Diverticular Disease

A diverticulum is a sac-like bulge in the wall of the colon, the section of the large intestine that extends from the small intestine to the rectum. In rare instances, diverticula are present at birth, but usually they form later in life. Most diverticula occur in the sigmoid colon, the curved part of the large intestine closest to the rectum.

Diverticulosis is the presence of many diverticula along the bowel wall; this occurs more commonly as people get older and in countries where the diet is generally low in fiber. Data from indicate that more than 50% of adults over the age of 60 have diverticula.

Diverticulitis occurs when one or more diverticula become inflamed; this inflammation may be local, confined to the area of the diverticulum, or may become more widespread to include the abdominal lining (peritoneum), called peritonitis. Small (microscopic) or large perforations (holes in the bowel wall) occur in 15% to 20% of persons who have diverticula.

Signs and Symptoms

Often diverticula cause no symptoms, although a person may experience some irregularities in bowel habits. If symptoms do appear, they may include the following: Some people with diverticulitis develop fistulas, or abnormal passageways from the intestines into the abdomen or to another organ such as the bladder. This may lead to a urinary tract infection, gas in the urine, pain while urinating, or a more frequent need to urinate.

Some people develop peritonitis, an inflammation of the lining of the abdomen. Symptoms of peritonitis may include sudden abdominal pain, muscle spasms, guarding (involuntary contraction of muscles to protect the affected area), and possibly sepsis, the term for an infection that has spread to the blood.

What Causes It?

The cause of diverticular disease is not certain, but several factors may contribute to changes in the wall of the colon. These include aging, the movement of waste through the colon, changes in intestinal pressure, a low-fiber diet, and anatomic defects.

Who's Most At Risk?

These factors increase the risk for developing diverticular disease: The following may contribute as well:

What to Expect at Your Provider's Office

Your healthcare provider will examine your abdomen for tenderness, swelling, and guarding and may try to detect any unusual mass around the intestines. He or she may also take your temperature and test your blood, urine, and stool for signs of infection or blood. Computed tomography, a barium enema, ultrasound, and other imaging techniques may help locate diverticula and any inflammation, fistulae, abscesses, or other abnormalities. In some cases, providers may perform a colonoscopy, in which an endoscope (a thin, lighted tube equipped with a camera) is inserted through the anus and rectum and into the colon. This procedure helps to locate diverticula, detect the presence of any polyps, and determine the source of bloody stools.

Treatment Options


To help prevent diverticular disease:

Treatment Plan

For mild symptoms, healthcare providers may recommend a clear liquid diet and prescribe antibiotics. More serious cases may require hospitalization, intravenous feeding to rest the bowel, and intravenous antibiotics. Eating a high-fiber diet and taking psyllium supplements may help following an acute episode. Within six weeks, a colonoscopy or barium enema may be performed to check the condition of your intestines.

For repeated attacks, a provider may recommend surgery. Those who are younger than age 40, who have severe complications, or whose condition becomes worse within a day or two of an attack may need surgery right away.

Drug Therapies

A healthcare provider may prescribe antibiotics to fight infection, anticholinergics to relieve cramping, and analgesics to relieve pain.

Surgical and Other Procedures

If the condition is severe or leads to complications, or if attacks recur, a healthcare provider may recommend one of the following procedures:

Complementary and Alternative Therapies

Nutrition plays an important role in preventing and treating gastrointestinal disease, especially diverticulosis. Specific dietary factors have been linked to the incidence of diverticular disease and may help minimize attacks and improve treatment results.

High-fiber Diet Glutamine
While specific nutrients that may have an impact on diverticular disease have not been studied as thoroughly as the high-fiber diet, glutamine supplements, which are thought to confer some degree of protection to the wall of the colon, may prove beneficial.

Omega-3 Essential Fatty Acids
Omega-3 essential fatty acids found in flax and cold water fish help fight inflammation. (On the other hand, omega-6 fatty acids, found in meats and dairy products, tend to increase inflammation.) For a condition such as diverticulitis, it may be wise to eat a diet rich in omega-3 fatty acids. This type of diet may also help prevent colon cancer.

Many herbs are used for the general beneficial effects of their fiber content, specifically: Homeopathy
There are case reports of individuals with gastrointestinal disorders, including diverticular disease, who have been treated successfully with homeopathy. There have not been enough scientific studies to date, however, to confirm these reports. An experienced homeopath considers each individual case and may recommend one of the following treatments to address particular symptoms:

Following Up

If you develop a fever, tenderness in the abdomen, or bleeding from the rectum or in the stool, you should alert your healthcare provider right away. For fever higher than 101°F, worsening symptoms, signs of peritonitis, or increased white blood cell count found in laboratory tests, hospitalization will be considered and even encouraged by your healthcare provider.

Prognosis/Possible Complications

About one-third of those who develop diverticulitis have a second episode, and of this group, half generally have a third attack. Twenty percent of patients develop complications after the first attack, 60% after a second attack. Complications may include: Those who have experienced bleeding once are at high risk for developing bleeding again.


Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men. Ann Epidemiol. 1995;5(3):221-228.

Acyclovir. NMIHI. Accessed at http://www.nmihi.com/a/acyclovir.html on November 9, 2018.

Ambrosetti P, Robert JH, Witzig JA, et al. Acute left colonic diverticulitis: a prospective analysis of 226 consecutive cases. Surgery. 1994;115(5):546-550.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:134-138, 314-321.

Ciprofloxacin. NMIHI. Accessed at http://www.nmihi.com/c/ciprofloxacin.html on November 9, 2018.

Co-amoxiclav. NMIHI. Accessed at http://www.nmihi.com/c/co-amoxiclav.html on November 9, 2018.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins Inc; 1999.

Diverticulitis. Ada Health. Accessed at https://ada.com/ on November 9, 2018.

Diverticular disease. NMIHI. Accessed at http://www.nmihi.com/d/diverticular-disease.htm on November 9, 2018.

Diverticulosis and Diverticulitis. MedlinePlus. Accessed at https://medlineplus.gov/ on November 9, 2018.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Feldman M, ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia, Pa: W.B. Saunders; 1998.

Ferzoco LB, Raptopoulos V, Silen W. Acute diverticulitis. N Engl J Med. 1998;338(21):1521-1526.

Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85-109.

Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342(2):78-82.

Kohler L, Sauerland S, Neugebauer E. Diagnosis and treatment of diverticular disease: results of a consensus development conference. Surg Endosc. 1999;13(4):430-436.

Manousos O, Day NE, Tzonou A, et al. Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece. Gut. 1985;26(6):544-549.

Metronidazole. NMIHI. Accessed at http://www.nmihi.com/m/metronidazole.html on November 9, 2018.

Murray M. Encyclopedia of Nutritional Supplements. Rocklin, Calif: Prima Publishing; 1996:315.

Nair P, Mayberry JF. Vegetarianism, dietary fibre and gastro-intestinal disease. Dig Dis. 1994;12(3):177-185.

O'Keefe SJ. Nutrition and gastrointestinal disease. Scand J Gastroenterol Suppl. 1996;220:52-59.

Sabiston DC, Lyerly HK, eds. Textbook of Surgery. 15th ed. Philadelphia, Pa: W.B. Saunders; 1998.

What is diverticular disease? Cleveland Clinic. Accessed at https://my.clevelandclinic.org/ on November 9, 2018.