Diverticular Disease
Small pouches that form in the wall of the colon — very common with age. Often silent (diverticulosis), sometimes inflamed (diverticulitis), occasionally bleed. Diet and water are the main protections.
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Diverticula are small pouches that form when the colon wall pushes outward at weak spots. Diverticulosis = pouches with no symptoms (very common with age). Diverticulitis = inflamed or infected pouches causing pain and fever. Diverticular bleeding = pouches that erode a small artery and bleed.
How common is it?
Found in 30% of adults over 60 and 60% over 80. Most common in the sigmoid colon. Saudi rates are rising as the diet becomes more Western (lower fiber, higher fat).
Why does it happen?
Long-standing low-fiber diet leads to small, hard stools that require pressure to move — pressure that pushes the colon wall outward at weak spots. Aging weakens the colon wall. Low physical activity, obesity, smoking, and NSAIDs increase risk of complications.
Symptoms
- DIVERTICULOSIS: usually no symptoms; sometimes mild bloating or change in bowel habits.
- DIVERTICULITIS: persistent pain in the LEFT lower abdomen, fever, change in bowel habits, sometimes nausea.
- DIVERTICULAR BLEEDING: sudden painless bleeding — large amounts of dark or bright red blood from the rectum.
Red flags — seek urgent medical care
Severe abdominal pain with high fever
Possible perforation or abscess — emergency.
Heavy rectal bleeding
ED for transfusion and assessment.
Cannot pass stool or gas with abdominal swelling
Possible obstruction.
Stool or air in the urine
Could be colovesical fistula — investigate urgently.
How is it diagnosed?
CT scan is the best test for suspected diverticulitis (showing inflammation, abscess, perforation). Colonoscopy is done 6 weeks AFTER an episode of diverticulitis to rule out cancer. For asymptomatic diverticulosis: usually found incidentally on colonoscopy.
Outlook — what to expect
Most diverticulosis stays silent forever. About 10-25% develop diverticulitis. Most diverticulitis episodes resolve with antibiotics and bowel rest. About 10% of diverticulitis cases need surgery (for abscess, perforation, fistula, or recurrent attacks). Bleeding usually stops spontaneously.
Treatment
Habits & Lifestyle
Lifestyle prevents complications.
- High-fiber diet daily — 25-30 g.
- 1.5-2 liters of water daily.
- Regular physical activity.
- Stop smoking.
- Avoid NSAIDs if possible — increase risk of bleeding and perforation.
- Maintain healthy weight.
Diet
Old advice to avoid nuts and seeds is OUTDATED — they are SAFE.
- Eat plenty of fruits, vegetables, whole grains, legumes — 25-30 g fiber daily.
- Nuts, seeds, popcorn are SAFE — eat them.
- Add psyllium if natural fiber isn't enough.
- During acute diverticulitis: clear liquids for 2-3 days, then low-residue, then back to high-fiber as you recover.
Medications
Antibiotics for some — but not all — diverticulitis episodes.
- Mild uncomplicated diverticulitis: many can be managed WITHOUT antibiotics, just rest and pain control.
- Moderate-to-severe diverticulitis: antibiotics covering Gram-negative and anaerobic organisms (e.g. ciprofloxacin + metronidazole, or amoxicillin-clavulanate) for 7-10 days.
- Severe cases or complications: IV antibiotics in hospital.
- 5-ASA and rifaximin have been tried for prevention of recurrence — modest benefit at best.
Procedures & Surgery
Procedures handle complications.
- Percutaneous abscess drainage (CT-guided) for diverticular abscess.
- Surgery (sigmoid colectomy) for: perforation, large abscess not amenable to drainage, fistula, recurrent attacks, complicated diverticulitis.
- Colonoscopy 6 weeks after diverticulitis episode to rule out cancer.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Should I follow up with a colonoscopy after this diverticulitis episode?
- Can I really eat nuts and seeds?
- What is my risk of recurrence?
- When would I need surgery?
Medically reviewed by: SGA Patient Education Panel · Last reviewed 24/04/2026