General Information Only: This article provides general educational information. It does not constitute medical advice and does not replace a consultation with a qualified medical practitioner. Every patient’s situation is different. Please consult your GP and Dr Kaushal directly for advice specific to your circumstances. In a medical emergency, call 000. |
Diverticular disease is extremely common in Australia — it affects approximately one in three people over the age of 50, and more than half of those over 70. In Camden and the wider Macarthur region, with a rapidly ageing population segment and dietary patterns common to South Western Sydney, diverticular disease is one of the most frequent reasons patients are referred to a gastrointestinal surgeon.
Despite how common it is, many patients with diverticular disease are confused about what it actually means, whether it requires treatment, what lifestyle changes help, and when surgery becomes necessary. This guide, written from the clinical perspective of Dr Devesh Kaushal — upper GI and general surgeon consulting at nearby Campbelltown — answers those questions clearly.
Nearest Rooms to Camden: 4 Hyde Parade, Campbelltown NSW 2560 Appointments available — contact the rooms to discuss current availability | Book online at drdeveshkaushal.com.au | Call (02) 7906 8312 |
What Is Diverticular Disease?
The word “diverticula” refers to small pouches that form in the wall of the large bowel (colon) — typically in the sigmoid colon (the lower left section). These pouches develop when the inner lining of the bowel pushes through weak spots in the outer muscular layer, creating small balloon-like protrusions ranging from a few millimetres to a centimetre in size.
Once formed, diverticula are permanent. They do not disappear. The broad term “diverticular disease” encompasses several related conditions:
Term | Meaning |
Diverticulosis | The presence of diverticula without inflammation or symptoms. Extremely common in older adults. Most people with diverticulosis have no symptoms at all. |
Symptomatic diverticulosis | Diverticula causing chronic left-sided abdominal discomfort, bloating, or altered bowel habits without acute inflammation. |
Diverticulitis | One or more diverticula become inflamed and infected. Causes acute left lower abdominal pain, fever, and altered bowels. The most common acute presentation. |
Complicated diverticulitis | Diverticulitis with serious complications — abscess, perforation, fistula, or bowel obstruction. May require urgent surgical treatment. |
Diverticular bleeding | A diverticulum erodes a blood vessel causing rectal bleeding — sometimes significant. Usually resolves without surgery but may recur. |
Why Do Diverticula Form? Risk Factors for Camden Patients
Diverticula form over years as a result of increased pressure within the colon pushing outward through points of natural weakness in the bowel wall. The following risk factors are particularly relevant for Camden and Macarthur region residents:
- Low dietary fibre intake: The most consistently identified risk factor. A diet low in fibre increases stool transit time and colon pressure. Refined Western diets — high in processed foods, white bread, and red meat with minimal vegetables and legumes — are strongly associated with diverticular disease.
- Age: Diverticula become significantly more common with age. The bowel wall weakens naturally over time. Approximately 50% of people over 60 have diverticulosis.
- Obesity: Increases intra-abdominal pressure and is associated with a higher risk of diverticulitis. Particularly relevant to Camden’s population profile.
- Physical inactivity: Regular physical activity is associated with a reduced risk of diverticular disease. Sedentary lifestyles common among long-distance commuters increase risk.
- NSAIDs and aspirin: Regular use of non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) and aspirin is associated with increased risk of diverticular bleeding and complications.
- Red meat consumption: High red and processed meat intake is associated with a higher risk of diverticulitis in population studies.
- Smoking: Associated with increased risk of complicated diverticulitis and poorer healing.
