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Diverticulosis

Diverticula - diverticulosis; Diverticular disease - diverticulosis; G.I. bleed - diverticulosis; Gastrointestinal hemorrhage - diverticulosis; Gastrointestinal bleed - diverticulosis; Jejunal diverticulosis

Diverticulosis occurs when small, bulging sacs or pouches form on the inner wall of the intestine. These sacs are called diverticula. Most often, these pouches form in the large intestine (colon). They may also occur in the jejunum in the small intestine, although this is less common.

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Presentation

Colon diverticula - series

Causes

Diverticulosis is less common in people age 40 and younger. It's more common in older adults. About half of Americans over age 60 have this condition. Most people will have it by age 80.

No one knows exactly what causes these pouches to form.

For many years, it was thought that eating a low-fiber diet may play a role. Not eating enough fiber can cause constipation (hard stools). Straining to pass stools (feces) increases the pressure in the colon or intestines. This may cause the pouches to form at weak spots in the colon wall. However, whether a low-fiber diet leads to this problem is not well proven.

Other possible risk factors that are also not well proven are lack of exercise and obesity.

Eating nuts, popcorn, or corn does not appear to lead to inflammation of these pouches (diverticulitis).

Symptoms

Most people with diverticulosis have no symptoms.

When symptoms occur, they may include:

You may notice small amounts of blood in your stools or on toilet paper. Rarely, more severe bleeding may occur.

Exams and Tests

Diverticulosis is often found during an exam for another health problem. For example, it is often discovered during a colonoscopy.

If you do have symptoms, you may have one or more of the following tests:

A colonoscopy is needed to make the diagnosis:

Angiography:

Treatment

Because most people have no symptoms, most of the time, no treatment is needed.

Your health care provider may recommend getting more fiber in your diet. A high-fiber diet has many health benefits. Most people don't get enough fiber. To help prevent constipation, you should:

You should avoid NSAIDs such as aspirin, ibuprofen (Motrin), and naproxen (Aleve). These medicines can make bleeding more likely.

For bleeding that does not stop or recurs:

If bleeding does not stop or recurs many times, removal of a section of the colon may be needed.

Outlook (Prognosis)

Most people who have diverticulosis have no symptoms. Once these pouches have formed, you will have them for life.

Up to 25% of people with the condition will develop diverticulitis. This occurs when small pieces of stool become trapped in the pouches, causing infection or swelling.

Possible Complications

More serious problems that may develop include:

When to Contact a Medical Professional

Call your provider if symptoms of diverticulitis occur.

References

Bhuket TP, Stollman NH. Diverticular disease of the colon. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 121.

Goldblum JR. Large bowel. In: Goldblum JR, Lamps LW, McKenney JK, Myers JL, eds. Rosai and Ackerman's Surgical Pathology. 11th ed. Philadelphia, PA: Elsevier; 2018:chap 17.

Fransman RB, Harmon JW. The management of diverticulosis of the small bowel. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:143-145.

Winter D, Ryan E. Diverticular disease. In: Clark S, ed. Colorectal Surgery: A Companion to Specialist Surgical Practice. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 10.

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Review Date: 10/27/2021  

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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