Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 25, 2016

Over time, small pouches called diverticula may form inside the colon, which is a condition called diverticulosis. While they don't initially cause any problems, the pouches can grow and become larger eventually causing complications such as diverticulitis.


Definition & Facts

Diverticulosis is a very common problem that affects around 200,000 people in America every year. The pouches within the walls of the colon do not cause major interruptions but can develop into diverticulitis if they become inflamed. Diverticulosis is often discovered during tests such as colonoscopies that are performed to examine other issues.

Symptoms & Complaints

For the most part, people don't complain of any symptoms. Many people have diverticulosis for years and never know they do. However, as time progresses, these little pouches can become inflamed and turn into diverticulitis, which occurs in about 1 out of 5 cases. Both conditions fall under the diverticular disease category. Symptoms of diverticulosis may include:

If the diverticulosis develops into diverticulitis, complications can include an abscess that forms in the pouches, a blockage in the colon, a fistula in parts of the bowels, or peritonitis. All of these conditions require immediate medical attention.


Doctors don't understand why diverticula form within the colon's walls. One theory is that there is abnormally high pressure inside the colon that presses against the wall. This pressure causes pouches to form from pushing through the wall.

When a person has a high fiber diet, his or her stool is able to move through the colon with ease as it is bulky. If a person is not eating enough fiber, the hard stool is difficult to pass. For the colon to be able to pass these harder stools, it must use great force. It's thought that the pressure used to pass these stools can cause weak spots within the walls of the colon, enabling diverticula to form. This occurs in the areas where blood vessels go through the muscle layers of the bowel.

There are many risk factors for this condition which include the following:

  • Age - The older a person is the more increased chance they have of developing diverticulitis.
  • Obesity - A person that is obese or overweight will have increased odds of developing this condition.
  • Smoking cigarette - Those who smoke are more likely to develop this condition as opposed to those who don't.
  • Sedentary lifestyle - When a person doesn't get enough physical activity, it can cause a higher risk of diverticulosis. It is reported that regular activity seems to lower the chance of developing this condition.
  • A diet high in fat/low in fiber- A diet high in fiber allows the stool to be bulky and pass without pressure build-up inside the colon.
  • Medications- Some drugs increase the risk of diverticulitis. These drugs include over the counter pain relievers like ibuprofen, steroids, and opiates.

Diagnosis & Tests

Because most people do not exhibit any symptoms, diverticulosis is usually found by accident during the course of an evaluation for another condition such as colorectal polyps. Gastroenterologists can look inside the colon using a procedure involving a small camera attached to a flexible tube. A sigmoidoscopy uses a short tube to examine the rectum and the lower part of the colon.

Colonoscopies involve a longer tube and are used to explore the entire colon area. These procedures are performed in the hospital as an outpatient procedure or at an equipped doctor's office. Any abnormal tissue samples will be sent to a pathologist for analysis.

Diverticulosis can also be diagnosed using computed tomography (CT) scans and barium X-rays. CT scans take cross sectional pictures of the body. While this test is generally not used to diagnose diverticulosis, it can play a part in identifying diverticula of the colon.

Barium enema X-rays are an examination of the colon and the rectum combined. To ensure that the area to be evaluated shows up on a X-ray image, the colon is filled with a white barium liquid through the anus. Because barium blocks X-rays, the barium-coated colon will show up clearly on the X-ray images. Barium enemas may also be performed to diagnose rectal bleeding and bloody stools.

Treatment & Therapy

Treatment for inflamed diverticula may vary depending on the severity of the disease and the person's symptoms. Diverticulitis may require the use of antibiotics to take care of the infection. Severe cases may require hospitalization. Patients with abscesses will need special treatment. A radiologist will use an ultrasound or a CT scanner to determine the location of the abscess. Upon discovery, a fine needle will be inserted through the abdomen and into the abscess in the colon. The needle is connected to a thin tube and is used to drain the pus from the abscess.

Percutaneous abscess drainage (PAD) is performed using local anesthesia. Depending on the size of the abscess, the procedure may need to be repeated several times. If the abscess is less than four centimeters in size, antibiotic treatment may be sufficient.

Intestinal obstruction can usually be resolved by surgery. If scarring and blockage are severe, a temporary or permanent colostomy may be required for the patient. Many doctors will recommend a high-fiber diet to make stools softer. Doctors may also recommend medications to help relax spasms in the colon for decreased pain and discomfort.

Prevention & Prophylaxis

It is important to have a regular bowel movement schedule to avoid complications from high pressure in the colon. A daily routine can help immensely. Eating plenty of fiber will ensure that stools pass quickly and without any effort, averting constipation.

Regular exercise is another important way to keep any new pouches from forming. Avoid foods that are high in fat; rather stick with fruits, veggies, grains and beans. The fiber content in these foods is much higher than in others. If getting enough fiber is an issue, taking a fiber supplement every day should help.