Diverticula: Colonic Pouches—Causes, Symptoms, Diverticulitis, and Prevention

Diverticula are small, sac-like outpouchings of the colonic wall, typically occurring in the sigmoid colon. They form when the inner mucosal layer herniates through weak points in the muscular wall where blood vessels penetrate.

Diverticulosis vs. Diverticulitis

• Diverticulosis: Presence of diverticula without inflammation (usually asymptomatic)
• Diverticulitis: Inflammation/infection of diverticula (symptomatic, potentially serious)

Risk Factors

• Age (>50 years; rare <40)
• Low-fiber diet (constipation, high intraluminal pressure)
• Obesity
• Physical inactivity
• Smoking
• NSAID/opioid use
• Genetics/family history
• Connective tissue disorders

Symptoms

Diverticulosis (Often Asymptomatic)

• Mild cramping, bloating
• Intermittent constipation/diarrhea
• Often discovered incidentally on colonoscopy

Diverticulitis

• Left lower quadrant abdominal pain (usually constant, severe)
• Fever and chills
• Nausea, vomiting
• Change in bowel habits
• Tenderness on examination
• Possible rectal bleeding

Complications

• Abscess formation
• Perforation → peritonitis
• Fistula formation (colovesical, colovaginal, coloenteric)
• Intestinal obstruction (stricture)
• Significant bleeding (diverticular hemorrhage)

Diagnosis

• CT abdomen/pelvis with contrast (gold standard for diverticulitis)
• Colonoscopy (for diverticulosis, after acute episode resolves)
• Blood tests: WBC, CRP, hemoglobin

Management

Asymptomatic Diverticulosis

• High-fiber diet (25–35 g/day)
• Adequate hydration
• Regular exercise
• No need to avoid nuts, seeds, popcorn (outdated advice)

Uncomplicated Diverticulitis

• Outpatient management: oral antibiotics (if indicated), liquid diet advancing
• Recent guidelines: antibiotics may not be needed for mild cases

Complicated Diverticulitis

• Hospitalization, IV antibiotics, drainage, possible surgery

Prevention

• High-fiber diet (fruits, vegetables, whole grains, legumes)
• Adequate fluid intake
• Regular physical activity
• Maintain healthy weight
• Limit red meat, processed foods
• Smoking cessation