If you've been told you have diverticular disease, you're 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're there but causing no trouble, this is called diverticulosis. When one or more of them become inflamed or infected, that's diverticulitis — and that's when you feel unwell.
If you just have the pouches but no inflammation, you may feel nothing at all. Some people notice mild lower tummy discomfort, bloating, or changes in their bowel habits — but many have no symptoms whatsoever.
When diverticulitis flares up, you'll usually feel pain in the lower left side of your tummy (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'll 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've 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 tummy pain, unpredictable bowels, and bloating. This pattern can be really draining and can significantly 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 you're getting attacks, and your overall health — it's 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's 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've had.
If you suddenly develop lower tummy pain with a fever, please get assessed promptly — don't wait to see if it settles. If your symptoms keep coming back, if something feels different from your usual pattern, or if you're struggling with ongoing discomfort, it's 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 see Mr Nguyen 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 doesn't 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 your attacks are becoming severe, very frequent, or complicated in a way that's really affecting your life.
There's 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's 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 tummy) is created. A second operation to reconnect the bowel and close the colostomy can usually be done 3–6 months later, once you've recovered.
Mr Ba Nguyen sees patients at his consulting rooms in Heidelberg and operates at Warringal Private Hospital and Epworth Eastern in Box Hill. To book an appointment, you'll need a referral from your GP or another specialist.