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Diverticulosis, otherwise known as “diverticular disease”, is the condition of having diverticula in the colon which are outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure. This is uncommon before the age of 40 and increases in incidence after that age.[1]
Diverticula are thought to be caused by increased pressure within the lumen of the colon. Increased intra-colonic pressure secondary to constipation may lead to weaknesses in the colon walls giving way to diverticula. Other causes may include a colonic spasm which increases pressure, which may be due to dehydration or low-fiber diets;[2] although this may also be due to constipation. Fiber causes stools to retain more water and become easier to pass (either soluble or insoluble fiber will do this). A diet without sufficient fiber makes the stools small, requiring the bowel to squeeze harder to remove the smaller stool.
Risk factors:
About 10% of the US population over the age of 40 and half over the age of 60 has diverticulosis. This disease is common in the US, Britain, Australia, Canada, and is uncommon in Asia and Africa. It is the most common cause for rectal bleeding in US adults over the age of 40 years.
Studies have identified dietary factors as potential explanations for the large variation in the disease. High intake of fiber, fruits and vegetables and brown bread was associated with approximately 40-50% reductions in the risk.[3] [4][5] On the other hand, higher intake of both red and processed meat increased the risk 2-4 fold in two studies,[4][3] while a third study found a 24-fold increase in the risk with higher total meat intake.[5] This could explain the lower risk among vegetarians.[6]
Dr. Denis Burkitt(1911-1993), who was the main proponent of the fiber theory, also believed that the use of the unnatural sitting posture for defecation is a major contributing factor in diverticulosis and other GI disorders (including hiatus hernias.)[7]
Contrary to a common recommendation to avoid eating popcorn, nuts and corn to prevent diverticular complications, a large prospective study of men indicates that the consumption of these foods does not increase the risk of diverticulosis or diverticular complications.[8][9]
Large mouth diverticula are associated with scleroderma.
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