Diverticular Disease of the Colon

What Is Diverticular Disease?

Diverticular disease refers to conditions related to the formation of small pouches, called diverticula, in the wall of the colon (large intestine). These pouches can develop when pressure inside the colon pushes against weak spots in the intestinal lining.

When diverticula are present without inflammation, the condition is called diverticulosis. Many people with diverticulosis have no symptoms and may not even know they have it.

When one or more diverticula become inflamed or infected, the condition is called diverticulitis, which can cause pain and other abdominal symptoms. Diverticulitis may be uncomplicated or may lead to complications such as abscess, perforation, or fistula.

Causes and Risk Factors

Diverticular disease is common, particularly in older adults, and becomes more prevalent with age. While the exact cause of diverticula formation is not fully understood, contributing factors include:

  • A low-fiber diet that leads to harder stools and increased colon pressure
  • Aging and weakening of the colon wall
  • Chronic constipation
  • Obesity and sedentary lifestyle
  • Smoking
  • Certain medications, such as steroids or opioids

Most people with diverticula will never develop symptoms, but some will go on to have diverticulitis.

Signs and Symptoms

Diverticulosis often causes no symptoms and may be discovered incidentally during routine colonoscopy or imaging.

Diverticulitis may present with:

  • Pain or tenderness in the lower abdomen, often on the left side
  • Fever or chills
  • Nausea or vomiting
  • Constipation or diarrhea
  • Bloating or gas

Complicated diverticulitis can lead to abscess, perforation, bleeding, fistula, or bowel obstruction, which may cause more severe pain and signs of infection.

How It’s Diagnosed

Diagnosis typically begins with a clinical evaluation based on symptoms and physical exam, followed by imaging studies such as:

  • CT scan of the abdomen and pelvis
  • Colonoscopy, usually performed after inflammation has resolved
  • Blood tests to check for infection or inflammation

A careful history and targeted testing help differentiate diverticular disease from other causes of abdominal pain.

Treatment

Uncomplicated diverticulosis may be managed with dietary changes such as increased fiber, hydration, and regular exercise to promote healthy bowel habits.

Diverticulitis is treated according to severity:

  • Mild cases: oral antibiotics, dietary modification, and rest
  • Moderate or complicated cases: hospitalization, IV antibiotics, or drainage of abscesses
  • Recurrent or complicated cases: surgical resection of the affected colon segment

Patient education and lifestyle changes are important components of long-term management.

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Frequently Asked Questions

Diverticulosis refers to the presence of small pouches (diverticula) in the colon wall that usually cause no symptoms. Diverticulitis occurs when those pouches become inflamed or infected, leading to pain and other symptoms.

Diverticula are thought to form when pressure inside the colon increases due to straining, often related to a low-fiber diet and chronic constipation. Aging also weakens the colon wall, increasing risk.

Symptoms may include lower abdominal pain (often on the left side), fever, nausea, changes in bowel habits, and bloating.

Diagnosis most often involves a CT scan to confirm inflammation and identify complications. Colonoscopy may be done later to evaluate the colon more fully once acute inflammation has resolved.

A high-fiber diet, adequate hydration, regular exercise, and maintaining a healthy weight may help prevent diverticulum formation and diverticulitis.

Surgery may be recommended for recurrent episodes of diverticulitis, complications such as fistula or perforation, or when medical therapy fails to control symptoms.