Diverticular disease and diverticulitis

When you eat plenty of fibre-rich foods and drink plenty of fluids, your poos are more likely to be bulky and soft. This type of poo can easily be moved along your gut by gentle contractions of the muscles in your gut wall.

If you do not eat enough fibre-rich foods and drink plenty of fluids, you can become constipated as your poos become harder. To pass harder poos, your bowel has to contract more forcefully, putting pressure on weaker parts of your gut wall. This causes bulges in the gut wall called diverticula.

Diverticulitis starts when some poo gets stuck in a bulging pouch in your colon wall (diverticulum) and causes an infection and inflammation. 

You might have diverticula without any symptoms. Sometimes, they are diagnosed after having a scan or colonoscopy.

Some people with diverticular disease may feel occasional cramps or pain in their lower tummy. This will be felt most on the left side, and it may also cause some bloating. Poos may change and be runnier (diarrhoea) or hard and small (constipated). Going to the toilet may help ease the pain or bloating.

If you have diverticulitis, you may:

• have more severe or constant tummy pains
• have hard poos (constipation) or runny poos (diarrhoea)
• feel sick (nausea)
• feel like throwing up (vomiting)
• feel feverish.

Bleeding from the small blood vessels at the neck of a diverticulum can happen. In some cases, it can be serious bleeding.

There can be several complications if you have developed diverticulitis.

These are uncommon but serious conditions that often require surgical treatment.

They include:

• an abscess forming next to the infected diverticula or somewhere else in your tummy
• a connection (fistula) between your bowel and another organ, such as your bladder
• a blockage of your bowel
• a hole in your bowel wall (perforation) causing its contents to spill into your abdomen and cause an infection (peritonitis).

If any of these complications develop, you will need to go to hospital. You will have a CT scan to see how bad the disease is, and then you will be able to get the correct treatment.

If you think you have diverticular disease or diverticulitis, talk to your healthcare provider.

They will talk to you about your symptoms and examine your tummy. You may be referred for some tests, including blood tests and maybe a colonoscopy, CT scan or ultrasound. This will be important if your healthcare provider wants to make sure your symptoms are not coming from a more serious condition.

Most people with diverticulosis and diverticular disease should follow a high-fibre diet and drink plenty of fluids. This can help to keep your poo soft and easy to pass and reduce the pressure in your large bowel. It can also help to ease symptoms you may already have, such as:

• bloating
• constipation
• runny poos (diarrhoea)
• pain.

High-fibre foods include:

• vegetables and fruit
• wholegrain breads and cereals, brown rice and wholemeal pasta
• nuts and seeds
• legumes (cooked dried beans, split peas and lentils)

If your diet is low in fibre, it is important that you gradually add more fibre over the course of a few weeks. This will help to prevent side effects, such as bloating and farting, which sometimes happen with a high-fibre diet.

Fibre supplements

If a high-fibre diet is not working, your healthcare provider or dietitian may suggest you take a fibre supplement. These are also called bulk-forming laxatives or bulking agents.

You can get them from your healthcare provider on prescription or buy them at a pharmacy. You can also get some at the supermarket.

Examples of bulk-forming laxatives include:

• psyllium (Konsyl-D, Metamucil, Mucilax)
• wheat dextrin (Benefiber).

Bulk-forming laxatives can have some effect within 12 to 24 hours, but may take 2 to 3 days to have their full effect. Take them according to the manufacturer's or your healthcare provider's directions.

Fluids

High-fibre foods and fibre supplements soak up fluid, so it is important to drink at least 8 cups of fluid each day. Water is best but milk or milky drinks, hot drinks, soup, custard and ice blocks all count as fluids.

Go easy on fruit juice, cordial, and fizzy drinks. These are all high in sugar.

Fibre and fluid for healthy bowels

If you have diverticulitis with no complications, your treatment will usually involve having only clear fluids for 2 to 3 days, followed by a low-fibre diet. This will help your digestive tract rest and heal.

Clear fluids include:

• water
• apple juice
• strained tomato or vegetable juice
• ginger ale
• lemonade
• clear soups, such as chicken stock in hot water
• black tea and coffee.

You will also be given simple pain relief, such as paracetamol.

Low-fibre diet

You may need to visit your healthcare provider during this time to make sure things are settling down.

Your symptoms will generally go away within a week, but you may feel tired and a little sore for a couple of weeks.

As you recover, you need to make sure that you are drinking plenty of fluids to reduce the chance of becoming constipated. Once your symptoms improve, you can slowly start to eat a low-fibre diet. When you no longer have symptoms, you can return to a normal high-fibre diet.

If you do not get better or your symptoms get worse and you feel very unwell, you should see your healthcare provider. You may need to be referred to hospital for further investigations and treatment. This may involve:

• antibiotics
• pain relief
• fluids given through a drip
• other treatment, such as draining an abscess
• an operation (very occasionally).

If you have bleeding, you may need a colonoscopy to find the cause of your bleeding and rule out things like bowel cancer.

Colonoscopy

If you have recurring issues, you may need to be referred to hospital for review and further treatment. This could include surgery.

To help prevent diverticular disease, you should:

• eat lots of high-fibre foods
• drink plenty of fluid.

This keeps your poos soft and helps prevent constipation.

Fibre and fluid for healthy bowels