Acquired herniations of mucosa and submucosa through the colonic wall

Affects 5-15% of persons over the age of 45 and 65-80% of persons over the age of 80

May be a consequence of a low-fiber diet » decreased stool volume » colonic mucosa contracting against small, hard stools » greater intraluminal pressure » each diverticula is a result of herniation of mucosa through a point of weakness at the muscular colonic wall

More common on Left side than on right side of colon (descending and sigmoid)

Western diets high in refined carbohydrates and low in dietary fiber may be a contributor

Western style toilets result in increased intraluminal pressures, compared to knee-chest position (3rd world countries)

Usually asymptomatic

If symptoms such as abdominal pain and altered bowel habits, consider IBS (avoid the term “painful diverticulosis”)

Sigmoidoscopy/Colonoscopy

Barium enema: demonstrate diverticula, but not inflammation

High fiber diet and antispasmotics are unproven, but commonly prescribed and probably the best treatment to date

Little evidence supports the advice of refraining from certain foods such as seeds and nuts (actually eliminates many high fiber foods)

Majority remain asymptomatic; complications of diverticular bleeding: 3-5%; See also GI Bleed-Diverticular Bleeding (Chapter 6.02)

Inflammation of diverticula