Diverticula are small sacs or pouches poking through the walls of the colon (see picture). They are caused by an increase pressure inside the colon and frequently some weakness in the colon wall. As we age all our tissues weaken, thus diverticular disease is much more common in older people. It is much less common in African countries where they eat a lot of fibre and also use the more natural squatting position for defecation.
Risk factors include a diet low in fibre, eating a lot of fat and red meat, reduced physical activity, obesity, and cigarette smoking.
A number of other risk factors have been suggested including caffeine and alcohol intake, but this has not been shown to be correct. Others have suggested that seeds and nuts which could potentially block the entrance to the diverticulum and therefore cause diverticulitis, should be avoided, but careful analysis has shown there is no evidence for this. (Click here)
Diverticula are common, usually cause no symptoms and are frequently seen on sigmoidoscopy or barium enemas, in up to 40% in older people some studies. They tend to cause no symptoms unless they become inflamed (diverticulitis) or bleed. Between 4 and 15% of people with diverticular disease developed diverticulitis.
Diverticulitis – the opening into the diverticulum becomes blocked and the contents of the diverticulum and surrounding walls become inflamed and infected. This can cause abdominal pain, a rise in temperature and often constipation.
What your doctor can do
- Diverticular disease – this does not require medical treatment.
- Diverticulitis – mild attacks can be treated at home, with the low fibre diet, drinking plenty of fluids and antibiotics. More severe attacks need to be treated in hospital with intravenous fluids as well. If the diverticulitis episodes recur, surgery to remove the affected area can cure the condition.
- Bleeding – frequently this is mild, but if it becomes severe then surgery is sometimes indicated.
What you can do - Lifestyle & diet
Lifestyle changes – there are a number of changes which can improve the bowel function, and reduce the risk of diverticular turning into diverticulitis. These include
- A regular high fibre diet, eating food rich in fibre, particularly fruit and vegetables, and sometimes taking a fibre rich supplements (see below).
- Avoiding constipation which raises the pressure inside the bowel and increases the development of diverticular. A good fibre rich diet can frequently do this, and also drink plenty of fluids.
- Squatting to defecate as done in African and Asian countries straightens up the sigmoid colon, and reduces the pressure inside the bowel. Putting your feet up on a stool while sitting on the toilet has a similar effect.
- Regular vigorous physical activity reduces the risk of diverticular disease.
- While there is no evidence that nuts popcorn seeds etc. block the opening to the diverticular, it is still probably best not to overdo these.
- Cigarette smoking has been conclusively shown to aggravate diverticular disease and encourage diverticulitis.
- Some drugs – non-steroidal anti-inflammatories (NSAIDs), steroid such as prednisone increase the risk of diverticulitis and bleeding, and opiates such as codeine and anything else that might cause constipation should be avoided if possible.
- Changes to the bacteria in the bowel has been shown to increase the complication rate, and thus regular probiotics should be taken.
Supplements I would recommend – a good multivitamin and multi mineral, omega-3 fish oils (to keep the bowel moving more gently), calcium and magnesium, probiotics and a good fibre preparation.
The Nutritional supplements I use and recommend to my patients
For diverticular disease patients - USANA - Cellsentials*, Biomega, Active Calcium plus, probiotics and fibergy (a fibre drink).