• Diverticula are bulges or pouches in the lining of the colon (large bowel).
• People with ADPKD might be twice as likely to get diverticula than the general population, but we are not certain.
• Most people with diverticula don’t get any symptoms.
• However, 1 in 5 people with diverticula can get pain, bloating, constipation or diarrhoea. Less commonly, diverticula can get infected or bleed.
• A healthy balanced diet containing lots of fibre can lower your risk of getting symptoms and complications from diverticula.
• Medicines used to treat symptoms include paracetamol for pain, laxatives for constipation, and antibiotics for an infection.

As people age, some develop bulges or pouches in the lining of their colon (the large bowel). These dead ends in the bowel are called diverticula (see picture).

Most people with diverticula don’t get any symptoms. However, sometimes people can get symptoms and, less commonly, diverticula can get infected or bleed.

Other terms you might hear are:

• diverticulosis: diverticula that aren’t causing symptoms
• diverticular disease: diverticula causing symptoms
• diverticulitis: infected and inflamed diverticula

Most people with ADPKD probably don’t have diverticula. However, people with ADPKD could be twice as likely to get diverticula than the general population. We are not sure of the exact risk because there has not been much research on this.

In a large American study, about 4 in every 100 people with ADPKD had been diagnosed with diverticula previously. This compared with about 2 in every 100 people in the general population.

The true number of people with diverticula may be much higher than this study found. This is because diverticula don’t usually cause symptoms. So, many people probably have them without ever knowing.

Some experts think as many as half the population could have diverticula by the time they’re 50 years old.

Your chance of having diverticula increases with age and when you have reached kidney failure.

If you have questions or concerns about your risk of diverticula, chat to your GP or kidney specialist.

Usually, diverticula don’t cause symptoms. However, in about 1 in 5 people, diverticula can cause symptoms such as:

• abdominal pain (usually on the left side)
• feeling bloated
• constipation
• diarrhoea
• blood in your poo

If a diverticulum gets infected (called diverticulitis) it can cause:

• severe abdominal pain
• a high temperature (38°C or higher)
• blood and mucus (slime) in your poo

If you get symptoms of infected diverticula, see your doctor urgently or contact the NHS for advice on 111.

You’ll only be tested for diverticular disease if you have symptoms. Screening is not routine in the general population or for people with ADPKD. If you have tests for other bowel problems, these may spot diverticula.

If you have symptoms such as bloating, constipation or diarrhoea, your doctor (GP) might refer you for tests to find the cause.

Tests for diverticula include:

• a blood test
• a test on a poo sample
• a colonoscopy or flexible sigmoidoscopy, for which a doctor will put a thin tube containing a camera through your anus into your bowel
• a computed tomography (CT) scan, which uses X-rays to make images of the inside of your body

Problems linked to diverticula can include:

• an infection (called diverticulitis)
• an abscess (collection of pus) in the abdomen
• bleeding from the bowel
• a hole in your bowel wall

In a study, 1 in 5 people with ADPKD who had received a kidney transplant got an infected diverticulum (diverticulitis) within 12 years.

If you have high blood pressure or constipation, this may increase your risk of getting problems linked to diverticula.

If you get any of the symptoms we listed earlier, see your GP.

There is no cure for diverticula. Changes to diet and medicines can help to prevent and manage symptoms.

Management of diverticula without symptoms

If you have diverticula but no symptoms (known as diverticulosis), you won’t need any treatment.

A healthy balanced diet containing lots of fibre can lower your risk of getting symptoms and complications. Foods high in fibre include whole grains, fruit and vegetables. You can find out more about a high-fibre diet at NHS Inform.

Treatment of diverticular disease

Diet

If you have diverticula that are causing symptoms (known as diverticular disease), your doctor may recommend a diet high in fibre. We explain this above.

Pain

If your diverticula are causing pain, your doctor will recommend painkillers, such as paracetamol.

Don’t take non-steroidal anti-inflammatory drugs such as ibuprofen (Nurofen®) unless your doctor says this is okay. These drugs can harm the kidneys of people with ADPKD. They may also increase your risk of getting bleeding diverticula or a hole in your bowel wall.

Constipation

If you have constipation, your doctor or pharmacist can recommend laxatives for you. The type of laxative that can help is a ‘bulk-forming laxative’. Examples are ispaghula husk, methylcellulose and sterculia.

Bleeding

Occasionally, diverticula can bleed due to a blood vessel bursting. This is usually painless but can cause a lot of blood loss.

If you have small amounts of blood when you poo, see your GP.

If you have a lot of blood coming out your bowel, get medical care urgently. Go to accident and emergency (A & E) or call 111 for advice.

If you have a big bleed, doctors in the hospital can assess how much blood you’re losing and give you a blood transfusion if needed. The bleeding usually stops on its own, but some people need surgery.

Treatment of diverticulitis

If you have signs of an infected diverticulum (called diverticulitis) and are unwell, your doctor will prescribe you antibiotics. They’ll explain the signs of the infection worsening to look out for and when to contact them. 

You might need to stay in hospital if you have a bad infection, can’t take oral antibiotics, or are in poorer health. 

Usually, diverticulitis gets better with antibiotics. However, if the infection spreads or causes an abscess, you might need surgery. 

We don’t know why diverticula are more common in people with ADPKD, especially those with kidney failure.

One suggestion is that the gene alterations that cause ADPKD may also weaken the muscle in the bowel wall. Another idea is that the ‘glue’ that holds cells together (the extracellular matrix) is abnormal in the bowel of people with ADPKD.

If you’re due to start dialysis, you and your kidney specialist will talk through the best options. The main two types of dialysis are:

• haemodialysis, for which a machine filters your blood
• peritoneal dialysis, where you put fluid in your abdomen

You can learn about dialysis on our website.

Having diverticula doesn’t usually stop you being able to have peritoneal dialysis. However, if you keep getting infected diverticula, haemodialysis might be a better option for you. This is because there is a risk that an infection in a diverticulum could spread into the area of the abdomen being used for peritoneal dialysis. This is just one factor your specialist will help you to consider, among many others.

• ADPKD progression
• Dialysis

• NHS Inform has information on the diverticular disease and diverticulitis including the prevention of problems (a high fibre diet).
• The NHS website has information on diverticular disease and diverticulitis, CT scans, and colonoscopy.
• Guts UK has information on diverticular disease and other bowel conditions (email: [email protected]; 020 7486 0341).

The Bladder and Bowel Community provides support to people with bladder and bowel conditions (email: [email protected]).