Your Guide to Diverticular Disease: Symptoms, Diet, and More

Medically Reviewed By Saurabh Sethi, M.D., MPH
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Diverticular disease refers to complications that arise from diverticula, which are small pouches that can form along the wall of the large intestine. The presence of diverticula is a condition known as diverticulosis. If these pouches cause inflammation in the colon, the condition is called diverticulitis. In most cases, diverticulosis does not cause symptoms or problems. However, diverticula can rupture, leading to inflammation or infection. This is diverticulitis, or a diverticulitis attack. It happens in less than 5% of people with diverticulosis.

This article will provide an overview of diverticular disease, including the difference between diverticulosis and diverticulitis. It will also discuss symptoms, risk factors, and treatments for diverticular disease.

What is diverticular disease?

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Diverticula are small pouches, or sacs, that can push out from the wall of the large intestine. This most often occurs in the lower part of the colon, which is known as the sigmoid colon.

When diverticula form, this is a condition known as diverticulosis. In many cases, the presence of these diverticula does not cause problems.

However, if symptoms or complications do develop, this is known as diverticular disease. Diverticulitis occurs when there is inflammation in the diverticula. It is one complication of diverticular disease.

What is the difference between diverticulosis and diverticulitis?

Though they have similar names, diverticulosis and diverticulitis are two distinct conditions.

Diverticulosis vs. diverticulitis

  • Diverticulosis is the presence of diverticula, which are small pouches that push out from weak areas of the lower intestinal wall. Diverticulosis typically does not cause symptoms or complications.
  • Diverticulitis is inflammation of diverticula. It is one indication of diverticular disease, which can also include symptoms such as diverticular bleeding.

Learn about other common digestive conditions here.

What are the signs and symptoms of diverticular disease?

Diverticulosis typically does not cause symptoms.

Symptoms of diverticular disease

If the presence of diverticula causes symptoms, this is known as diverticular disease. Symptoms may include:

Symptoms of diverticulitis

If diverticulitis develops, symptoms can include:

Diverticulitis can lead to potentially life threatening complications. Seek immediate medical care for symptoms of diverticulitis.

What causes diverticular disease?

Researchers believe that diverticula form due to pressure in the colon that pushes against weak areas of the intestinal wall. This causes pouches to bulge out into the intestinal tract.

It is unclear exactly what causes the development of diverticular disease. Experts believe that several factors may play a role, including:

  • certain genes
  • pieces of stool or bacteria that become trapped in a diverticulum, causing infection or perforation
  • changes in the gut microbiome
  • nerve, muscle, or tissue problems in the colon
  • immune system conditions

Current guidance about food causes of diverticular disease

In the past, doctors recommended that people with diverticular disease avoid seeds, popcorn, and nuts. The belief at the time was that these foods could get trapped in the diverticula, causing inflammation.

However, a 2008 study found no evidence that these foods increased the risk of developing diverticular disease.

What are the risk factors for diverticular disease?

Experts have identified several lifestyle risk factors that may play a role in the development of diverticular disease, including diverticulitis. These include:

  • eating a diet high in red meat
  • not eating enough fiber
  • having a sedentary lifestyle and a lack of physical activity
  • smoking
  • having obesity
  • taking certain medications, such as corticosteroids or nonsteroidal anti-inflammatory drugs

If you have risk factors, talk with your gastroenterologist or another healthcare professional about modifications you can make to lower your risk.

How do doctors diagnose diverticular disease?

To diagnose diverticulitis, your gastroenterologist or other medical professional will ask about your symptoms, your health history, and any medications and supplements you take.

During a physical exam, your doctor will likely check your abdomen to see if you have tenderness.

They may also perform a digital rectal exam. This is a screening exam your doctor may use to check for pain, masses, rectal bleeding, and other problems.

Tests for diverticular disease

These tests can also determine if you have diverticulitis.

