Diverticular Disease, No Longer Just a Disease of the Elderly
If you think you do not need to know about Diverticular Disease because you are too young, think again!
A diagnosis of diverticular (di-ver-tic-u-lar) disease might sound like a lesson in ABC’s to you and its symptoms (think diarrhoea, pain, constipation) may not feel like the most topical of conversations for your dinner table, but did you know that in Western society approximately 60% of people over the age of 60 are likely to develop this condition over time? Additionally, medical professionals are now seeing an increasing incidence of this once thought of disease of the elderly in individuals even younger than 40 years of age and there is a good explanation why.
So, what is it? (Let us get the names straight!)
Diverticula (di-ver-tic-u-la) are marble sized bulges that can pop up inside the colon (large intestine) over time. For most, these common little fellas remain unremarkable, and a person experiences no symptoms, however, gets a diagnosis of diverticulosis and is simply monitored over time.
For approximately 20% of these people however, their diverticula may start to morph into the ‘symptomatic’ type over time. A person with symptoms or diverticular disease may experience symptoms including pain, especially in the left-hand side of the abdomen (which can be rather crippling) and some (or all) of the gloriously dramatic symptoms of the bowel including bloating, constipation, diarrhoea, blood and/or mucous in stools to varying degrees. This person’s diverticular disease may come and go over time.
For the even more unlucky (approximately 20% more), these diverticula can advance themselves to the full-on (extroverted in your face) type (diverticulitis) variation of diverticular disease which include some (or all) of those symptoms and the additional bonus of an actual infection of the diverticula. The addition of infection often adds fever, vomiting and nausea for a person (oh what joy!) and can require hospitalisation, can cause damage to the bowel for the long-term and at (near) worst case can require surgery.
So why do some people go on to develop Diverticulitis and some people just seem to live in harmony with their Diverticula?
Genetics are well documented to influence the development of diverticular disease. Also, as all muscles in our body naturally deteriorate with age, unfortunately our colon muscles also do not escape this sag, and can more easily become compromised (hence, hello diverticula in older age).
In the past there has been suggestion that food particles (think nuts, popcorn, seeds, and undigested food) can become ‘stuck’ inside these diverticula pockets and then ‘fester’ away causing infection (diverticulitis), but latest research suggests that the inflammation involved (not necessarily the food getting stuck) is now thought to be a cause of how the diverticulitis could start in the first place. It is the actual inflammation process that can compromise the wall of the (possible already thinning and sagging) colon allowing harmful bacteria through little punctures (causing infection and flare ups).
Can we prevent it?
At this stage advice on how to prevent this disease is sketchy and inconclusive, but now that inflammation has been highlighted as a probable cause of developing actual diverticular disease (or becoming symptomatic) we can start to predict here that a lifestyle that may help to reduce inflammation, might prevent flare ups or even chance of diverticula forming in the first place.
It may no-longer be valid to simply blame common foods (as above) getting ‘stuck’ in the diverticular pockets and hence just do a blanket avoidance of such foods (as you may have heard in the past). Instead, I suggest a more holistic approach to prevention and management could be a great way to go.
Working with your Dietitian to highlight your own bowel trigger foods, the balance in your diet, your intake of inflammatory foods/anti-inflammatory foods and a whole lifestyle approach to reduce (and further prevent) inflammation in the body is what I’m suggesting here.
The digestive system does not exist as an entity of its own, there is a very complex dialogue that exists between the mind, the environment and the body and how it functions. Complex connections between inflammation linked to stress, smoking, alcohol, low physical activity, poor immunity, poor sleep, allergy and intolerance, and other chronic disease processes might be why we are seeing diverticular disease in much younger age groups now and why diverticular disease is no longer just seen as a disease of the elderly.
So, what to do when you are in the sh*t (pardon the pun) (aka... managing a flare-up)
1. Book in to see your doctor.
Get a ‘proper 'diagnoses (ensure other bowel issues such as coeliac disease, inflammatory bowel disease, and bowel cancer are ruled out). Understand what is happening, be aware of your body and your symptoms. Discuss latest research and ideas regarding management and form a treatment plan with your doctor (depending on symptom severity). Often a course of antibiotics is necessary if there is infection. Be aware that diverticular disease is still quite poorly understood which can make prevention and treatment opinions differ between health practitioners. There is ongoing research needed in the field to help minimise this confusion.
2. Be proactive and book in with your Dietitian.
Your Dietitian will help you to understand your symptoms and recommended what dietary actions need to be taken. There is no ‘one-size-fits-all’ here and no ‘diverticular disease diet.’ Instead, you will work through the possible issues triggering your bowel and the inflammatory process. You might be advised to follow a ‘low fibre’ diet during a flare-up event to ease symptoms, but it is especially important to know that a ‘low fibre’ diet is not intended to be lifelong, does not ‘cure’ diverticulitis, and has no scientific evidence behind preventing further flare ups. It is merely to settle symptoms if necessary. Your Dietitian will be able to advise on what type and how much fibre will be best for your bowel with aim to get you consuming a relatively ‘unrestricted’ balanced healthy intake. Regular follow up with your Dietitian is encouraged (even when you have no symptoms) to maintain a healthy digestive tract for the future.
3. Consider other key players in the body’s general inflammation process.
Should you be having a flare-up in symptoms (or even want to prevent future episodes), consider all factors in the inflammation process. To reduce the risk of future melodramatic bowel events (and take the recommended holistic approach to your health) seek appropriate assistance with:
- Stress management
- Sleep ‘hygiene’
- Physical activity
- Alcohol reduction
- Smoking cessation
- Chronic disease self-management
4. Lastly, it is absolutely essential to give yourself time for recovery.
When your symptoms have subsided, your Dietitian will be able to help you reinstate the more harmonious guardianship of your diverticula, maintain a (generally) unrestricted eating pattern, good bowel (and general) health, and get you right back to those fulfilling retirement (or now pre-retirement) activities ASAP!
Tursi, A., and Elisei, W. (2019). Role of Inflammation in the Pathogenesis of Diverticular Disease, Mediators of Inflammation, Vol. 2019, DOI:10.1155/2019/8328490
Chakhvadze, B, Fedotova, E, and Chakhvadze, T. (2020). Diverticular Disease of the Colon, Acta Chirurgica Latviensis, Vol. 18 (1), pp.7-14, DOI:10.2478/chilat-2020-0002
Weizman, A and Nguyen, G (2011). Diverticular disease: Epidemiology and management, Can J Gastroenterol, Jul 25(7), pp 385-389, DOI: 10.1155/2011/795421
Reichert, M and Lammert, F (2015). The genetic epidemiology of diverticulosis and diverticular disease: emerging evidence, United European Gastroenterology, https://doi.org/10.1177/2050640615576676