Diverticula occur throughout the gut, but the majority are in the colon.
What are diverticula?
A gut diverticulum (singular) is an outpouching of the wall of the gut to form a sac or pouch. Diverticula (plural) may occur at any level from the esophagus to the colon. There are different ways to classify a diverticulum as either being a true diverticulum or a false diverticulum. A true diverticulum includes all three layers of the gut; the lining mucosa, the muscle, and the outer serosa (see Figure 1 above). False diverticula are missing the muscle layer and are therefore very thin-walled.
Colonic diverticula are typically false diverticula. The condition of having a diverticulum or diverticula is called “diverticulosis.” Inflammation of a diverticulum and the surrounding tissue is called “diverticulitis.”
How common are colonic diverticula?
In the United States, over half the population will have at least one diverticulum, and usually more, by the age of 60. Although diverticulosis has traditionally been thought of as a condition found in older individuals, it is increasing in younger individuals as well.
Diverticulosis is the most common finding on a routine colonoscopy. A colonoscopy is a simple test that does not involve cutting into the body. A healthcare provider uses a long flexible tube called an endoscope. This tube has a camera and light on the end. This tool allows your provider to see inside your GI tract to examine the lower portion of the GI tract. This flexible tube is inserted through the anus, into the rectum and colon.
Diagnosis of diverticulosis is most common in Europe and Australia and less so in Africa and Asia. It is believed that these changes may be related to differences in diet, lifestyle, and detection technologies.
What causes it?
The formation of diverticula is not completely understood. It is thought to be related to relatively high
pressure caused by stool pushing against the colon wall and weakening it, causing outpouching. Though most diverticula occur in the left colon, they can also occur elsewhere. They are typically not seen in the rectum. The muscle layer along the site of left colon diverticula is commonly thickened, lending credibility to the notion of high pressure within the colon. The result may be rows of bulges along the colon at the sites of the penetrating arteries. Arteries are blood vessels that distribute oxygen-rich blood to your entire body. People with connective tissue disorders may be more likely to have diverticulosis.
Do they cause symptoms?
Most individuals who possess colonic diverticula are unaware of them. Diverticulosis is often an “incidental” finding (seen on a CT scan or colonoscopy that was done for reasons other than looking for diverticulosis specifically).
There is controversy about whether diverticula can cause symptoms by themselves, without overt inflammation present. Some healthcare providers would treat symptoms of abdominal pain, bloating, and changes in bowel movements (diarrhea or constipation) as diverticular disease, while other healthcare providers would treat these symptoms as irritable bowel syndrome (IBS). Diverticulosis and IBS are very common, so you can have both at the same time, although one may not cause the other. It is important to give your healthcare provider a description of how frequently you get belly pain, what it feels like, what triggers it, and if other factors are present, like fever, vomiting, or diarrhea.
Risk Factors for Developing Diverticulitis
Diverticulitis – diverticulum can become inflamed and burst, causing inflammation and pain in that location, as well as fever, decreased appetite, and often changes in bowel movements (BMs). Risk factors for diverticulitis include conditions related to a chronic inflammatory state, like cardiovascular disease, diabetes, and obesity. A chronic inflammatory state is when the body has longterm inflammation lasting several months to years.
In addition, lifestyle habits like physical inactivity, cigarette smoking, and chronic use of medications like nonsteroidal anti-inflammatories (like ibuprofen), steroids, and opiates are associated with a higher risk of diverticulitis. It has not been proven that nuts and seeds cause diverticulitis and research suggest that those who avoid nuts and seeds may be more likely to have diverticulitis, perhaps because avoiding nuts and seeds leads to lower fiber intake.
What can you do?
Diverticula does not shrink over time, and you cannot get rid of them. However, most people will never have problems from diverticulosis.
Studies show that a high-fiber diet is associated with less diverticulitis. Maintaining a healthy lifestyle with plenty of fruits, vegetables, and protein, avoiding tobacco and cigarette smoking, and moderate exercise are excellent for your overall health and may also reduce your risk of diverticulitis. In a large national analysis of men, those who exercised regularly were less likely to have diverticulosis or episodes of diverticulitis or diverticular bleeding.
Talk to your healthcare provider if you have been told you have diverticulosis. It is useful to know if diverticula are present. The information may help your provider in the event of an attack of pain or bleeding that could result from these otherwise innocent little colonic outpouchings. If you have been diagnosed with diverticulitis, talk with your healthcare provider about whether you should have a follow-up colonoscopy. This is especially important if you have had complicated diverticulitis.
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Adapted from “Diverticula, Diverticulosis, Diverticulitis: What’s the Difference?” By: Joy Liu, MD, Northwestern University- Feinberg School of Medicine, Chicago, IL. Adapted from article by W. Grant Thompson, M.D., F.R.C.P.C., F.A.C.G., Professor Emeritus, Faculty of Medicine, University of Ottawa, Ontario, Canada.
