Diverticular Disease

Diverticular disease refers to conditions involving small bulges or pockets (diverticula) that develop in the walls of the colon. It includes diverticulosis (presence of diverticula) and diverticulitis (inflammation or infection of diverticula). While the condition is more prevalent in Western countries due to low-fibre diets, cases in India are rising due to urban lifestyle changes. Early recognition and proper management are key to avoiding complications.

Diverticular disease is a gastrointestinal condition characterised by the formation of diverticula—small pouches that protrude through weak spots in the colon wall. These are usually found in the sigmoid colon. When these pouches remain symptomless, the condition is known as diverticulosis. If the pouches become inflamed or infected, it progresses to diverticulitis, which can cause severe abdominal pain and complications.

Globally, diverticular disease affects up to 50% of people over the age of 60. It is more common in developed nations where diets are low in fibre. In India, though traditionally rare, incidence is increasing, especially in urban populations adopting Western diets and sedentary lifestyles.

Diverticular disease can be classified into the following types:

1. Diverticulosis: Presence of diverticula without symptoms.
2. Symptomatic Uncomplicated Diverticular Disease (SUDD): Diverticula with chronic gastrointestinal symptoms like bloating or discomfort.
3. Acute Diverticulitis: Inflammation or infection of diverticula.
4. Complicated Diverticulitis: Includes abscesses, perforations, fistulas, or peritonitis.

The exact cause is not fully understood, but contributing factors include:

• Low-fibre diet: Leads to constipation and increased pressure in the colon.
• Ageing: Weakens colon walls.
• Genetics: Family history may increase risk.
• Obesity: Particularly abdominal obesity.
• Sedentary lifestyle: Physical inactivity is linked to higher risk.
• Smoking: Increases risk of complications like diverticulitis.

Many people with diverticulosis are asymptomatic. However, when symptoms occur, they may include:

• Cramping or pain in the lower abdomen (usually left side)
• Bloating and flatulence
• Changes in bowel habits (constipation or diarrhoea)
• Rectal bleeding
• Fever and chills (in diverticulitis)
• Nausea and vomiting (in severe cases)

Diagnosis typically involves the following methods:

• Physical Examination: Checks for abdominal tenderness.
• Blood Tests: To detect signs of infection or inflammation.
• Stool Test: Rules out other causes like infections.
• Colonoscopy: Used to view diverticula directly.
• CT Scan: Most accurate tool for diagnosing diverticulitis and its severity.
• Barium Enema X-ray: Occasionally used for visualising diverticula.

Treatment depends on the severity and type of condition:

1. Diverticulosis:
   
   • High-fibre diet (whole grains, fruits, vegetables)
   • Fibre supplements like psyllium
   • Adequate hydration
2. Mild Diverticulitis:
   
   • Antibiotics including AB-CEF 200 mg tablet and Jifon 200mg tablet.
   • Liquid or low-fibre diet temporarily
   • Pain relievers (Voveran SR 75 mg tablet)
3. Severe or Complicated Diverticulitis:
   
   • Hospitalisation
   • Intravenous antibiotics

Surgery (colectomy) if there are abscesses, perforation, or recurrent episodes

While not a substitute for medical treatment, these may support gut health:

• Probiotics: May help maintain a healthy gut flora.
• Ayurvedic herbs: Triphala and isabgol (psyllium) under medical advice.
• Acupuncture: For managing abdominal discomfort.
• Yoga and meditation: Stress management aids digestive health.

Always consult your doctor before trying alternative therapies.

Several factors increase the likelihood of developing diverticular disease:

• Age over 40
• Low-fibre diet
• Obesity
• Lack of exercise
• Smoking
• Use of NSAIDs (non-steroidal anti-inflammatory drugs)
• Family history of diverticular disease

If untreated, diverticular disease can lead to serious issues:

• Abscesses: Pus-filled cavities near infected diverticula
• Perforation: Tear in the colon wall
• Peritonitis: Life-threatening infection of the abdominal cavity
• Intestinal blockage: Due to scarring
• Fistula: Abnormal connection between the colon and other organs
• Bleeding: From ruptured blood vessels in diverticula

• Track Symptoms: Keep a journal to monitor triggers.
• Adjust Diet: Avoid seeds and nuts if they aggravate symptoms (though modern evidence is mixed).
• Stay Hydrated: Drink at least 2 litres of water daily.
• Use Heat Packs: For abdominal discomfort.
• Join Support Groups: Helps manage mental health and gain shared experiences.

• Myth: Only older people get it
  
  
  • Fact: While more common with age, it can affect younger adults too.
     
• Myth: Seeds and nuts cause diverticulitis
  
  
  • Fact: Recent studies show no direct link.
     
• Myth: Surgery is the only option
  
  
  • Fact: Many cases are managed with diet and medication.
     
• Myth: Fibre should be avoided during flare-ups
   
• Fact: Only during acute episodes; otherwise, fibre is essential.

Seek medical attention if you experience:

• Persistent or severe abdominal pain
• Fever and chills
• Rectal bleeding
• Nausea and vomiting
• Constipation or bloating lasting more than a few days

Prompt treatment can prevent complications.

• What is the best diet for my condition?
• Do I need antibiotics or other medications?
• How often should I have follow-up exams?
• Will I need surgery?
• Can lifestyle changes help prevent recurrence?
• Are there any long-term risks I should be aware of?

• Be Understanding: Flare-ups can be painful and unpredictable.
• Offer Dietary Help: Prepare fibre-rich meals.
• Attend Appointments: Accompany them for emotional support.
• Stay Informed: Read up on the condition to offer better help.
• Respect Their Limits: They may need rest during flare-ups.

Diverticular disease is manageable with timely diagnosis and appropriate lifestyle modifications. Recognising early symptoms, maintaining a high-fibre diet, and staying active can prevent complications. For those affected, a support system and ongoing medical care play a crucial role in improving quality of life. As awareness grows in countries like India, early intervention can reduce the burden of this digestive disorder.