Diverticula and diverticulitis: what the finding means and what it does not

The letter is lying on the kitchen table. The colonoscopy was unremarkable, it says. And then comes a subordinate clause you have never read before: multiple diverticula in the sigmoid colon.

You type the word into your phone. The first page talks about inflammation. The second about emergency surgery. The third about how you are not allowed to eat seeds any more from now on.

Many people know exactly this evening. The finding is worded harmlessly, and it still feels like a diagnosis.

So I am not starting with reassurance. Reassurance lasts until the next search query. I am starting with numbers.

Source: Shahedi 2013, retrospective colonoscopy cohort, PMID: 23856358. The limitations of these figures appear further down, they belong to the picture.

Before we go on, one list belongs up front. Not because it is likely, but because in case of doubt it makes the difference.

Diverticulosis, diverticular disease, diverticulitis: three words that get confused constantly

Imagine three siblings who look very much alike. Two of them are completely unremarkable. Only one causes trouble, and rarely at that. Yet all three carry the same family name, which is why every one of them gives you a fright.

That is exactly what happens with these three words.

Diverticula are small pouches of the bowel lining pushing outwards. More precisely they are pseudodiverticula. The German S3 guideline describes them as herniation of the mucosa with parts of the submucosa through preformed weak points of the bowel wall. So it is not the whole wall that bulges out, only the inner lining pushing through a gap.

Diverticulosis means: these pouches are there, and they cause no symptoms. That is the incidental finding in your letter.

Diverticular disease means: there are diverticula, and there are symptoms that can be traced back to them.

Diverticulitis means: one diverticulum or a group of diverticula is inflamed. That is an acute event with pain, usually in the left lower abdomen, often with fever and raised inflammatory markers.

The German guideline has its own classification for this, the CDD. It is sober and quite readable once you have seen it. And it answers the most important question right in the first line.

Look at the first line once more. In a medical guideline that otherwise words things very cautiously, next to type 0 stands the note that this is not a disease. That is not consolation, that is a definition.

One more word about type 3a, symptomatic uncomplicated diverticular disease. It is the blurriest category in the whole table. The German guideline writes about it, in its own words, that it ultimately cannot be reliably separated from functional disorders such as irritable bowel syndrome. So if persistent abdominal symptoms accompany you and imaging stays quiet, it is worth looking in the direction described in the article on irritable bowel syndrome.

And now you know why the same three words trigger such different feelings on the internet. They describe three different states, and the most common of them is the most harmless.

How many people have diverticula, and how many never develop inflammation

The second question after the finding is almost always: why me?

The honest answer is sobering and relieving at the same time. Not only you. From a certain age onwards it is the majority.

Something else about this statistic is remarkable. In statement 2.7 the guideline records that the frequency is currently rising particularly in younger age groups. In the American registry the rate of inpatient treatments rose by 26 percent between 1998 and 2005, the average age fell from 64.6 to 61.8 years, and the steepest rise was found among 18 to 44 year olds, from 151 to 251 cases per million. Among those over 75 it declined.

Now to the question you actually have.

So why do you read something different everywhere? Because an old figure lives on.

That leaves the finding that runs most strongly against intuition. The risk falls with age, even though diverticula become more common.

At first that sounds wrong. It makes sense once you keep apart what was measured. The 24 percent refer to age at the time of diagnosis, not to age as such. Anyone who already has diverticula at forty belongs to a particular group. On the one hand this person has more years of life ahead in which something can happen. On the other hand the early finding speaks for a more pronounced predisposition. The German guideline reports alongside this that the cumulative probability over 10.8 years was highest in 40 year olds, at around 11 percent.

One last point in this section, because it often gets muddled. Diverticular bleeding is something other than diverticulitis. Diverticula are regarded as the most common source of bleeding from the large bowel. The bleeding is usually painless, it can come from arterial vessels at the neck of the diverticulum, and by the account of the German S3 guideline the great majority come to a stop on their own. The German guideline records explicitly that the bleeding is as a rule a complication of diverticulosis and not of diverticulitis. Even so: every visible bleeding from the bowel belongs in a medical assessment. Always.

