Richard Low’s Intestine Condition Explained: What is Diverticulosis?

Singapore veteran actor Richard Low recently revealed that he was hospitalised after experiencing intestinal bleeding caused by diverticulosis. According to media reports by The Star, the 74-year-old actor noticed blood in his stool and spent six days in hospital before recovering.

Following the news, many Singaporeans have been searching for Richard Low’s intestine condition and wondering whether diverticulosis is a serious illness.

Diverticulosis itself is very common, particularly in adults over the age of 50. Many people never experience symptoms and only discover the condition during a colonoscopy or abdominal scan performed for another reason. However, complications such as intestinal bleeding or diverticulitis can occur and should be assessed by a doctor.

Here’s what you should know about diverticulosis, including its symptoms, complications and when to seek medical attention.

Diverticulosis, Diverticulitis and Diverticular Bleeding: What’s the Difference?

What happened to Richard Low?

According to The Star, Richard Low was hospitalised after experiencing intestinal bleeding caused by diverticulosis. Reports stated that he sought medical attention after noticing blood in his stool and remained in hospital for six days before recovering.

Although diverticular bleeding often stops on its own, some people require hospital treatment to identify the source of bleeding and prevent further complications. Depending on the severity, treatment may involve observation, intravenous fluids, blood transfusions, colonoscopy or other procedures to control the bleeding.

Richard Low’s experience has increased public awareness of diverticulosis, a condition that many people have without realising it.

What is diverticulosis?

Diverticulosis occurs when small pouches, known as diverticula, develop in weak areas of the wall of the large intestine (colon). These pouches most commonly form in the lower part of the colon.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diverticulosis becomes increasingly common with age and often causes no symptoms. Many people only discover they have the condition during a colonoscopy or abdominal scan performed for another reason.

Most people with diverticulosis remain symptom-free throughout their lives. However, some people may develop complications such as diverticular bleeding or diverticulitis.

It is important not to confuse diverticulosis with diverticulitis.

• Diverticulosis means the pouches are present.
• Diverticulitis occurs when one or more pouches become inflamed or infected.
• Diverticular disease is a broader term used when diverticula cause symptoms, bleeding or inflammation.

According to media reports, Richard Low’s intestine condition involved diverticular bleeding, rather than diverticulitis.

What caused Richard Low’s intestinal bleeding?

While only Richard Low’s treating doctors know the full details of his medical condition, media reports indicate that his bleeding was caused by diverticulosis.

Diverticular bleeding occurs when a small blood vessel running alongside one of the pouches weakens and ruptures. This can lead to sudden bleeding into the colon, resulting in bright red or maroon blood in the stool. Unlike diverticulitis, diverticular bleeding often occurs without abdominal pain.

In many cases, the bleeding stops on its own. However, heavy or persistent bleeding may require hospital treatment, colonoscopy or other medical procedures to identify and control the source of bleeding.

Although diverticular bleeding is one of the more common causes of lower gastrointestinal bleeding in older adults, blood in the stool should never be ignored. It can also be caused by haemorrhoids, colorectal polyps, inflammatory bowel disease, colorectal cancer or other digestive conditions. A doctor can determine the underlying cause and whether further investigations are needed.

How is diverticulosis diagnosed?

Many people with diverticulosis do not know they have the condition because it often causes no symptoms. In many cases, diverticulosis is discovered incidentally during tests performed for another reason, such as colorectal cancer screening or investigation of bowel symptoms.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diverticulosis is commonly diagnosed through imaging tests or procedures that allow doctors to examine the colon.

Common diagnostic methods include:

Colonoscopy

A colonoscopy uses a flexible camera inserted through the rectum to examine the inside of the large intestine. It allows doctors to identify diverticula, investigate bleeding and check for other causes of bowel symptoms, such as polyps or colorectal cancer.

CT scan

A computed tomography (CT) scan may be used when doctors suspect complications such as diverticulitis. It can help identify inflammation, infection, abscesses or other problems affecting the colon.

Other tests

Depending on the symptoms, a doctor may recommend additional tests such as:

• Blood tests to look for signs of infection or inflammation
• Stool tests to investigate gastrointestinal bleeding
• Other imaging tests when appropriate

Diverticulosis cannot usually be confirmed based on symptoms alone because many people have no symptoms, while symptoms such as abdominal pain, constipation or blood in the stool can occur with many other conditions.

If you notice blood in your stool, persistent abdominal pain or changes in bowel habits, a doctor can help determine whether further investigation is needed.

Who is at risk of diverticulosis?

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diverticulosis becomes increasingly common with age and affects a large proportion of older adults. Although anyone can develop the condition, the likelihood increases significantly after the age of 50.

