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Diverticular disease

What is diverticular disease?

Diverticular disease is a problem of your large bowel (colon) and is related to a lack of fibre in your diet. About 1 person in 3 over the age of 60 years throughout the Western world has this problem.

It is not really a disease, but a condition in which small pouch-like swellings hang from the bowel wall. Infection in such a pouch is called diverticulitis.

What is the cause?

Normally, the large bowel moves the faeces along its length with gentle rhythmic contractions of muscles in the bowel wall-this is called peristalsis. Without adequate fibre in the diet the motion is dry, small and difficult to move along. The intestinal muscles must therefore perform strong contractions and generate high pressure. This high pressure may push thinner lining through the weaker spots in the wall, rather like blowing up a balloon. The pockets or pouches formed are called diverticula. You may have many of these diverticula along the length of the large bowel.

What are the symptoms?

Diverticular disease rarely causes symptoms. A lack of fibre in the diet can cause you to experience bloating, flatulence (desire to pass wind) and abdominal pains.

Are there any tests?

There are two tests done to confirm diverticular disease. The first is sigmoidoscopy. A hollow tube is passed into the back passage, through which your doctor can see the bowel lining. The second is a barium enema. Barium dye is forced into the back passage and a series of X-ray films clearly show diverticula outlined by use of this dye.

Are there any complications?

Complications are infection and bleeding, which are uncommon. If infection (diverticulitis) develops, you will experience abdominal pain, nausea and fever. These symptoms or any bleeding require prompt attention by your doctor.

What is the treatment?

The gradual introduction of fibre with plenty of fluids (especially water) will improve any symptoms you may have and reduce the risk of complications. Your diet should include:

• cereals, such as bran, shredded wheat, muesli or porridge
• wholemeal and multigrain breads
• fresh or stewed fruits and vegetables

Bran can be added to your cereal or stewed fruit starting with 1 tablespoon and gradually increasing to 3 tablespoons a day. Fibre can make you feel uncomfortable for the first few weeks, but the bowel soon settles to your improved diet.

Note

Unusual symptoms such as bleeding, constipation, diarrhoea and other changes in your normal habit may be a sign of bowel cancer. If they occur, report to your doctor.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia