Diverticulosis vs Diverticulitis

Diverticulosis vs Diverticulitis

Diverticulosis and Diverticulitis are collectively referred to as diverticular diseases. These are the digestive conditions that affect the large intestine, specifically the colon. While diverticulosis is usually asymptomatic, it can lead to diverticulitis, which can be more serious and cause various symptoms; therefore needs to be treated as well.

Age, gender, lifestyle, diet, genetics, and geography all play a role in the development of these conditions. Thus, this article intends to offer a thorough comparison of diverticulosis and diverticulitis, taking into account various factors such as their causes, symptoms, diagnosis, treatment, and prevention methods.

By gaining a better understanding of these conditions, individuals can take proactive measures to manage their health and seek necessary medical attention when required.

Diverticulosis vs Diverticulitis

How to Prevent or Treat Diverticular Disease

Terminology of Diverticulosis vs Diverticulitis

Diverticula (singular diverticulum), is a structural alteration that causes bulging of the gut in the form of pouches and pockets. These are formed as a result of herniation of the intestinal mucosa and submucosa through circular muscle layer defects in the weakened areas of the colon. Increased colonic pressure at the insertion points of the vasa recta can also contribute to the formation of diverticula. [1]

They can occur singularly or in multiple numbers. They typically range from 0.5 to 1 cm in size.[2] The presence of these diverticula leads to a condition known as “Diverticulosis”. They are most often found in the lower region of the large intestine, i.e., the colon.

On the other hand, Diverticulitis is a condition that arises due to the complication of diverticulosis. It is a disorder in which the diverticula in the colon wall undergo some inflammation or infection. [3] Usually, food and waste that become stuck in the diverticula and cause irritation and infection lead to this problem. It has various types depending upon the severity of complications.

Symptoms of Diverticulosis vs Diverticulitis

Diverticulosis is usually asymptomatic and painless. Therefore, most people with diverticulosis are usually unaware of their condition and are often discovered incidentally during a routine medical examination for another condition. [4] But in some cases, it shows symptoms such as bloating, pain in the lower left side of the abdomen, fever, bleeding from the rectum, nausea, vomiting, cramping, constipation, or diarrhea.[5]

On the other hand, Diverticulitis presents itself in several forms, each of which has its associated symptoms.

Symptomatic uncomplicated diverticular disease, also known as painful diverticular disease. It is marked by non-specific episodes of lower abdominal pain without visible signs of inflammation. [6] Pain is usually periodic but can be persistent. Abdominal pain, constipation, bloating, irregular bowel movements, and diarrhea are some symptoms. [7]

Recurrent symptomatic diverticular disease: It is characterized by the recurrence of previously described symptoms, typically several times per year. [6]

Complicated diverticular disease: It is a more severe form that typically affects 25% of people with diverticulitis, and is diagnosed when complications are present.[8] Abscess, intestinal wall perforation, phlegmon, stricture, fecal peritonitis or fistula purulent, and small bowel blockage because of post-inflammatory adhesions are the possible complications. [6] Additionally, 5%-15% of individuals experience diverticular hemorrhage, which can be severe in 3%–5% of cases. [9,10].

The Prevalence of Diverticular Disease

Diverticulosis prevalence rates range from 5 to 45% in Western and industrialized countries, based on age and method of diagnosis.[11] However, diverticulitis was once thought to occur in 15% to 25% of people with diverticulosis, but new research suggests that the actual risk may be less than 5%.[12] Complications result in significant morbidity and death. The 1-year fatality rate for perforation alone is 19%. [13]

In 2004, there were 313,000 hospitalizations, 1.9 million outpatient visits, and 3365 deaths in the United States because of diverticular disease. [14] According to estimates, the US spends 2.5 billion dollars a year on diverticular illness. [15]

Between 1998 and 2005, hospital admissions for diverticulitis in the United States increased by 26%, while elective procedures rose by 28%. [16] Diverticular disease affects a large number of patients, with an estimated 2,682,168 outpatient clinic appointments. It was the most common gastrointestinal-related hospitalization release code, with 219,133 discharges for diverticulitis and 64,222 for diverticulosis in 2009. [17] However, there is no recent data on its prevalence.

Factors Affecting Their Prevalence

The onset of diverticular disease can be affected by a number of variables, including age, dietary preferences, lifestyle, genetics, and hormonal changes. It is challenging to determine an individual’s risk of developing diverticulitis due to the complex interactions between these factors.


Evidence from the research indicated that up to 53% of an individual’s susceptibility to developing diverticulosis and diverticulitis may be due to genetic factors. [18] Additionally, scientific investigations have identified certain genes that may be involved in the development of diverticular disease. [19] However, further study is needed to understand how genetics causes these conditions.


