Q: What is diverticular disease and how does it develop. If this becomes diverticulitis, is it serious and is surgery the only remedy?

A:Diverticulae are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets. Indications are that a low-fibre diet over the years creates increased colon pressure and results in pockets or diverticulae. The symptoms of diverticular disease are abdominal pain (usually in the lower left abdomen), diarrhoea, cramps, alteration of bowel habit and occasionally, severe rectal bleeding. These symptoms occur in a small percentage of patients with the condition and are sometimes difficult to distinguish from Irritable Bowel Syndrome. Diverticulitis - an infection of the diverticulae - may cause one or more of the following symptoms: pain, chills, fever and change in bowel habits. More intense symptoms are associated with serious complications such as perforation, abscess or fistula formation. Treatment: Diverticulosis and diverticular disease are usually treated by diet and occasionally, medications to help control pain, cramps and changes in bowel habits. Increasing the amount of dietary fibre (grains, legumes, vegetables, etc.) - and sometimes restricting certain foods reduces the pressures in the colon, and complications are less likely to arise. Diverticulitis requires more intense management. Mild cases may be managed without hospitalisation, but this is a decision made by your physician. Treatment usually consists of oral antibiotics, dietary restrictions and possibly stool softeners. Severe cases require hospitalisation with intravenous antibiotics and strict dietary restraints. Most acute attacks can be relieved with such methods. Surgery is reserved for recurrent episodes, complications or severe attacks when there is little or no response to medication. In surgery, usually part of the colon - commonly the left or sigmoid colon - is removed and the colon is hooked up or anastomosed again to the rectum. Complete recovery can be expected. Normal bowel function usually resumes in about three weeks.