Mucosal herniation through muscle coat, most commonly in the sigmoid colon

Aetiology

• The main risk factors are age over 50 years and low dietary fibre

Pathophysiology

• In the presence of a lack of fibre, the muscles of the colon must work harder to move faeces along
• This causes very high pressures in the colon, and as a result some parts of the mucosa will form out-pouchings

Clinical features

• Approximately 75% of people with diverticula have asymptomatic diverticulosis
• When cause symptoms - left iliac fossa pain/tenderness, altered bowel habit
• Of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis (diverticular inflammation - see notes)

Investigations

• Barium enema
• Sigmoidoscopy: if inconclusive

Management

Asymptomatic

• Recommend high fibre diet and high fluid intake

Symptomatic

• Analgesics
• Laxatives if necessary (avoid stimulant laxatives)