The incidence of diverticulitis has been shown to increase with age. The prevalence of diverticular disease ranges from less than 10% in people under the age of 40 to an estimated 50% to 66% in people who are 80 years or later. In the sixth, seventh, and eighth decades of life, the age of onset has been observed more frequently.[20] However, recent medical literature shows a rise in diverticulosis in young patients. The most significant increase was observed in the 18-44 age range. The incidence is lower in individuals aged 45 to 64. Surprisingly, the group of people over 65 did not experience any major changes in incidence. [21]


Findings about which gender is more likely to get diverticulitis are not consistent. Men were found to have a higher risk of developing diverticular disease, according to previous studies. [22], [23] However, more recent research in the United States discovered that women were more likely to be hospitalized for diverticulitis-related conditions. Study design and population heterogeneity limit these works. [16], [24]

Race & Geography:

Diverticular disease is often called a 20th-century illness or a Westernized disease due to its rise in incidence in the last century and its geographic variation. The condition is extremely rare in Africa, especially sub-Saharan Africa and Asia, which is in sharp contrast to the numbers found in Europe and the United States. [25], [26] Studies from China and Korea have noted a prevalence of 0.5% to 1.7%; however, these individuals had a right-sided diverticular incidence of up to 75%, which is a different pattern from the western region. [27]

Diverticular disease was discovered to be more prevalent in White people (31% prevalence) than in sub-Saharan Black people (4% prevalence).[28] Also, greater access to diagnostic equipment and medical treatment in industrialized countries also leads to a higher rate of diagnosis and treatment.

Use of Certain Medication:

Certain medications, such as the regular use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), have been linked to an increased chance of developing diverticulosis and diverticular bleeding. [29] Also, the use of a proton pump inhibitor (PPI) may increase the risk of developing diverticulitis, although it does not affect the severity of the condition. [30]


The prevalence of diverticulitis is significantly impacted by one’s dietary habits. A diet low in fiber and high in processed foods, red meat, and high-fat dairy products increases the risk of developing diverticulitis. [31] On the other hand, a diet rich in fiber and low in these foods reduces the risk.

Also, patients with diverticular disease have been told to avoid nuts, grains, corn, and popcorn because undigested particles can lodge in the diverticulum and cause complications. Here is the list of foods to avoid with diverticulitis. However, the HPFS group did not find any association between them. Surprisingly, they actually found that consuming nuts and popcorn twice a week may lower the risk of developing diverticular disease by 20% and 27%. [32]

Similarly, longer colon transit time increases pressure on the colon, leading to the formation of diverticula, which can become inflamed and result in diverticulitis. A shorter transit time, regulated by a fiber-rich diet and hydration, reduces the risk of diverticulosis and diverticulitis. [33]


Obesity is a risk factor for diverticulitis. According to the WHO, the global obesity incidence exceeds 10% for both genders and has more than doubled in the last 40 years, with 1.3 billion overweight (BMI 25-30) people and 600 million obese (BMI > 30) people. [34] Several studies have shown that increased BMI, waist circumference, and weight gain are associated with an increased risk of diverticulitis. Adipose tissue secretes a number of pro-inflammatory cytokines, which may contribute to the development of diverticulitis. [35], [36], [37],


Smoking raises the chances of getting diverticulitis. According to a meta-analysis, there is a link between tobacco smoking and an increased risk of diverticular disease and its complications. [38], [39] Similarly, a case study found that people who smoke have a higher risk of having diverticulitis surgery. [40]

According to a study, it has been shown to increase the chance of pneumonia, post-operative wound infections, and complications. [41], [42]

Physical Activity:

A decreased level of physical activity has been linked to an increased risk of diverticular disease. A study of nearly 50,000 American men aged 40 to 75 found that regular running was associated with a significantly reduced risk of diverticulitis and diverticular bleeding. [43]

Additionally, a systematic review and meta-analysis of prospective studies also found that lower levels of physical activity were associated with a heightened risk of diverticular disease. [44]

Diagnosis of Diverticulosis and Diverticulitis

Diverticulosis rarely causes symptoms or requires therapy but If symptoms like abdominal pain, constipation, or diarrhea occur, a CT scan or colonoscopy may be needed to identify the cause and rule out other medical issues. Following are some of the commonly used diagnostic techniques:

Medical History:

Taking a person’s medical history is the foremost step in diagnosing diverticulosis and diverticulitis diseases. A history of previous episodes of diverticulitis, a family history of the condition, and personal health history, such as inflammatory bowel disease, can increase the likelihood of developing diverticulitis. Similarly, diverticula with colonic or other locations are common in patients with Ehlers-Danlos syndrome, [45] Williams syndrome,[46] Coffin-Lowry, [47] and polycystic renal disease. [48]

Physical examination:

Physical examination is an important part of diagnosing diverticulosis and diverticulitis. During a physical examination, a physician will check for abdominal pain, tenderness, and a mass in the lower left side of the abdomen, which may indicate diverticulitis. [49] A digital rectal check could also be part of the physical examination. [50]

Since the clinical diagnosis can be unreliable in 24% to 68% of cases, laboratory and radiological studies can be used to accurately diagnose acute diverticulitis. [51]

Stool test:

Stool tests check for the presence of blood or infection in the stool, which can be indicative of diverticulitis. The presence of blood in the stool can indicate that there is bleeding in the colon, [52] while the presence of infection can indicate that there is inflammation or an abscess present.

