Diverticulosis vs. Diverticulitis: What Are the Differences?

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As people get older, the wall of the colon (large intestine) might weaken in some spots. This is a normal, common occurrence that can cause pockets to form in the colon wall. These pockets bulge outward through the wall of the colon.

A single one of these pockets is called a diverticulum and more than one are called diverticula. The condition of having diverticula is called diverticulosis. Diverticula can occur anywhere in the small or large intestines.

A mature woman holding her stomach in discomfort.

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When one or more of the diverticula becomes infected or inflamed, it causes a condition called diverticulitis. The difference between diverticulosis and diverticulitis is that diverticulosis is normal and doesn’t usually cause symptoms. Diverticulitis can be severe and causes symptoms of pain, nausea, and a fever.

Diverticulitis and diverticulosis together are also called diverticular disease. Learn more about the differences between diverticulitis and diverticulosis, which are both forms of diverticular disease.

Symptoms

While diverticulosis often has no symptoms, diverticulitis can have painful and concerning symptoms.

Diverticulosis

Diverticulosis is common, especially in people over the age of 40. It's estimated that about 70% of people over the age of 80 have diverticular disease. In most cases, the bulges don't cause any symptoms, and no treatment is needed. People usually don't even know that they have them.

Diverticulosis might not be diagnosed unless a person has a colonoscopy to screen for colon cancer. A colonoscopy is a test in which a physician uses a tube with a camera and a light on the end to look inside the large intestine. 

In many cases, diverticulosis does not cause any symptoms. However, some people have abdominal symptoms such as bloating, gas, and pain that are not due to acute diverticulitis. This condition is called chronic diverticular disease. It sometimes occurs after a bout with diverticulitis.

Diverticulitis

Diverticulitis is a complication of diverticular disease. It is a more serious condition and can be severe in some cases. The symptoms of diverticulitis could include:

  • Abdominal cramping
  • Abdominal pain
  • Blood in the stool
  • Change in bowel habits

Causes

The causes of both diverticulosis and diverticulitis are still unclear.

Diverticulosis

It’s still not known for sure what causes diverticulosis. However, the theory that is most studied is that eating a diet low in fiber could lead to the formation of diverticula.

A low-fiber diet could cause constipation, which is when stool is hard to pass or is passed only infrequently. It’s thought that having constipation could cause the intestinal walls to be put under too much pressure. The tension causes sections of the colon to become weak and to develop pockets (diverticula).

Diverticulitis

Diverticulitis occurs when one or more of the diverticula becomes inflamed. It’s not well understood why this happens. Stool normally contains a certain amount of bacteria. One theory is that the stool, and the bacteria in it, may enter into the diverticula. Once there, the bacteria may lead to an infection. 

A second theory is that diverticulitis is an inflammatory condition. Inflammation in the diverticula may lead to the symptoms. A small percentage of patients have what is known as “smoldering” diverticulitis. Their symptoms don’t respond to treatments and cause ongoing problems.

Diagnosis

Diverticulosis is usually noted incidentally during imaging for other conditions. If diverticulitis is suspected, imaging tests will be performed.

Diverticulosis

Having diverticula in the colon usually doesn’t cause any symptoms. For that reason, there won’t be any testing done to find it. Sometimes diverticulosis is found when tests are done while looking for the cause of symptoms for another condition, such as during routine colon cancer screening.

Diverticulitis

Suppose there are symptoms such as rectal bleeding, stomach pain or cramps, and a change in bowel habits (such as new diarrhea or constipation). In that case, a physician may suspect diverticulitis and make a diagnosis from the symptoms. However, tests may be done to ensure the diagnosis is correct. These tests can include:

Treatment

Diverticulosis requires no treatment, but dietary changes may be recommended. Treatment for diverticulitis depends on how severe the symptoms are.

Diverticulosis

There usually isn’t any treatment for diverticulosis, because there are no symptoms. If found, your doctor may recommend some changes to your diet to avoid constipation. That includes limiting foods that aren’t part of a high-fiber diet and adding in more fruits, vegetables, grains, nuts, seeds, beans, and legumes.

