Colonic Diverticula – Causes, Symptoms & Treatment
Colonic diverticula are small pouches that form in the wall of the large intestine. They are very common and usually cause no symptoms, but can become inflamed.
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Colonic diverticula are small pouches that form in the wall of the large intestine. They are very common and usually cause no symptoms, but can become inflamed.
What Are Colonic Diverticula?
Colonic diverticula are small, sac-like pouches that form when the inner lining of the colon (large intestine) pushes through weak spots in the muscular wall. These weak spots typically occur where blood vessels pass through the intestinal wall. The most common location is the sigmoid colon, the S-shaped segment just before the rectum. When multiple pouches are present, the condition is called diverticulosis. If one or more of these pouches become inflamed or infected, the condition is known as diverticulitis.
Causes and Risk Factors
The development of colonic diverticula is influenced by several factors:
- Low-fiber diet: Insufficient dietary fiber leads to hard stools and increased pressure inside the colon, pushing the lining through weak points in the wall.
- Age: The condition becomes increasingly common with age, particularly in people over 70 years old.
- Physical inactivity: A sedentary lifestyle slows bowel transit and increases intraluminal pressure.
- Obesity: Excess body weight is an independent risk factor.
- Genetic predisposition: A family history of diverticular disease increases the risk.
Symptoms
Approximately 80% of people with diverticula experience no symptoms at all, and the condition is often discovered incidentally during a colonoscopy. Symptoms may occur with symptomatic diverticulosis or diverticulitis and include:
- Cramping abdominal pain, typically in the lower left abdomen
- Alternating constipation and diarrhea
- Bloating and a feeling of fullness
- Fever, nausea, and persistent tenderness in cases of diverticulitis
- In severe cases: rectal bleeding (diverticular bleeding)
Diagnosis
Colonic diverticula are diagnosed using the following methods:
- Colonoscopy: The gold standard for direct visualization of the diverticula and exclusion of other conditions such as colorectal cancer.
- CT scan of the abdomen: Particularly useful in suspected diverticulitis and for detecting complications such as abscess or perforation.
- Ultrasound: A supplementary tool, especially in the acute assessment of diverticulitis.
- Blood tests: Inflammatory markers such as CRP and white blood cell count help confirm active inflammation.
Treatment
Uncomplicated Diverticulosis
Asymptomatic diverticula do not require specific treatment. Preventive measures include a high-fiber diet (vegetables, legumes, whole grains), adequate fluid intake, and regular physical activity to reduce the risk of diverticulitis.
Uncomplicated Diverticulitis
Mild inflammation can often be managed on an outpatient basis. Treatment includes:
- Temporary liquid or low-residue diet
- Antibiotics (e.g., amoxicillin/clavulanate or ciprofloxacin plus metronidazole)
- Pain relief (e.g., paracetamol or metamizole)
Complicated Diverticulitis
When complications arise -- such as abscess formation, perforation, fistula, or bowel obstruction -- hospitalization is required. In severe cases, surgery may be necessary to remove the affected segment of the colon, a procedure known as sigmoid resection.
Prevention
Maintaining a high-fiber diet, staying physically active, achieving a healthy body weight, and avoiding smoking can significantly reduce the risk of developing diverticula and diverticulitis.
References
- Leifeld L. et al. - S2k Guidelines on Diverticular Disease/Diverticulitis, AWMF Registration No. 021-020, German Society of Gastroenterology (DGVS), 2022.
- Feuerstein J. D., Falchuk K. R. - Diverticulosis and Diverticulitis. Mayo Clinic Proceedings, 2016; 91(8): 1094-1104.
- World Gastroenterology Organisation (WGO) - Global Guidelines: Diverticular Disease, 2022. Available at: www.worldgastroenterology.org
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