What Are Diverticula?
Diverticula are small sac-like protrusions of the mucosa that develop through the muscular wall of the colon. They represent a degenerative change of the intestinal wall, usually associated with increased intraluminal pressure and chronic constipation.
This condition mainly affects individuals over 50 years old, and diverticula are most commonly found in the sigmoid colon.
How Diverticula Form
The formation of diverticula is related to a disruption in bowel motility and low dietary fiber intake.
When stool is hard and remains longer in the colon, the increased pressure during bowel movement causes a herniation of the mucosa through weak points of the muscular wall.
This leads to the development of small “pockets” (diverticula), which usually do not cause symptoms.
When Diverticulitis Occurs
Diverticulitis is the inflammation or infection of one or more diverticula.
It may present suddenly with pain in the lower left abdomen, fever, constipation or diarrhea, and general malaise.
In severe cases, abscesses, perforation, or peritonitis can develop, requiring immediate medical treatment.
Diagnosis of Diverticulitis
Diagnosis is based on a combination of clinical examination, laboratory tests (leukocytosis, CRP), and imaging studies.
Abdominal CT scan is the diagnostic test of choice, providing accurate localization of inflammation and assessment of potential complications.
Colonoscopy is not performed during an acute inflammatory episode, but at a later stage (after 6–8 weeks) to confirm the diagnosis and exclude colorectal malignancy.
Treatment of Diverticulitis
Treatment depends on the severity of symptoms:
- Mild cases: managed conservatively with antibiotics, hydration, and clear fluids for a few days.
- Moderate to severe diverticulitis: requires hospitalization, intravenous antibiotics, and monitoring.
- Complications (e.g., perforation, fistulas, abscesses, or recurrent episodes): may require surgical treatment.
Recurrent diverticulitis can lead to strictures or permanent damage of the colonic wall, in which case surgical resection of the affected segment is a definitive solution.
Diet and Prevention of Diverticula
Proper nutrition is essential for both the prevention and management of the condition:
Dietary fiber: increases stool bulk, reduces intraluminal pressure, and prevents constipation. Good sources include fruits, vegetables, oats, and whole grains.
Adequate hydration: at least 1.5–2 liters of water daily.
Physical activity: supports normal bowel motility.
Recent studies show that polyphenols (antioxidants found in fruits and vegetables) have anti-inflammatory effects, supporting mucosal integrity and a healthy gut microbiome.
Key Points to Remember
The presence of diverticula does not necessarily indicate disease.
However, regular follow-up with a gastroenterologist, proper nutrition, and preventing constipation are crucial to avoid complications.
In any case of abdominal pain or fever, timely evaluation by a specialist is essential for safe and effective management.
Frequently Asked Questions (FAQ)
- How often do I need a colonoscopy if I have diverticula?
Colonoscopy is recommended after full recovery from an episode of diverticulitis and then every 5–10 years, depending on findings and family history. - Can I eat seeds or nuts?
It was previously believed that seeds and nuts could trigger diverticulitis, but today there is no evidence supporting this theory.
However, during acute inflammation or a recent episode, temporary avoidance is recommended. - How can I prevent new episodes of diverticulitis?
Follow a high-fiber diet, reduce red meat, avoid constipation, and maintain physical activity.
Prevention is based on bowel motility and dietary balance. - When should I see a gastroenterologist?
If you experience persistent abdominal pain, fever, blood in the stool, or changes in bowel habits, immediate medical evaluation is required.
Early diagnosis reduces complications and allows for targeted treatment.
Dr. Theodoros Argyropoulos
Specialized in endoscopic diagnosis and treatment of digestive diseases.
Provides comprehensive care for colon disorders, including diverticulosis, diverticulitis, and inflammatory bowel diseases.