Diverticulosis might be treated if you have symptoms. Fiber supplements, probiotics, and some prescription medications may be suggested.

Diverticulitis

For diverticulitis that’s considered uncomplicated, the first treatment might be antibiotics, although they are being used more infrequently as diverticulitis is better understood. Antibiotics might be given orally, or, if in the hospital, through an IV.

Diverticulitis may be associated with certain complications in the colon. About 12% of people with diverticular disease will have a complication. This can include:

For complicated diverticulitis that includes one or more of these associated conditions, hospitalization might be needed. Patients might be put on a liquid diet and pain medications might be used. There may also be a need for surgery. The type of surgery that’s used will depend upon the complication.

Complications outside the colon can also occur with diverticulitis. These might also need treatment in the hospital:

  • High fever
  • Inability to keep food down
  • Leukocytosis (a high number of white blood cells)
  • Sepsis (a whole-body reaction to an infection)

Other treatments for diverticulitis are being studied, including Asacol (mesalamine), Xifaxan (rifaximin), and probiotics. However, these treatments haven’t so far shown a good response for diverticulitis and are currently not recommended for use.

Prevention

Diverticulosis

Preventing constipation and straining while having a bowel movement may help in avoiding diverticulosis. Some of the general advice that may be used includes eating enough dietary fiber, drinking plenty of water, and getting daily exercise.

Diverticulitis

Patients used to be told to avoid foods like nuts, seeds, corn, and popcorn in order to prevent symptoms of diverticular disease or diverticulitis. However, it’s no longer thought that these foods contribute to symptoms or worsening diverticular disease.

A high-fiber diet, drinking enough water, and exercise are usually recommended to avoid developing diverticulitis. Avoiding red meat may also be recommended, as some studies show it may be a risk for diverticulitis.

Cyclooxygenase inhibitors (COX inhibitors), nonsteroidal anti-inflammatory drugs (NSAIDs), and aspirin have also been associated with bleeding in the digestive system. It may be recommended that people with active diverticulitis avoid these medications, except for aspirin that’s taken to prevent a stroke or heart attack.

Summary

Diverticulosis is a condition of having pouches in the wall of the colon. If these pouches become inflamed, it becomes diverticulitis. Diverticulosis may not have any symptoms, while diverticulitis could cause pain and blood in the stool. The causes of both are unclear.

Treatment often isn't needed for diverticulosis, although a diet higher in fiber is recommended to prevent constipation. Diverticulitis may require treatment with antibiotics. It can lead to several complications.

A Word From Verywell

Diverticular disease is common. It may or may not be avoidable, which is why it’s important to adopt a high-fiber diet and to pay attention to digestion and bowel movements. When diverticular disease is found, working with healthcare professionals to understand it and to make any changes is helpful.

Most people won’t develop diverticulitis or other complications. Talk to your healthcare professional about prevention and how to live well with diverticular disease.

Frequently Asked Questions

  • Is diverticulitis or diverticulosis more serious?

    Diverticulosis that doesn’t cause any symptoms isn’t considered to be serious. However, diverticulitis can have symptoms that range from those that are troublesome to those that are severe and require hospitalization for treatment.

  • What foods should you avoid with diverticular disease?

    People who live with diverticular disease are usually advised to eat more fiber and drink more water. Getting enough fiber in the diet is important. That might mean finding enough balance so that there is enough fiber in the diet to have bowel movements that are soft and easy to pass.


    Some people with diverticular disease may find that certain foods may cause symptoms. This might be discovered through a process of trial and error. It may help to start a food and symptom log to keep track of what to avoid. Bring the log to appointments with healthcare professionals and go over it together to find patterns.

  • What does healthy poop look like in diverticulitis?

    Bowel movements are somewhat individual and will vary from person to person. However, there are some rules of thumb. Having bowel movements regularly (at least once every few days) that are soft and easy to pass is important. This will help not only with overall health but also in avoiding complications from diverticular disease.

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6 Sources
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