About Diverticular Disease

By the age of 85, about 66% of the population will have some diverticula.

A diverticulum (plural: diverticula) is a pouch or pocket that forms where there is weakness in the wall of the digestive tract.  What do  pockets do?  They collect stuff.  When it comes to intestinal pockets, the “stuff” can cause all kinds of trouble.

The term, diverticular disease, covers two states: diverticulosis, in which the wall of the intestine has developed pockets, and diverticulitis, in which the “stuff” in the pockets has caused perforation, inflammation and/or infection.  The development of diverticula is a common change in the integrity of the large intestine.

The presence of diverticula is an uncommon finding in people under the age of 40.  It is usually found in the lowest portion of the colon, called the sigmoid colon, although people of Chinese, Hawaiian or Japanese ethnicity may have it in higher regions.  It is rarely found in people of African ancestry.

The main cause of diverticula is thought to be recurrent spasms in the muscular layer of the colon, resulting in anatomical and physiological changes that lead to the development of “pockets”.

Interestingly, despite variable incidence by race and ethnicity, genetics is not considered to be an important risk factor in most cases.  More significant risk factors include:

  • a low-fiber diet
  • obesity
  • a sedentary lifestyle
  • medications and other substances like corticosteroids, nonsteroidal anti-inflammatory drugs, alcohol, and caffeine
  • smoking
  • and polycystic kidney disease.

Basically, anything that contributes to constipation increases your risk of developing diverticula at a younger age.

What It Feels Like

Diverticula are asymptomatic in up to 70% of cases; in other words, most people with diverticula would not be aware that they have them.

If the diverticula become inflamed, there can be sharp, cramp-like pain, usually in the lower left quadrant of the abdomen, accompanied by gas with constipation and/or diarrhea.  If infection is present, there may be fever, nausea and vomiting, and rectal bleeding.

If you have symptoms of either diverticulosis or diverticulitis, you should be assessed by a doctor because both conditions can lead to serious complications.


Testing for uncomplicated diverticulosis is not necessary; the diagnosis is made on the basis of the medical history and physical exam.

With diverticulitis, the medical history and physical exam may be supported by:
blood work, urinalysis, x-rays, CT scans and/or endoscopy.

Treatment Options

In uncomplicated diverticulosis, the objective is to prevent the development of deverticulitis.  This is accomplished through dietary and lifestyle changes, weight management, and medications to control muscle spasms and pain.

Diverticulitis can have severe complications such as bowel perforation and sepsis.
Treatment depends on the degree of complication but will generally include bed rest, dietary changes, pain control, and antibiotics.  Surgery may be recommended.

As with other cases of digestive system problems, the goals are to promote tissue healing and the restoration of normal function to the digestive tract.  Any modifiable risk factors that exist will be addressed.

When it comes to the dietary implications, it’s important to consider what other factors may be contributing to bowel spasms, such as concurrent Irritable Bowel Disorder or food sensitivities and to do deal with these as well.

I like to teach people how to use a progressive diet that allows them to control the level of residue and bulk according to their symptoms.  For example, when someone is experiencing a flare-up, they follow a low residue, low fiber diet until the inflammation is resolved.  From there, they progress in a step-wise manner to dietary levels that are more challenging and much higher in fiber.


Many people will pass through their lives never knowing that they had diverticula.  But for those who are symptomatic, dietary and lifestyle modifications are a must.  The changes may require a bit of effort, but they yield huge results for digestive well-being and the prevention of serious disease.