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Diverticulosis

Diverticulosis is a common condition, affecting almost half of Americans by age 50 and most by age 80.  Fortunately the majority of people never experience any symptoms.  Diverticuli are pouches on the colon that consist of the inner lining that has been pushed out through layers of muscle in the wall of the colon.  The cause is not precisely known, but there is an association with a low fiber diet.   Complications of diverticulosis generally are manifested by either diverticular bleeding or diverticulitis, which is inflammation/infection of one or more of the pouches.  There is no risk of cancer from diverticular disease.

Diverticular bleeding is one of the most common causes of lower GI hemorrhage.  It generally occurs in older adults.  It can be severe, but is self-limiting in most cases.  While hospitalization and at times transfusion are required, it is rare to need surgery for this.  Removal of the colon is reserved for patients in whom there is ongoing or recurrent bleeding.

Diverticulitis occurs when there is inflammation and/or infection of the diverticuli.  It is unknown at this point why some patients develop this while others do not.  It affects about 1 in 20 patients with diverticular disease.  It was previously thought that consuming foods such as popcorn, seeds, and nuts may cause attacks of diverticulitis but many studies have been done that show this not to be the case.  In fact, some of these foods are good fiber sources and may be helpful in preventing diverticulitis.

Most episodes of diverticulitis can be treated as an outpatient with diet changes and antibiotics.   Patients who are unable to tolerate oral intake or have signs of more serious infection require hospitalization.  Surgery is not necessary if symptoms resolve with these measures.

A minority of patients present with a perforation or rupture of the colon due to diverticulitis.  These patients require emergency surgery, which consists of removal of the affected part of the colon and sometimes a temporary colostomy.  There may be a second surgery required to close the colostomy.  Almost always this occurs as a first episode of diverticulitis.  It is rare for people who have had prior episodes of diverticulitis to require emergency surgery.

Indications for surgery for diverticulitis other than perforation include an inability to resolve an episode despite adequate treatment, a stricture or narrowing of the colon due to scarring, or a fistula or abnormal connection to another organ such as the bladder or vagina.  The decision to have surgery for uncomplicated repeated attacks is an individual one.   When surgery is required for these reasons it can usually be performed as a one-stage procedure with no need for a colostomy.

In summary, diverticulosis is a common benign condition affecting most Americans by age 80.   A small percentage of people develop complications from this.  Most can be treated with supportive measures, but some will require surgery to achieve resolution of their symptoms.  A high fiber diet may help prevent attacks of diverticulitis.