treatment. Where you have symptoms, Mr Hussain confirms the diagnosis and rules out other causes — particularly bowel cancer — usually with a colonoscopy or CT colonography, and explains a clear management plan focused on diet and lifestyle.

If you have an acute attack of diverticulitis, a CT scan shows how severe it is and whether there are any complications. Many mild attacks settle with rest, fluids and pain relief, and selected cases can be managed at home, with a colonoscopy arranged a few weeks later once the inflammation has settled. Surgery is reserved for repeated severe attacks or complications, and is planned carefully — usually as keyhole surgery with an enhanced recovery programme.

Recovery depends very much on the type of treatment. A mild attack of diverticulitis managed conservatively usually improves within a few days, and Mr Hussain will advise on diet and on the colonoscopy that is often arranged a few weeks later to inspect the bowel once the inflammation has settled. Building up dietary fibre gradually after an attack helps to reduce the chance of further episodes.

After keyhole sigmoid colectomy, most people stay in hospital for around three to five days and follow an enhanced recovery programme, getting up and eating early. It is normal to feel tired for a few weeks, and bowel habit can take a little time to settle. Most people return to their usual activities within four to six weeks, avoiding heavy lifting at first. After a Hartmann's reversal, recovery is similar, and your team will guide you as your bowel function returns to normal.