Many people have small pouches in their colons that bulge outward
through weak spots, like an inner tube that pokes through weak places in a tire.
Each pouch is called a diverticulum. Pouches (plural) are called diverticula.
The condition of having diverticula is called diverticulosis. About 10 percent
of Americans over the age of 40 have diverticulosis. The condition becomes more
common as people age. About half of all people over the age of 60 have
When the pouches become infected or
inflamed, the condition is called diverticulitis. This happens in 10 to 25
percent of people with diverticulosis. Diverticulosis and diverticulitis are
also called diverticular disease.
causes diverticular disease?
Although not proven, the dominant theory is that a low-fiber diet
is the main cause of diverticular disease. The disease was first noticed in the
United States in the early 1900s. At about the same time, processed foods were
introduced into the American diet. Many processed foods contain refined,
low-fiber flour. Unlike whole-wheat flour, refined flour has no wheat bran.
Diverticular disease is common in developed or industrialized
countries—particularly the United States, England, and Australia—where low-fiber
diets are common. The disease is rare in countries of Asia and Africa, where
people eat high-fiber vegetable diets.
Fiber is the part of fruits, vegetables, and grains that the body
cannot digest. Some fiber dissolves easily in water (soluble fiber). It takes on
a soft, jelly-like texture in the intestines. Some fiber passes almost unchanged
through the intestines (insoluble fiber). Both kinds of fiber help make stools
soft and easy to pass. Fiber also prevents constipation.
Constipation makes the muscles strain to move stool that is too
hard. It is the main cause of increased pressure in the colon. This excess
pressure might cause the weak spots in the colon to bulge out and become
Diverticulitis occurs when diverticula become infected or
inflamed. Doctors are not certain what causes the infection. It may begin when
stool or bacteria are caught in the diverticula. An attack of diverticulitis can
develop suddenly and without warning.
What are the symptoms?
Most people with diverticulosis do not have any discomfort or
symptoms. However, symptoms may include mild cramps, bloating, and constipation.
Other diseases such as irritable bowel syndrome (IBS) and stomach ulcers cause
similar problems, so these symptoms do not always mean a person has
diverticulosis. You should visit your doctor if you have these troubling
The most common symptom of diverticulitis is abdominal pain. The
most common sign is tenderness around the left side of the lower abdomen. If
infection is the cause, fever, nausea, vomiting, chills, cramping, and
constipation may occur as well. The severity of symptoms depends on the extent
of the infection and complications.
What are the complications?
Diverticulitis can lead to bleeding, infections, perforations or
tears, or blockages. These complications always require treatment to prevent
them from progressing and causing serious illness.
Bleeding from diverticula is a rare complication. When
diverticula bleed, blood may appear in the toilet or in your stool. Bleeding can
be severe, but it may stop by itself and not require treatment. Doctors believe
bleeding diverticula are caused by a small blood vessel in a diverticulum that
weakens and finally bursts. If you have bleeding from the rectum, you should see
your doctor. If the bleeding does not stop, surgery may be necessary.
Abscess, Perforation, and Peritonitis
The infection causing diverticulitis often clears up after a few
days of treatment with antibiotics. If the condition gets worse, an abscess may
form in the colon.
An abscess is an infected area with pus that may cause swelling
and destroy tissue. Sometimes the infected diverticula may develop small holes,
called perforations. These perforations allow pus to leak out of the colon into
the abdominal area. If the abscess is small and remains in the colon, it may
clear up after treatment with antibiotics. If the abscess does not clear up with
antibiotics, the doctor may need to drain it.
To drain the abscess, the doctor uses a needle and a small tube
called a catheter. The doctor inserts the needle through the skin and drains the
fluid through the catheter. This procedure is called percutaneous catheter
drainage. Sometimes surgery is needed to clean the abscess and, if necessary,
remove part of the colon.
A large abscess can become a serious problem if the infection
leaks out and contaminates areas outside the colon. Infection that spreads into
the abdominal cavity is called peritonitis. Peritonitis requires immediate
surgery to clean the abdominal cavity and remove the damaged part of the colon.
Without surgery, peritonitis can be fatal.
A fistula is an abnormal connection of tissue between two organs
or between an organ and the skin. When damaged tissues come into contact with
each other during infection, they sometimes stick together. If they heal that
way, a fistula forms. When diverticulitis-related infection spreads outside the
colon, the colon's tissue may stick to nearby tissues. The organs usually
involved are the bladder, small intestine, and skin.
The most common type of fistula occurs between the bladder and
the colon. It affects men more than women. This type of fistula can result in a
severe, long-lasting infection of the urinary tract. The problem can be
corrected with surgery to remove the fistula and the affected part of the colon.
The scarring caused by infection may cause partial or total
blockage of the large intestine. When this happens, the colon is unable to move
bowel contents normally. When the obstruction totally blocks the intestine,
emergency surgery is necessary. Partial blockage is not an emergency, so the
surgery to correct it can be planned.
