Understanding diverticular disease and SUDD
A plain-language guide for patients
The short version
- Diverticula are small pouches in the wall of the large bowel. They are very common and become more common as we get older.
- Simply having the pouches is called diverticulosis. Most people who have them never have any trouble.
- SUDD means the pouches are linked to ongoing symptoms, such as lower tummy pain, bloating, or a change in bowel habit, but there is no infection and no other complication.
- SUDD is usually a long-term condition that can be managed well. The goal is fewer and milder symptoms and a better quality of life.
- Your daily habits matter most. Some medicines can help, and your specialist will tailor these to you.
- Learn the warning signs (see the red box at the end) and get help promptly if they appear.
1What are diverticula?
Over time, small weak spots can develop in the muscle wall of the large bowel (the colon). The soft inner lining can push out through these weak spots, forming small balloon-like pouches called diverticula.
2Where SUDD fits in
It helps to picture three different situations. They are not the same thing, and telling them apart is the key to understanding your diagnosis.
Diverticulosis
The pouches are present but cause no symptoms. Very common with age. No treatment needed.
SUDD
The pouches are linked to ongoing symptoms (lower-left tummy pain, bloating, changed bowel habit). There is no infection.
Diverticulitis
A pouch becomes inflamed or infected. A separate, acute problem, usually with more pain and often fever. Needs prompt care.
SUDD is not the same as diverticulitis. Having SUDD does not mean you have an infection. It means the pouches are causing symptoms while the bowel is not inflamed.
3Why do I get symptoms?
The exact cause is not fully understood. Current thinking is that symptoms may come from a combination of things: a low level of irritation in the bowel wall, a bowel that is more sensitive than usual, and changes in how the bowel muscle squeezes and moves.
SUDD also shares many features with irritable bowel syndrome (IBS), and in some people the two overlap. This is one reason symptoms vary so much from person to person, and why treatment is aimed at settling and managing symptoms rather than offering a single guaranteed cure.
4How is it diagnosed?
Your specialist will confirm that the pouches are present and, just as importantly, make sure nothing else is causing your symptoms. This usually involves a camera test of the bowel (a colonoscopy) and sometimes a scan.
These tests are done to be thorough, and to rule out other conditions such as inflammation of the bowel or growths. Being careful here is a good thing.
5What helps most: your daily habits
The foundation of managing SUDD is a healthy bowel routine. These same habits are also linked with a lower chance of a future episode of diverticulitis.
Eat more fibre
Build up slowly to avoid bloating. Wholegrains, fruit, vegetables, and legumes. Soluble fibre such as oats and psyllium is often well tolerated.
Drink enough fluid
Fibre works best when you are well hydrated. Water is ideal. Spread your drinks through the day.
Stay active
Regular physical activity supports healthy, regular bowel function. A daily walk counts.
Keep a healthy weight
Carrying excess weight is linked with more bowel trouble and a higher risk of complications.
Do not smoke
Smoking is linked with a higher risk of diverticular complications. Stopping helps your whole gut.
Plant-rich diet
A diet rich in fruit, vegetables, and wholegrains, and lower in red and processed meat, is best for your bowel.
Myth buster
You do not need to avoid nuts, seeds, or popcorn. The old advice to steer clear of these foods has been studied carefully in large groups of people and shown to be unnecessary. They do not raise your risk, and may even help thanks to their fibre.
6Medicines your doctor may consider
There is no single medicine that cures SUDD, and the evidence for each option is modest. Your specialist will decide what suits you and how to use it. Options can include:
- Fibre supplements (such as psyllium) to help regulate the bowel.
- A bowel-specific antibiotic called rifaximin, sometimes given in short, repeated courses to ease symptoms. It stays mostly within the gut.
- Antispasmodic medicines to relieve cramping pain.
Some treatments that were once popular, such as the anti-inflammatory medicine mesalazine, have not been shown to prevent future attacks of diverticulitis, and are generally not recommended for that purpose.
Important: please do not start, stop, or change any medicine without speaking to your doctor. The choice of medicine, the dose, and how long to take it are decided individually, based on your own situation.
7What to realistically expect
For most people, SUDD is a long-term but manageable condition. Symptoms tend to come and go. Finding the combination of habits and, if needed, medicines that works for you can take some trial and adjustment.
A realistic goal is fewer and milder symptoms and a better quality of life, rather than a guaranteed cure. Staying in touch with your specialist means your plan can be reviewed and adjusted over time.