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Allen KamravaMD · MBA · FACS · FASCRS

Colon and Rectum

Diverticulosis

Diverticulosis is a common condition where small pouches, or diverticula, form in the wall of the colon, and is often asymptomatic.

Reviewed by Allen Kamrava, MD, MBA, FACS, FASCRS · Last reviewed 2025-10-12

Overview

What is diverticulosis?

Diverticulosis is a condition in which small, bulging pouches (diverticula) develop in the digestive tract, most commonly in the lower part of the large intestine (the sigmoid colon). These pouches form when weak spots in the colon wall give way under pressure, causing small sacs to protrude outward. Diverticulosis is very common, especially in older adults—it's found in over 50% of people over the age of 60. Most people with diverticulosis have no symptoms and may never know they have the condition. When symptoms do occur, the condition is referred to as symptomatic uncomplicated diverticular disease (SUDD).

Symptoms

What are the symptoms of diverticulosis?

Most people with diverticulosis have no symptoms. When symptoms do occur, they can be vague and may include:

  • Mild abdominal cramps or pain, usually in the left lower quadrant.
  • Bloating.
  • Constipation or other changes in bowel habits.

In a small percentage of people, diverticulosis can lead to more serious complications:

  • Diverticulitis: This occurs when one or more of the pouches become inflamed or infected.
  • Diverticular bleeding: This happens when a small blood vessel within a diverticulum ruptures, leading to a sudden, painless passage of a significant amount of maroon or bright red blood from the rectum.

Causes & risk factors

What causes diverticulosis?

The exact cause of diverticulosis is not fully understood, but it is widely believed to be related to a low-fiber diet. A diet low in fiber can lead to constipation and hard stools, which increases the pressure inside the colon when the muscles strain to move the stool along. This high pressure is thought to cause the weak spots in the colon wall to bulge out and form diverticula.

Other risk factors include:

  • Age: The prevalence of diverticulosis increases with age.
  • Genetics: There appears to be a hereditary component to the disease.
  • Lifestyle factors: Lack of physical activity, obesity, and smoking are also associated with an increased risk.

When to see a doctor

When should I see a doctor?

Since diverticulosis is often asymptomatic, it is frequently discovered during a routine colonoscopy for colorectal cancer screening. If you are experiencing symptoms like persistent abdominal pain, bloating, or changes in your bowel habits, you should see a doctor to get an accurate diagnosis. It is important to seek immediate medical care if you develop symptoms of a complication, such as severe abdominal pain and fever (which could be diverticulitis) or the passage of a large amount of blood from your rectum.

Diagnosis & tests

How is diverticulosis diagnosed?

Diverticulosis is most commonly diagnosed during a colonoscopy. The endoscopist can directly visualize the openings of the diverticula in the colon wall. It can also be diagnosed with imaging studies like a CT scan of the abdomen or a barium enema.

Treatment

How is diverticulosis treated?

For asymptomatic diverticulosis, no treatment is needed. The main recommendation is to adopt a high-fiber diet to help keep stools soft and prevent the formation of more diverticula or the development of complications.

  • High-Fiber Diet: Aim for 20-35 grams of fiber per day. This can be achieved by eating more fruits, vegetables, whole grains, beans, and legumes. A fiber supplement, such as psyllium or methylcellulose, can also be helpful.
  • Adequate Hydration: Drink plenty of fluids, especially water, to help the fiber work effectively.
  • Exercise: Regular physical activity can help promote normal bowel function.

For symptomatic uncomplicated diverticular disease (SUDD), the same lifestyle modifications are recommended. In some cases, medications to control colon muscle spasms may be prescribed.

Frequently asked questions

Do I need to avoid nuts, seeds, and popcorn if I have diverticulosis?
No. For many years, it was thought that these foods could get trapped in the diverticula and cause inflammation (diverticulitis). However, large-scale studies have shown this is not true. In fact, a diet rich in these foods may even be protective. There is no need to avoid nuts, seeds, or popcorn.

Can diverticulosis turn into cancer?
No, diverticulosis is a benign condition and does not turn into cancer. However, the symptoms of diverticular disease can sometimes mimic those of colorectal cancer, so it is important to have a full colonic evaluation to rule out cancer.

If I have diverticulosis, will I get diverticulitis?
Not necessarily. The majority of people with diverticulosis will never develop diverticulitis. It is estimated that only about 4-5% of people with diverticulosis will go on to have an episode of diverticulitis in their lifetime.

References

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