The colon is a long tube-like structure that stores and then eliminates waste material. Some people develop small bulging sacs pushing outward from the colon wall. One of these sacs is called a diverticulum. Several of these sacs are called diverticula. The condition of having diverticulum in the colon is called diverticulosis. Diverticulosis can occur throughout the colon but is most common in the left lower part of the colon called the sigmoid colon. The disease is common in the Western world but is extremely rare in areas such as Asia and Africa. Diverticular disease increases with age. It is uncommon before age forty and is seen in more than 50% of people over the age of sixty in the United States.

The muscular wall of the colon grows thicker with age. A diet low in fiber can lead to small, hard stools which are difficult to pass. Thickening of the colon wall may result from increasing pressures required by the colon to eliminate stool. Over time, strong contractions of the colon push the inner intestinal lining outward through gaps in the muscle walls, forming diverticula.

Most patients with diverticulosis have few or no symptoms. The diverticulosis condition may be diagnosed incidentally during testing for other colon problems. Only one out of five people with diverticulosis will develop symptoms of the disease. The most common symptoms include abdominal cramping, constipation, diarrhea and bloating. These symptoms are related to difficulty of passing the stool along the left colon narrowed by diverticular disease.

Complications include diverticulitis (inflammation of the sacs), abscess (collection of pus in the abdomen), peritonitis (generalized infection in the abdomen due to perforation of a sac), bleeding, and colon obstruction. Symptoms include fever, pain, and tenderness in the lower left abdomen. Constipation or diarrhea may also occur. Passage of blood from the rectum may also occur with or without abdominal pain.

Once suspected, the diagnosis of diverticular disease can be confirmed by a variety of tests. A barium enema can be performed to look at the colon. Diverticula are seen as barium filled pouches protruding from the colon wall. Direct visualization of the colon can be done with a flexible scope inserted through the rectum and advanced into the colon. Either the short scope (sigmoidoscope) or the long scope (colonoscope) may be used to assist in the diagnosis and to rule out other diseases. If there are persistent pain and fever, a CAT scan or ultrasound may be necessary.

Most patients with diverticulosis have few or no symptoms and do not require any specific treatment. A high fiber diet and fiber supplement are recommended to prevent constipation and the formation of more diverticula. Patients with mild symptoms of bloating or abdominal pain may benefit from anti-spasmodic drugs. Some doctors recommend avoidance of nuts, seeds, or popcorn to prevent complications of diverticulosis, particularly if a person has had bleeding or other complications.

If diverticulitis occurs, antibiotics may be necessary. Antibiotics by mouth are usually sufficient when symptoms are mild. Low fiber diet or liquid diet may also be recommended temporarily. In severe diverticulitis with fever, pain, or bleeding, patients may need to be hospitalized and given intravenous antibiotics.

Colonoscopy or bleeding scans may be done to confirm the diagnosis and the source of bleeding. Surgery may be necessary if infection or bleeding are persistent or occur frequently or if perforation develops.

Once formed, diverticula are permanent. No treatment has been found to prevent complications of diverticular disease.

A diet high in fiber increases stool bulk and prevents constipation. This may help prevent further diverticular formation or worsening of the condition. Avoiding seeds, nuts or popcorn, which can plug the diverticular openings and cause infection, may be helpful. If you have known diverticular disease and develop unexplained fever, chills, or abdominal pain, notify your doctor immediately.