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Diverticular disease and diverticulitis

Diverticula

Diverticula are sac-like pouches that protrude from the smooth muscular layer of the colon with age. These sac-like pouches tend to develop where the muscles are weakest, or at areas where penetrating vessels cross through the muscles. They are caused by increased pressure along these weakened areas, such as during constipated bowel movement, being overweight and living a sedentary lifestyle, or due to a low-fibre diet.

The presence of diverticula, and consequently diverticular disease in Singapore, is more common in people over the age of 40, and affecting up to 50% of people over the age of 60. Generally, diverticula exhibit no symptoms and require no treatment. Consequently, diverticula are usually only discovered during a colonoscopy or CT scan, or when patients exhibit symptoms. 

Diverticular disease is diagnosed when Singaporeans exhibit symptoms caused by diverticula, such as abdominal pain, irregular bowel movement, or blood in stools. When diverticula become inflamed or infected, the condition is known as diverticulitis. Diverticulitis can cause severe abdominal pain, fever, nausea and a marked change in bowel habits, and lead to the development of abscesses. If left untreated, diverticulitis can potentially lead to serious complications and even loss of life. It is therefore important to seek prompt treatment from a colorectal clinic in Singapore upon first experiencing these symptoms.

Diverticulosis and Diverticulitis

Symptoms of diverticular disease include:

Both diverticular disease and diverticulitis exhibit similar symptoms, with diverticulitis having more intense and severe ones such as fever and intense pain. By recognising these symptoms as they arise, patients are able to seek earlier and timely treatment at colorectal clinics, avoiding a significant decline in one’s quality of health.

• abdominal pain that tends to come and go and gets worse during or shortly after eating. Pain is relieved with passing motion or flatus.

• constipation, diarrhoea, or both

• occasionally, blood in stools

If your diverticula become infected and inflamed (diverticulitis), you may suddenly:

• get constant, more severe abdominal pain

• have a fever of 38C

• have diarrhoea or constipation

• get mucus or blood in your stools (rectal bleeding)

Tests to confirm diverticular disease or diverticulitis

The two tests commonly done to confirm the diagnosis is CT scan and colonoscopy or both.

Consequences of diverticulitis

The inflammation of diverticula caused by diverticulitis can lead to other conditions beyond just fever and pain. Acute diverticulitis can lead to abscesses, blockages known as stenosis, fistulas which connect bowel sections and organs, as well as peritonitis, a dangerous condition of rupturing which requires immediate medical attention and treatment.

About 25% of people with acute diverticulitis develop complications, which may include:

1. An abscess, which occurs when pus collects in the pouch.

2. A blockage (stenosis) in your bowel caused by scarring.

3. A fistula (abnormal connection) between sections of bowel or the bowel and other organs.

4. Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling bowel contents into your abdominal cavity. Peritonitis is a surgical emergency and requires immediate treatment

Treatment for diverticular disease and diverticulitis

As with other conditions, prompt and effective treatment for diverticular disease and diverticulitis is key to avoiding more severe health outcomes. Treatment depends on the severity of conditions, which may range from medicines and eating a healthier diet, to undergoing major surgery to remove affected sections of one’s large intestine.

1. Medical Treatment

In mild cases, starting on a high fibre diet with simple painkillers and oral antibiotics will help. However, in more severe cases, admission to hospital for intravenous fluid and antibiotics with stronger pain killers may be necessary.

2. Surgical Treatment

In rare cases, surgery may be needed to treat serious complications of diverticulitis. Surgery usually involves removing the affected section of your large intestine. This is called a colectomy. This is the treatment for rare complications such as fistulas, peritonitis or a blockage in your intestines.

The most common complication of diverticulitis is developing abscesses. Severe abscesses are drained with a technique known as percutaneous drainage, which is done by a radiologist. Often, after the abscess is successful drained, surgery can be planned electively.