Symptoms of Acute Diverticulitis
Acute diverticulitis typically presents with a combination of the following symptoms — usually developing over one to two days:
Left lower abdominal pain: The hallmark symptom. The pain is typically constant, localised to the left iliac fossa (lower left abdomen), and worsens with movement. In some patients, the pain may be more central or in the right lower abdomen — particularly those of Asian background where right-sided diverticulitis is more common. |
Fever: Usually 37.5 to 39 degrees Celsius. Indicates active infection and inflammation. |
Change in bowel habits: Diarrhoea or constipation — often alternating. The bowel becomes unsettled during active inflammation. |
Nausea: Common during acute attacks. Vomiting is less common but may occur. |
Urinary symptoms: Urgency, frequency, or discomfort when passing urine — if the inflamed bowel is adjacent to the bladder. |
Bloating and abdominal distension: Particularly if bowel function is slowed during the attack. |
⚠ Seek emergency care immediately if you experience: • Severe, sudden worsening of abdominal pain — particularly if the abdomen becomes rigid (board-like) • High fever above 39 degrees with severe abdominal pain • Inability to keep fluids down • Heavy rectal bleeding • Signs of peritonitis — widespread tenderness across the entire abdomen These may indicate perforation, peritonitis, or major bleeding. Call 000 or go to Campbelltown Hospital Emergency immediately. |
How Diverticular Disease Is Diagnosed
- CT scan of the abdomen: The gold standard investigation for acute diverticulitis. CT scan confirms the diagnosis, assesses the severity and extent of inflammation, and identifies complications (abscess, perforation, fistula). This is performed at Campbelltown Hospital during an acute admission.
- Blood tests: Full blood count (raised white cells indicate infection), CRP (elevated in inflammation), and metabolic panel.
- Colonoscopy: NOT performed during an acute attack — the inflamed bowel is at risk of perforation under pressure. Colonoscopy is arranged 6 to 8 weeks after the acute episode resolves to confirm the diagnosis, exclude bowel cancer (which can mimic diverticulitis), and assess the extent of diverticulosis.
- Abdominal ultrasound: Can identify uncomplicated diverticulitis and abscesses. Less accurate than CT but avoids radiation — useful in younger patients and pregnancy.
Severity Classification — How Bad Is Your Diverticulitis?
Dr Kaushal uses the modified Hinchey classification to guide management decisions. This classification is based on CT findings and determines whether the episode can be managed with antibiotics, requires drainage, or needs urgent surgery:
Stage | Finding | Treatment | Surgery Needed? |
Ia | Pericolic inflammation / small abscess | Oral antibiotics — outpatient or inpatient | Usually not |
Ib | Pericolic abscess > 4cm | IV antibiotics ± radiological drainage | Sometimes (if drainage fails) |
II | Pelvic or distant abscess | IV antibiotics + CT-guided drainage | Often required electively |
III | Purulent peritonitis (non-faecal) | Emergency surgery — laparoscopic or open | Yes — urgent |
IV | Faecal peritonitis — perforation | Emergency surgery — Hartmann’s procedure | Yes — urgent |
When Is Surgery Recommended for Diverticular Disease?
The majority of diverticulitis episodes are managed successfully with antibiotics and dietary modification. Surgery is recommended in the following circumstances:
Emergency surgery (urgent — same admission):
- Hinchey III or IV — perforated diverticulitis with peritonitis
- Bowel obstruction from diverticular stricture not responding to conservative measures
- Diverticular bleeding that is haemodynamically significant and not controllable endoscopically
Elective surgery (planned — after recovery from acute episode):
- Two or more episodes of acute diverticulitis requiring hospitalisation
- Complicated diverticulitis — abscess, fistula, or stricture formation — even if resolved
- Failure to resolve with antibiotics (persistent sepsis)
- Fistula formation — abnormal connection between bowel and bladder, vagina, or skin
- Immunocompromised patients — higher complication risk with each episode
- Unable to exclude bowel cancer on imaging and colonoscopy
Important: The decision to recommend surgery is made following thorough individual assessment — considering the number of episodes, severity, complications, the patient’s age, health, and personal preferences. Surgery is not automatically recommended after a single uncomplicated attack. Dr Kaushal will discuss all options clearly at your consultation. |
Types of Surgery for Diverticular Disease
Laparoscopic sigmoid colectomy (elective):
The sigmoid colon — the most commonly affected section — is removed through keyhole incisions. The two ends of the remaining bowel are rejoined (anastomosis). Most patients are home within 3 to 5 days. Return to normal activities at 4 to 6 weeks.