Blood tests:

Diverticulitis and diverticulosis are often diagnosed with blood tests. White blood cell counts above normal can suggest inflammation or infection. Inflammation and infection boost white blood cell production, which can indicate diverticulitis. [53]

Imaging tests:

Some of the commonly used imaging tests include:

Abdominal X-ray:

It uses radiation to create images of the abdomen. X-rays can sometimes show gut diverticula (diverticulosis), but they cannot always diagnose diverticulitis. [54]

CT scan:

Diverticulitis is better diagnosed by CT scan. CT scans use X-rays and computers to create precise body images. It has over 97% sensitivity and specificity. It can detect diverticulitis symptoms such as bowel wall thickening, inflammation around the colon, fluid accumulation, and tiny abscesses. It may also indicate fistulas. [55]

Barium enema:

A barium enema test uses a chalky liquid called barium to create X-ray images of the colon. The barium outlines the interior of the colon, facilitating the detection of any abnormalities. This test can show the presence of multiple diverticula in patients with painful diverticular disease but is not recommended in the acute stage of diverticulitis due to the risk of perforation. [56]


A colonoscopy can be used to diagnose both diverticulosis and diverticulitis. A colonoscopy is often performed after acute diverticulitis. This test helps check the inside of the colon and rule out cancer. A flexible tube with a camera and light is inserted into the rectum and moves through the colon. To avoid perforations, it’s usually done 6 weeks after the patient has fully healed. [57]

Need for Treatment

Diverticulitis typically requires treatment because it involves inflammation or infection in the diverticula. In contrast, diverticulosis does not typically require treatment.


Antibiotics can cure acute diverticulitis and prevent complications like abscesses and perforation, according to research. Metronidazole, ciprofloxacin, and amoxicillin-clavulanate are used for this. [58] However, Rifaximin is considered to be a suitable and effective treatment for uncomplicated diverticular disease, especially when combined with dietary fiber supplementation. [59]

Diet modification:

Dietary changes may help prevent or treat diverticulitis.[60] You can also follow a diverticulitis diet plan (consult your physician first). Here are some suggestions [61]

  • Eat more fiber-rich foods, including whole grains, vegetables, fruits, and legumes
  • Limit processed, high-fat, and high-sugar meals.
  • Keep hydrated to facilitate the movement of fiber through the digestive tract.
  • Refrain from drinking too much alcohol.
  • Eat smaller, more frequent meals instead of large, heavy meals.
  • Gradually increase fiber intake to prevent bloating, cramping, and gas.
  • Consume the soups you can eat with diverticulitis


Probiotics have been shown in studies to help reduce inflammation and improve symptoms linked with diverticulitis. [62] Probiotics may also aid in the restoration of normal intestinal flora, which may have been changed in diverticular disease as a result of stasis and decreased colonic transit time. [63] For instance,

  • Consuming lactobacilli decreases symptoms of uncomplicated diverticular disease, such as bloating and abdominal pain. [64]
  • Lactobacillus salivarius, Lactobacillus acidophilus, and Bifidobacterium lactis have been found to be effective in treating acute diverticulitis. [65]

See Also: Probiotics vs Prebiotics

Lifestyle changes:

Changes in lifestyle, such as maintaining a healthy weight through exercise and a balanced diet, staying hydrated, ceasing smoking, managing stress [66] through relaxation and exercise, and adhering to a regular sleep schedule, can aid in diverticulitis prevention, symptom management, and the prevention of chronic conditions.


Surgery is usually recommended for severe or life-threatening cases of diverticulitis when antibiotics and dietary changes don’t work or when the patient develops complications like a hole or abscess in the intestine, a stricture (narrowing of the intestine), or peritonitis (inflammation of the lining of the abdomen). In some cases, recurrent diverticulitis may also require surgery. [66]

Sigmoid resection is the most common surgery for all types of diverticular disease (sigmoidectomy) It involves removing the sigmoid colon and a small part of the rectum. The sigmoid colon is where most diverticula occur and the surgery aims to remove the affected area. The ends of the intestine are then sewn back together. [67] Similarly, research comparing sigmoid resection with conservative therapy discovered that sigmoid resection is superior to conservative treatment in enhancing quality of life in patients with recurrent, complicated, or persistent painful diverticulitis. [68]

Remember that diverticulitis surgery is not always required and will depend on the severity of the condition, the risks and benefits of surgery, and the patient’s overall health.


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