How much should you worry about diverticula in the gut?

by Nicky Pellegrino / 07 November, 2018
RelatedArticlesModule - Diverticula gut

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Worried about bags under your eyes? It’s the ones in your bowel that could really give you grief.

It’s yet another thing no one ever tells you about getting older – you get wrinkles on the inside. Okay, perhaps not exactly wrinkles, but the same loss of elasticity that changes the skin on your face and body is happening internally as the years go by. And in the digestive system, that leads to diverticula, small bulging pouches in the wall of the colon, usually in the area where the muscles do most work to contract when expelling faeces.

“Diverticula are something we see every day,” says Campbell White, a gastroenterologist at Taranaki Base Hospital. “Almost every time you do a colonoscopy you see some. About 20% of people will have them by the time they’re 40, and by your 70s and 80s, almost everyone has them. They’re just there, a bit like the wrinkles on your face. The question we always have is are they the cause of a problem or an innocent bystander?”

These pouches are usually harmless, but if they do become infected or inflamed, it is painful and can lead to nausea, vomiting, bleeding from the rectum and perforation of the bowel. In rare, very acute cases of diverticulitis more serious complications such as a blockage of the colon or an abscess can occur.

Research suggests the younger you are when the pouches form, the higher your risk of developing diverticular disease later in life.

There appears to be a hereditary link. One Danish study of siblings and twins found half the potential risk of diverticular disease came from genetics. But lifestyle factors are also believed to be a big contributor.

White says if something increases your risk of heart disease and type 2 diabetes, then it’s likely to increase the chance of problems with diverticula as well. The typical Western high-fat diet, with too much red meat and sugar and inadequate fruit, vegetables and wholegrains, isn’t good for your colon. If you’re obese, sedentary or smoke cigarettes, you’re not doing your digestive system any favours either.

However, there are some myths about diet and diverticulitis, says White. “The one that keeps going around is that you should avoid eating nuts and seeds. But it’s been looked at and they’re protective rather than bad. I don’t recall ever doing a colonoscopy and seeing a nut jammed in a diverticula. It doesn’t seem to happen.”

Dr Campbell White.

Only a small number of people with diverticula will develop a problem and just 4% experience acute complications. These days, the trend is to treat these conservatively with antibiotics whenever possible.

“The surgical treatments are quite drastic and involve removing portions of the bowel, so we try to avoid that,” says White. “Even with small micro-perforations we tend to use antibiotics in the hope it will settle down.”

For something so common, there hasn’t been a great deal of research, and evidence for other interventions isn’t great. There is some research suggesting higher levels of vitamin D can have a protective effect, whereas regular use of aspirin and anti-inflammatories appear to increase the risk of complications.

Other studies show about 39% of those who’ve had one attack of diverticulitis will have another episode within five years, although the first is typically the worst.

Psyllium fibre supplements such as Metamucil are often recommended to prevent diverticula becoming problematic. These keep bowel movements soft, which allows for easier passage. Research into fibre has had some conflicting results, and those in the middle of a flare-up are generally advised to keep their diet bland and easily digestible.

People with diverticulitis can also suffer from an irritable bowel and the symptoms, including diarrhoea, constipation and abdominal pain, are easily confused.

“Sometimes people will say, ‘It’s my diverticula playing up’, and probably it’s irritable bowel,” says White. “And the other thing we always worry about is cancer. So if you’re getting symptoms, don’t over-attribute them to diverticula; get them checked out at least once.”

This article was first published in the June 23, 2018 issue of the New Zealand Listener.

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