Diverticular Disease and Diverticulitis

Diverticular disease occurs when small pouches (diverticula) form in the wall of the large intestine (colon). These can be a- or mildly symptomatic (diverticulosis), but if these pouches become inflamed or infected, they can cause more severe symptoms (diverticulitis).

• Diverticular disease (non-inflamed):
• • Crampy pain, usually in the lower left abdomen (but sometimes right) ¹
  • Bloating, constipation, or diarrhea ¹
  • Blood in stool (sometimes) ¹
• Diverticulitis (inflamed/infected):
  • Sudden onset of severe and constant abdominal pain ¹
  • Fever ¹
  • Mucus or blood in stool ¹
  • Nausea, sometimes vomiting ¹

Because symptoms overlap with other bowel conditions (like Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), a medical evaluation is important. ¹

The exact cause of diverticula is not fully understood, but several factors contribute:

• A diet low in fibre is strongly linked to diverticulosis. ³
• Other risk factors include: obesity, lack of exercise, smoking, and use of certain medications such as NSAIDs ³.
• Inflammation (diverticulitis) likely happens when stool or bacteria become trapped in a pouch. ³
• South African studies note that as diets become more westernised (lower fibre), the prevalence of diverticular disease in African populations has grown. ²

Make an appointment if you have:

• Recurrent crampy belly pain, especially with changes in bowel habits
• Blood or mucus in your stool; or
• Symptoms of infection: fever, constant pain, or nausea

Seek urgent medical attention if you experience:

• Severe abdominal pain with vomiting
• Persistent, reoccurring or heavy bleeding from the rectum or passing clots of blood
• Signs of sepsis (abnormally high or low temperature, confusion, rapid breathing, pale or blotchy skin) ¹

To diagnose diverticular disease or diverticulitis, your doctor may:

1. Take a symptom history and do a physical exam.
2. Order blood tests to check for inflammation or infection.
3. Request imaging: a CT scan is often used in suspected diverticulitis. ⁴
4. In non-acute cases, a colonoscopy or sigmoidoscopy may be done to look inside your bowel and to exclude other conditions. ⁵

Treatment depends on how severe the disease is.

Diverticular disease (no inflammation):

• Pain relief: usually paracetamol is safe.
• Laxatives: bulk-forming laxatives may help with constipation.
• Antispasmodics: to ease cramping.
• Diet: increasing fibre and fluid intake helps maintain regular bowel movements. ⁴

Diverticulitis (inflamed/infected):

• Mild cases (uncomplicated): may be managed at home with a liquid or low-fibre diet, oral antibiotics, and pain relief ⁴.
• Severe or complicated cases: hospital admission may be needed for IV antibiotics, drainage of abscesses, or surgery (e.g., colon resection, colostomy) ⁴.
• After recovery, colon evaluation is usually recommended to assess for disease extent or rule out other problems. ⁵

Treatment of complications

Although rare, diverticulitis can lead to one of the following acute complications which may need urgent surgical or medical treatment

• Abscess (pus-filled pocket) ¹
• Bowel obstruction (blockage) ¹
• Fistula (an abnormal connection between bowel and another organ or the skin of the buttocks or abdomen) ¹
• Perforation (hole) in the bowel, causing infection in the abdomen (peritonitis) ¹

Although rare, diverticulitis can lead to one of the following acute complications which may need urgent surgical or medical treatment

• Abscess (pus-filled pocket) ¹
• Bowel obstruction (blockage) ¹
• Fistula (an abnormal connection between bowel and another organ or the skin of the buttocks or abdomen) ¹
• Perforation (hole) in the bowel, causing infection in the abdomen (peritonitis) ¹

Once you have recovered, follow all the prevention guidelines below and follow up with your doctor or a gastroenterologist, especially if you have repeated symptoms.

• Maintain a high-fibre diet once you’ve recovered, to reduce the risk of future flare-ups. ¹
• Stay well-hydrated — fibre only works well with enough fluids.
• Engage in regular physical activity; this supports bowel health.
• Avoid or carefully manage use of NSAIDs or opioids, as they may increase risk of complications. ³
• Follow up with your doctor or a gastroenterologist, especially if you have repeated symptoms.

Diverticular disease carries an increased risk of colonic cancer. Prevention of DD and its management, once diagnosed, is thus crucial to reduce this risk.

Early management of inflammation can prevent acute complications and reduce risk of developing Colonic cancer

1. High-fibre diet is the cornerstone of prevention and maintaining control of your symptoms once recovered from a flare-up.
2. Hydration and exercise support healthy bowel function.
3. Avoid NSAIDs, opiods or codeine-type painkillers unless advised—these may worsen diverticular disease and can increase the risk of complications.
4. Smoking cessation reduces risk of developing DD.
5. Prompt treatment of inflammation can prevent complications.

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.