  • a barium enema, which is a procedure that uses a barium mixture to highlight your colon on a series of X-ray images
  • blood tests to check for high white blood cell counts, which may be a sign of infection
  • colonoscopy, which is a procedure that allows clinicians to examine the lining of your colon and rectum using a thin, flexible instrument called a colonoscope
  • a CT scan, which creates layered images of the lower intestine to provide more detail than standard X-rays
  • video capsule endoscopy, which is a noninvasive imaging test that involves swallowing a vitamin-sized capsule with a camera that takes photos as it travels through the digestive tract

If your doctor determines that you have diverticular disease, which may include diverticulitis, they will discuss your treatment options and dietary recommendations.

Learn more about what to expect during colonoscopy.

What are the treatment options for diverticular disease?

Treatment for diverticular disease will depend on the severity of symptoms. Options for diverticular disease treatment include the following.

Liquid diet

If diverticulitis symptoms are mild, doctors may advise a liquid-only diet to help the lower intestine rest. You will likely see your doctor for a follow-up visit after 2–3 days to see if your symptoms have improved.

Antibiotics

Some people who develop diverticulitis may need antibiotics to treat the infection. Doctors may prescribe these in pill form or via an IV tube in a hospital.

Antibiotics may also be able to treat small abscesses that can form as a complication of diverticular disease.

Surgery

Diverticulitis surgery may be necessary if complications develop or if antibiotics are not effective.

Types of surgeries for diverticular disease include:

  • Colon resection, or colectomy: This procedure involves removing a section of the large intestine. The surgeon may connect the two ends of the large intestine or create a stoma. This is an opening to the outside of the body that connects to a temporary colostomy bag that collects waste.
  • Fistula repair: This procedure repairs an abnormal tunnel that can develop between the large intestine and another organ. In cases of diverticulitis, fistulas may form between the colon and the bladder or vagina.
  • Removal of an intestinal blockage: Doctors may be able to treat a partial obstruction with fluids and dietary changes. A complete intestinal obstruction is a life threatening emergency that requires immediate surgery to remove the blockage.
  • Perforation repair: If a perforation of the intestinal wall causes waste material to spill into the abdominal cavity, this can lead to peritonitis, which is an infection of the abdominal lining. Surgery is necessary to clean out the abdominal cavity and repair the perforation.

Most people with diverticular disease do not need surgery. By working with your medical care team to treat early symptoms of diverticular disease, you can prevent more serious complications that require surgical treatment.

Learn more about what to expect with a colostomy.

What are the diet and nutrition tips for diverticular disease?

Because a diet low in fiber is a risk factor for diverticulitis, doctors recommend including fiber-rich foods in your daily meals. If you are not used to eating high amounts of fiber, it is best to add these foods gradually to give your digestive tract time to adjust.

Doctors also advise limiting red meat and including fresh fruits and vegetables in your diet.

Your gastroenterologist can refer you to a licensed dietitian who can provide guidance on healthy eating with diverticular disease.

Other frequently asked questions

These are other questions people often ask about diverticular disease. The answers have been reviewed by Dr. Saurabh Sethi, M.D., M.P.H.

Is diverticular disease serious?

Diverticular disease can lead to serious, sometimes life threatening complications. In the United States, about 200,000 people per year are hospitalized for diverticulitis.

What should I not eat with diverticulosis?

Despite previous thinking that foods such as nuts and seeds increased the risk of inflammation, experts now say that there is no reason for people with diverticulosis to avoid specific foods.

What does poop look like with diverticulitis?

Symptoms of diverticulitis can include blood or mucus in the stool. If you notice these symptoms, contact your doctor right away to prevent further complications.

Summary

Diverticular disease is a term for complications that arise due to the presence of small pouches in the intestine called diverticula. When these pouches become inflamed, the condition is known as diverticulitis.

Symptoms can include abdominal pain, constipation, diarrhea, or blood in stool. Treatment depends on the severity of symptoms and may include a liquid diet, antibiotics, or surgery.

Contact your doctor right away if you experience symptoms of diverticular disease so you can get a prompt diagnosis and begin treatment.

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Medical Reviewer: Saurabh Sethi, M.D., MPH
Last Review Date: 2022 May 31
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