Diverticulosis

Diverticulosis is a condition characterized by the presence of diverticula in the colon, most often the sigmoid colon. The majority are asymptomatic. It is common in older adults and is more prevalent in Western countries. It is frequently found incidentally during colonoscopy, imaging, or surgery.

Diverticula are sac-like protrusions formed when mucosa and submucosa herniate through weak spots in the muscular wall where blood vessels penetrate. They arise from increased intraluminal pressure and changes in colonic wall structure. Risk factors include age, low-fiber diet, obesity, physical inactivity, and smoking. Genetic factors may contribute.

Most people have no symptoms. When present, symptoms include intermittent lower abdominal discomfort or bloating, changes in bowel habits, and sometimes minor rectal bleeding in rare cases. It is important to distinguish diverticulosis from diverticulitis, which involves inflammation and typically presents with persistent fever, higher pain, and leukocytosis.

Diagnosis is often made during routine colonoscopy or imaging performed for other reasons. Barium studies or CT may reveal diverticular disease. Acute diverticulitis is diagnosed clinically and with CT, and colonoscopy is usually deferred during an acute episode.

For asymptomatic diverticulosis, no specific treatment is required beyond routine medical care. A diet higher in dietary fiber is commonly advised to reduce symptoms and stabilize bowel movements, though evidence varies. Uncomplicated diverticulosis generally does not require antibiotics. Management focuses on symptom relief and prevention of complications.

Possible complications include diverticular bleeding and diverticulitis. Preventive measures include maintaining a high-fiber diet, hydration, weight control, regular exercise, and avoidance of unnecessary NSAID use.