Factors associated with diverticulosis or its complications include:

• Increasing age
• A low-fibre diet
• Frequent constipation or straining during bowel movements
• Being overweight or obese
• Physical inactivity
• Smoking
• Family history of diverticular disease
• Regular use of certain medicines, including non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen

Many people are diagnosed only after undergoing a colonoscopy or abdominal scan for colorectal cancer screening or investigation of bowel symptoms.

What are the symptoms of diverticulosis?

Most people with diverticulosis have no symptoms and may never know they have the condition.

However, when symptoms or complications occur, they may include:

• Blood in the stool
• Mild abdominal discomfort
• Bloating
• Constipation
• Changes in bowel habits

If diverticulitis develops, symptoms may include:

• Persistent abdominal pain (usually on the lower left side)
• Fever
• Nausea or vomiting
• Loss of appetite
• Diarrhoea or constipation

These symptoms can also occur with other digestive conditions, including inflammatory bowel disease, colorectal cancer or severe constipation. If your symptoms are persistent or worsening, you should seek medical assessment.

Can diverticulosis cause serious complications?

Yes, although most people with diverticulosis never develop serious complications.

Possible complications include:

• Diverticular bleeding, which may cause bright red or maroon blood in the stool
• Diverticulitis, where one or more pouches become inflamed or infected
• Abscess, a collection of infected fluid near the colon
• Bowel obstruction, caused by inflammation or scarring
• Perforation, where a hole develops in the bowel wall
• Fistula, an abnormal connection between the colon and another organ

While these complications are relatively uncommon, they can become serious if left untreated.

Seek urgent medical attention immediately if you experience:

• Heavy rectal bleeding
• Severe or worsening abdominal pain
• Fever with persistent abdominal pain
• Repeated vomiting
• Severe abdominal swelling
• Fainting or dizziness
• An inability to pass stool or gas

Can diverticulosis be prevented?

There is no guaranteed way to prevent diverticulosis because ageing and genetics also contribute to its development.

However, maintaining healthy bowel habits may help reduce the risk of complications such as diverticulitis.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), healthy lifestyle habits that support bowel health include:

• Eating a fibre-rich diet with fruits, vegetables, beans and whole grains
• Drinking enough fluids throughout the day
• Exercising regularly
• Maintaining a healthy weight
• Avoiding smoking

If you regularly take NSAIDs such as ibuprofen or naproxen, speak with your doctor before making any changes. Do not stop prescribed medication without medical advice.

Contrary to older advice, people with diverticulosis generally do not need to avoid nuts, seeds or popcorn, unless a healthcare professional has identified a personal trigger.

Can you speak to an online doctor about diverticulosis?

Yes. An online consultation can be a useful first step if you have mild bowel symptoms, questions about diverticulosis or an existing diagnosis that requires follow-up.

During a telemedicine consultation, a doctor may:

• Review your symptoms and medical history
• Assess your bowel habits, diet and lifestyle
• Recommend measures to improve fibre intake and relieve constipation
• Review medicines that may increase your risk of bleeding
• Determine whether blood tests, imaging, colonoscopy or referral to a gastroenterologist may be appropriate

The American Gastroenterological Association (AGA) advises that antibiotics are not routinely recommended for every patient with uncomplicated diverticulitis. Instead, treatment is individualised based on the severity of symptoms, overall health and risk of complications. If diverticulitis is suspected, your doctor will determine whether antibiotics, imaging or in-person assessment are appropriate.

Diverticulosis itself cannot be diagnosed through a video consultation alone. Depending on your symptoms, your doctor may recommend an in-person examination, CT scan, colonoscopy or referral to a specialist.

Telemedicine is not suitable for heavy rectal bleeding, severe abdominal pain, repeated vomiting, fainting or suspected bowel obstruction. These symptoms require prompt in-person or emergency medical assessment.

When should you see a doctor?

Arrange a medical review if you experience:

• Blood in your stool
• Ongoing or recurrent abdominal pain
• Changes in bowel habits lasting more than a few weeks
• Recurrent constipation
• Persistent bloating
• Unexplained weight loss

While these symptoms do not always indicate diverticulosis, they should be assessed to determine the underlying cause and whether further investigations are needed.

Seek emergency medical care immediately if you develop:

• Heavy rectal bleeding
• Severe abdominal pain
• Fever with worsening abdominal pain
• Repeated vomiting
• Fainting or dizziness
• An inability to pass stool or gas

Prompt medical assessment is important because these symptoms may indicate diverticular bleeding, diverticulitis or another serious digestive condition requiring urgent treatment.

Sources

This article was prepared using information from the following sources:

• The Star. Richard Low hospitalised after intestinal bleeding caused by diverticulosis.
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diverticular Disease.
• American Gastroenterological Association (AGA). Clinical Practice Update on Medical Management of Colonic Diverticulitis.
• American Society of Colon and Rectal Surgeons (ASCRS). Diverticular Disease.
• NHS. Diverticular disease and diverticulitis.