Q. We hear a great deal about this condition. What is it?

A. This means that small outpockets occur along the large bowel, the colon and, less often, the small bowel. They may be single or in great numbers, start small and gradually increase in size. Food material from the bowel enters and leaves readily, but if the entry to the pouch becomes clogged, germs may breed inside the pouch causing inflammation, a bit like appendicitis. The non-infected condition is called diverticulosis and if infection takes place it is referred to as diverticulitis.

Q. What symptoms take place?

A. If there is no infection present symptoms may be absent. Some may notice vague abdominal pains with altered bowel habits. If infection occurs suddenly, there may be the onset of acute abdominal pain in the lower region, a fever, maybe vomiting, lack of appetite. There is usually pain most marked in the left lower abdomen, the opposite side to appendicitis. On the other hand, the disorder may become chronic and continue for months or years, giving general low bowel tenderness and discomfort, often relieved by a bowel action. There may be intermittent diarrhoea or constipation with mucus, blood and maybe pus in the stools.

Q. What about diagnosis and treatment of diverticulosis?

A. A special x-ray called the barium enema is usually diagnostic for the little pouches can usually be clearly seen. Sometimes an examination by the sigmoidoscope or colonoscope is used to make certain cancer is not present — an ever present fear with similar symptoms. It is difficult to see the pouches under direct vision, however, for their openings are usually closed.

Treatment has altered dramatically in recent years when doctors working in Africa noticed it was rare in natives. They attributed this to the high fibre diet they ate and noticed their stools were loose and bulky. The ‘transit time’, the length of time it takes food to travel from the mouth to anus was also much less. This led to the idea that the normal western diet, depleted as it is of natural fibre, increases transit time, increases the pressure inside the bowel and this probably causes the bowel pouchings.

Q. How has this affected treatment?

A. Instead of giving a low residue diet, once popular, doctors now prescribe a high fibre diet, usually one containing a lot of unprocessed bran, the coarse outer layer of the wheat grain and the most readily accessible source of fibre. Not only will this help prevent diverticulosis from occurring in the first place but is good treatment for established cases and may quickly relieve symptoms. The amount given is that sufficient to produce one soft bowel action daily — often 2-4 tablespoonsful a day is adequate.

Antibiotics are often given for acute cases of diverticulitis. In severe protracted cases which do not respond, surgical removal of the affected part is sometimes carried out.

Q. Do you think everybody should eat bran each day?

A. I do, and have been advocating this for many years. Around two tablespoonsful a day are usually adequate. It may take 6-12 weeks for the system to adjust to this and in the early stages abdominal rumblings and a feeling of fullness and bloat are common. Passing wind and burping are also frequently encountered. But the system soon becomes accustomed to it, settles down and regular easy bowel frequency is usual.

Many claim they dislike the taste of it — ‘it’s like stewed cardboard,’ they say. I agree. But have it with cereal or stewed fruit or make it into cookies, rissoles or other recipes and this will mask the neutral flavour. Some people take it in orange juice. As a disease preventive and good health measure it is worth a bit of discomfort, for the results are certainly worthwhile. As already noted it may help reduce the occurrence of large bowel cancer. It can certainly relieve haemorrhoids (piles) and varicose veins and may reduce the risks of appendicitis, hiatus hernia and even peptic ulcers.

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