If you have been told you have diverticular disease, you are in good company — it affects more than half of people over 70 in Western countries. The small pouches that form in your bowel wall are called diverticula. When they are there but causing no trouble, this is called diverticulosis. When one or more of them become inflamed or infected, that is diverticulitis — and that is when you feel unwell.
If you just have the pouches but no inflammation, you may feel nothing at all. Some people notice mild lower abdominal discomfort, bloating, or changes in their bowel habits — but many have no symptoms whatsoever.
When diverticulitis flares up, you will usually feel pain in the lower left side of your abdomen (though sometimes the right side is affected), along with fever, nausea, and a change in your bowels. In more serious cases, complications can develop — including an abscess (a pocket of infection), a perforation (a hole in the bowel wall), or a blockage. These are less common, but if they happen you will need urgent treatment.
If your doctor suspects diverticulitis, a CT scan of your abdomen and pelvis is the best way to confirm it and check for any complications. After you have recovered from an attack, a colonoscopy (a camera examination of the inside of your bowel) is usually recommended around 6–8 weeks later — just to make sure nothing else is going on.
If your attack is mild, you can often manage at home with pain relief, resting your bowel, and a course of antibiotics by mouth. More severe episodes may need you to come into hospital for stronger antibiotics through a drip. Occasionally, if there is a significant abscess, a drain may need to be placed under CT guidance. Surgery — specifically keyhole removal of the affected part of the bowel (laparoscopic sigmoid colectomy) — is considered when attacks keep coming back, when complications occur, or in younger patients who are likely to have many more episodes ahead of them. Emergency surgery is needed if the bowel perforates and causes widespread infection in the abdomen.
Some people find that their diverticulitis keeps coming back, or that it never fully settles between attacks — leaving them with ongoing left-sided abdominal pain, unpredictable bowels, and bloating. This pattern can be draining and can substantially affect your day-to-day life.
Certain factors make recurrence more likely, including younger age at your first attack, smoking, obesity, and being on medications that suppress your immune system. The good news is that guidelines have moved away from the old approach of recommending surgery after a fixed number of attacks. Instead, the decision to operate is based on how much your symptoms are affecting your life, how often and how severely the attacks are coming, and your overall health — it is a conversation, not a formula.
For people with recurrent or ongoing diverticulitis, keyhole surgery to remove the affected segment of bowel (laparoscopic sigmoid colectomy) offers a long-term solution. Most people recover well and do not need a permanent stoma (bag). Surgery is planned for after the inflammation has settled — usually at least 6–8 weeks after your last acute episode. The decision is always made together, weighing up how much trouble the condition is causing you against the risks of an operation.
Mr Nguyen's first priority is always to avoid surgery if at all possible — and for most people with diverticular disease, that is exactly what happens. When an operation is the right choice, he performs it as a keyhole procedure, which means smaller incisions, less pain, and a faster recovery. Most patients are home within 2–3 days and back to normal activities within a few weeks. Every decision about whether to operate is made together with you, taking into account how much your symptoms are affecting your life rather than following a rigid rule about how many attacks you have had.
If you suddenly develop lower abdominal pain with a fever, please get assessed promptly — do not wait to see if it settles. If your symptoms keep coming back, if something feels different from your usual pattern, or if you are struggling with ongoing discomfort, it is well worth seeing a specialist to talk through your options.
For an acute attack, your GP may treat the first uncomplicated episode with antibiotics and rest, or arrange a hospital admission if you are more unwell. Once things have settled, you will be referred for a colonoscopy six to eight weeks later to confirm the diagnosis and rule out anything else. Most patients are seen within one to two weeks of referral.
For ongoing or recurrent symptoms, the consultation focuses on a careful history, imaging review, and a clear conversation about your options. Dietary changes — particularly increasing fibre — and good hydration are the foundation, and most patients do well long-term with these alone. Surgery is reserved for complicated disease, recurrent attacks that are affecting your life, or complications such as a fistula or stricture. When surgery is needed, it is usually a keyhole bowel resection, and a follow-up appointment is arranged to make sure recovery is going smoothly.
Eating plenty of fibre, drinking enough water, exercising regularly, and keeping a healthy weight all help to reduce your risk of further attacks. And good news — you no longer need to avoid nuts, seeds, or popcorn. Current evidence does not support those old restrictions, so you can go back to enjoying them.
Most people with diverticulitis never need surgery. An operation is only considered when attacks become severe, very frequent, or complicated in a way that is affecting your life.
There is no magic number. What matters more is how badly the attacks are affecting you — your pain, your time in hospital, your ability to work and enjoy life — and how fit you are for an operation. Some people are referred for surgery after a second admission; others with milder episodes are managed non-surgically for much longer. A consultation after any recurrent attack is a good opportunity to talk through what is right for your situation.
A Hartmann's procedure is an emergency operation done when the bowel perforates and causes a serious infection in the abdomen. The diseased section of bowel is removed, and a temporary colostomy (a bag on the abdomen) is created. A second operation to reconnect the bowel and close the colostomy can usually be done 3–6 months later, once you have recovered.
Have questions about diverticular disease?
Mr Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is required.