How does the doctor diagnose diverticular
To diagnose diverticular disease, the doctor asks about medical
history, does a physical exam, and may perform one or more diagnostic tests.
Because most people do not have symptoms, diverticulosis is often found through
tests ordered for another ailment.
When taking a medical history, the doctor may ask about bowel
habits, symptoms, pain, diet, and medications. The physical exam usually
involves a digital rectal exam. To perform this test, the doctor inserts a
gloved, lubricated finger into the rectum to detect tenderness, blockage, or
blood. The doctor may check stool for signs of bleeding and test blood for signs
of infection. The doctor may also order x rays or other tests.
What is the treatment for diverticular
A high-fiber diet and, occasionally, mild pain medications will
help relieve symptoms in most cases. Sometimes an attack of diverticulitis is
serious enough to require a hospital stay and possibly surgery.
Increasing the amount of fiber in the diet may reduce symptoms of
diverticulosis and prevent complications such as diverticulitis. Fiber keeps
stool soft and lowers pressure inside the colon so that bowel contents can move
through easily. The American Dietetic Association recommends 20 to 35 grams of
fiber each day. The table below shows the amount of fiber in some foods that you
can easily add to your diet.
The doctor may also recommend taking a fiber
product such as Citrucel or Metamucil once a day. These products are mixed with
water and provide about 2 to 3.5 grams of fiber per tablespoon, mixed with 8
ounces of water.
Until recently, many doctors suggested avoiding foods with
small seeds such as tomatoes or strawberries because they believed that
particles could lodge in the diverticula and cause inflammation. However, it is
now generally accepted that only foods that may irritate or get caught in the
diverticula cause problems. Foods such as nuts, popcorn hulls, and sunflower,
pumpkin, caraway, and sesame seeds should be avoided. The seeds in tomatoes,
zucchini, cucumbers, strawberries, and raspberries, as well as poppy seeds, are
generally considered harmless. People differ in the amounts and types of foods
they can eat. Decisions about diet should be made based on what works best for
each person. Keeping a food diary may help identify individual items in one's
If cramps, bloating, and constipation are problems, the doctor
may prescribe a short course of pain medication. However, many medications
affect emptying of the colon, an undesirable side effect for people with
Treatment for diverticulitis focuses on clearing up the infection
and inflammation, resting the colon, and preventing or minimizing complications.
An attack of diverticulitis without complications may respond to antibiotics
within a few days if treated early.
To help the colon rest, the doctor may recommend bed rest and a
liquid diet, along with a pain reliever.
An acute attack with severe pain or severe infection may require
a hospital stay. Most acute cases of diverticulitis are treated with antibiotics
and a liquid diet. The antibiotics are given by injection into a vein. In some
cases, however, surgery may be necessary.
When is surgery necessary?
If attacks are severe or frequent, the doctor may advise surgery.
The surgeon removes the affected part of the colon and joins the remaining
sections. This type of surgery, called colon resection, aims to keep attacks
from coming back and to prevent complications. The doctor may also recommend
surgery for complications of a fistula or intestinal obstruction.
If antibiotics do not correct an attack, emergency surgery may be
required. Other reasons for emergency surgery include a large abscess,
perforation, peritonitis, or continued bleeding.
Emergency surgery usually involves two operations. The first
surgery will clear the infected abdominal cavity and remove part of the colon.
Because of infection and sometimes obstruction, it is not safe to rejoin the
colon during the first operation. Instead, the surgeon creates a temporary hole,
or stoma, in the abdomen. The end of the colon is connected to the hole, a
procedure called a colostomy, to allow normal eating and bowel movements. The
stool goes into a bag attached to the opening in the abdomen. In the second
operation, the surgeon rejoins the ends of the colon.
Points to Remember
Diverticulosis occurs when
small pouches, called diverticula, bulge outward through weak spots in the
colon (large intestine).
The pouches form when pressure
inside the colon builds, usually because of constipation.
Most people with
diverticulosis never have any discomfort or symptoms.
The most likely cause of
diverticulosis is a low-fiber diet because it increases constipation and
pressure inside the colon.
For most people with
diverticulosis, eating a high-fiber diet is the only treatment needed.
You can increase your fiber
intake by eating these foods: whole grain breads and cereals; fruit like
apples and peaches; vegetables like broccoli, cabbage, spinach, carrots,
asparagus, and squash; and starchy vegetables like kidney beans and lima
Diverticulitis occurs when
the pouches become infected or inflamed and cause pain and tenderness around the
left side of the lower abdomen.
National Institutes of Health (NIH)
Nutritional and Herbal Therapy for
- Eat a high-fiber diet. This is the most important
thing to remember to prevent diverticular disease. Eat more fruits,
vegetables, whole grains and less red meat and dairy.
- Regular exercise is important to reduce
occurrence of symptoms.
- Omega-3 fatty acids help reduce
- Tumeric, ginger and bromelain (in
pineapples) reduce inflammation.
- Drink plenty of water to help ease passage
through the colon.