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
Abdominal pain, especially pain low on the left side of the abdomen
after a meal
Either painless rectal bleeding or passing of blood in stool may
Irregular bowel movements including constipation or
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
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
Male gender, for diverticulitis
The following may contribute as well:
High fat intake
Lack of regular physical
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.
To help prevent diverticular disease:
Eat a high-fiber diet (15 g of fiber per day). This helps stools move
through the intestines and helps maintain proper pressure in the
If you have diverticula, avoid foods such as seeds that may block the
opening of a diverticulum and lead to inflammation.
Exercise regularly to decrease the occurrence of
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.
A healthcare provider may prescribe antibiotics to fight infection,
anticholinergics to relieve cramping, and analgesics to relieve
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
Colonoscopy with electrocoagulation. Electrocoagulation involves
applying electric current to an area to stop bleeding. This may be necessary if
problems with the structure of any arteries or veins contribute to the
Sigmoidectomy, or removal of the sigmoid colon. Unless there are
complications, a surgeon can perform this operation laparoscopically (through
small incisions, using an endoscope).
Hartman's procedure. In an emergency, this procedure may be used to
detach the sigmoid colon from the rectum, close the rectum, and reconnect the
sigmoid colon directly to an opening created on the surface of the body. This
procedure reduces the risk of sepsis (infection of the blood) and death. The
procedure is reversed in a second operation within six months.
Angiography. This procedure may be used to inject medication directly
into the arteries to control bleeding.
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
Population based studies suggest that eating a high-fiber diet helps
prevent diverticular disease and other gastrointestinal disorders. A review of
such studies reports that vegetarians are less likely to have diverticular
disease, most likely because they tend to eat more fiber.
In another study where participants completed interviews and food
questionnaires, the following foods were associated with a decreased likelihood
of having diverticular disease: cucumber, lettuce, spinach, and brown bread.
Beef and lamb were associated with an increased risk of having diverticular
disease. The authors concluded that eating more fiber and eating less red meat
(particularly beef and lamb) and fewer milk products may help reduce
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
Psyllium seed (Plantago
ovata)—recommended by the World Health Organization
to relieve constipation related to diverticulitis.
(Linumusitatissimum)—may be helpful in
treating diverticulosis. It works as a bulk-forming laxative, softening stool
and speeding transit time through the intestine. It also includes high levels of
essential fatty acids.
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
Belladonna—used for abdominal pain and
cramping that comes on suddenly and feels better with firm pressure;
particularly helpful if constipation accompanies the pain
Bryonia—used for abdominal pain that
worsens with movement and is relieved by heat; particularly useful if vomiting
and/or constipation with dry, hard stools accompanies the pain
Colocynthis—used for sharp, cramping
abdominal pains that improve with pressure; particularly useful if pain is
accompanied by restlessness and
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
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:
An abscess (pocket of pus)
A perforation (hole) in the intestine leading to peritonitis, sepsis,
and even shock
Fistulas, which may also lead to sepsis
Those who have experienced bleeding once are at high risk for developing
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.
Ambrosetti P, Robert JH, Witzig JA, et al. Acute left colonic diverticulitis:
a prospective analysis of 226 consecutive cases. Surgery.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded
Commission E Monographs. Newton, Mass: Integrative Medicine Communications;
Reviewed By: Participants in the review process include: Robert A. Anderson, MD, President
, American Board of Holistic Medicine, East Wenatchee, WA; Constance Grauds,
RPh, President, Association of Natural Medicine Pharmacists, San Rafael, CA;
Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley
Hospital, Harvard University and Senior Medical Editor Integrative Medicine,
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