Hartmann’s procedure (emergency):
In cases of perforated diverticulitis with faecal contamination, it is not safe to rejoin the bowel at the same operation. The diseased sigmoid colon is removed, the rectal stump is closed, and a temporary colostomy (stoma) is formed. The colostomy can often be reversed in a second operation — typically 3 to 6 months later.
Laparoscopic peritoneal lavage (selected cases):
In selected cases of purulent (not faecal) peritonitis (Hinchey III), laparoscopic washout of the abdominal cavity without bowel resection may be appropriate. This approach avoids a stoma in suitable patients and allows elective surgery once the infection has settled.
Lifestyle Changes to Reduce Recurrence
After recovering from diverticulitis, dietary and lifestyle changes can reduce the risk of future episodes:
- Increase dietary fibre gradually to 25–30 grams per day — vegetables, legumes, wholegrains, and fruit
- Drink at least 2 litres of water daily — fibre requires adequate hydration to work
- Exercise regularly — 30 minutes of moderate activity on most days
- Achieve and maintain a healthy weight — obesity significantly increases recurrence risk
- Stop smoking — associated with more severe diverticulitis episodes and worse healing
- Avoid regular NSAID use where possible — discuss alternatives with your GP
- Nuts and seeds: The historic advice to avoid these has been revised. Current evidence does not support avoiding nuts, seeds, or corn in diverticular disease.
Frequently Asked Questions — Diverticular Disease Camden
Does diverticulitis always need antibiotics?
For mild, uncomplicated diverticulitis (Hinchey Ia) in otherwise healthy patients, research suggests that antibiotics may not be required in all cases and that a liquid diet alone may be sufficient. However, this approach is only appropriate in selected patients and requires close monitoring. Dr Kaushal will advise the most appropriate management based on your specific presentation, CT findings, and clinical condition.
Will I need a stoma (colostomy bag) after diverticulitis surgery?
Not necessarily. Elective laparoscopic sigmoid colectomy is performed as a single-stage procedure — the bowel is removed and rejoined in the same operation, with no stoma required in most cases. A temporary stoma may be required after emergency surgery (Hartmann’s procedure) for perforated diverticulitis — but this is usually reversible. Dr Kaushal will explain the expected plan for your specific situation.
How do I get assessed for diverticular disease near Camden?
See your Camden GP and request a referral to Dr Kaushal at 4 Hyde Parade, Campbelltown — approximately 15 minutes from Camden. Call (02) 7906 8312 or book online at drdeveshkaushal.com.au. If your symptoms are urgent, call directly so the team can prioritise your appointment.
Is diverticular disease covered by Medicare?
Yes. Consultation, colonoscopy, and surgery for diverticular disease all attract Medicare rebates with a valid GP or specialist referral. Contact the rooms for a clear cost outline before your appointment.
Book Your Consultation Near Camden
If you have been diagnosed with diverticular disease, have experienced an episode of diverticulitis, or have chronic left lower abdominal symptoms that have not been properly investigated — Dr Devesh Kaushal provides experienced gastrointestinal surgical assessment at his Campbelltown rooms, just 15 minutes from Camden.
Both public and private patients are welcome. Ask your Camden GP for a referral today.
Contact Dr Devesh Kaushal Nearest Rooms to Camden: 4 Hyde Parade, Campbelltown NSW 2560 Phone: (02) 7906 8312 Email: [email protected] Book Online: drdeveshkaushal.com.au Office Hours: Monday – Friday, 9:00 AM – 5:00 PM Operating at: Sydney Southwest Private Hospital Liverpool | Campbelltown Public Hospital | Campbelltown Private Hospital | The George Hospital Appointments available — contact the rooms to discuss current availability | Book online 24/7 | Medicare & Private Health Insurance Accepted |
Medical Disclaimer: The information in this article is for general educational purposes only. It does not constitute medical advice. Individual circumstances vary significantly. Always consult your GP and treating surgeon for personalised advice. In a medical emergency, call 000 or present to your nearest emergency department.
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