And now you know why the same condition is described on the internet once as a ticking clock and once as a footnote. It depends on which decade the figure comes from.

How diverticula arise: vascular gaps, pressure, connective tissue, age, genes

The third question usually comes quietly. Did I cause this myself?

To answer it, a look at the anatomy pays off. And it is surprisingly vivid.

Think of a bicycle inner tube inside its tyre. When the tube bulges out somewhere, it does not do so where you pumped hardest. It does so where the tyre has a seam or a weak spot. The pressure supplies the energy, the structure decides the location.

The bowel wall has such weak spots, and they are not a construction fault. They are a necessity. The mucosa needs blood, and the blood vessels have to pass from outside to inside through the muscle layer. At every point where such a vessel, a vas rectum, pierces the muscle layer, a small gap arises. The German guideline calls them loci minoris resistentiae, places of lesser resistance. An American review article describes more precisely where they lie: in parallel rows along the mesenteric side of the antimesenteric taeniae.

That leaves genetics. There is a figure on this that answers the quietest worry of this topic, and that is why I put it here.

On the molecular level, matching candidate genes appear, among them S100A10, BMPR1B, ELN, that is the elastin gene, and EFEMP1. These findings are associations, not diagnostics. There is no useful genetic test for diverticula, and you do not need one.

And now you know why these pouches sit almost entirely in the last stretch of the large bowel and why they do not recede. They are a change in shape, not a deposit.

The shift many people missed: nuts, grains and seeds

There are pieces of advice in medicine that sound so plausible they take on a life of their own. This one is the best example.

The idea went like this: diverticula have a narrow neck. If something hard and undigested gets in there, a fragment of nut, a corn kernel, a leftover piece of popcorn, then it gets stuck. And where something is stuck, inflammation follows.

That is vivid, it fits the anatomy, and it has led generations of people to leave the seeded bread untouched. In hindsight the German guideline describes it as a "formerly often voiced notion". It was never documented.

In 2008 somebody measured it.

What came of it has been in the German guideline since 2021. And not as a footnote, but as its own recommendation with evidence level 2, recommendation grade B and strong consensus.

The commentary makes it even clearer. Contrary to the earlier notion that undigested residues lodge in the necks of diverticula, the analysis of the cohort showed that these foods, eaten regularly, even lowered the risk.

And still, in 2026, you find German language patient information in which, in connection with diverticular disease, it says that raw vegetables, nuts and seeds are to be avoided. That is not a reproach. It is simply what happens when a recommendation is five years old and the text on the page is older.

And now you know why you may reach for the nut bread at the next family meal without having to justify yourself.

And what about fibre? Two datasets that seem to contradict each other

Now it gets interesting. And a little uncomfortable, because here two good datasets point in different directions.

The classic explanation comes from Painter and Burkitt in the late sixties and early seventies. They observed that diverticula were rare in rural Africa and common in industrialised countries, and concluded that the low fibre Western diet was responsible. Little fibre, hard stool, more pressure, pouching. A clear chain, in every textbook for decades.

Except: when modern studies examined this chain, it broke in several places.

A year later the same working group cleared away the most obvious objection. Anyone who knows they have diverticula remembers their digestion differently. So only people who knew nothing of their finding were analysed: 539 with diverticula, 1569 without.

The result was even clearer. Those with fewer than seven bowel movements per week, so constipated in the narrower sense, had a lower probability of diverticulosis, odds ratio 0.56 with 0.40 to 0.80. Hard stool likewise rather lower, 0.75 with 0.55 to 1.02. No association with straining, no association with incomplete emptying. And no association with fibre intake comparing the highest with the lowest quartile, odds ratio 0.96 at a mean intake of 25 versus 8 grams a day.

With that, the old causal chain has been tested at its weakest point and not confirmed. If you want to know more about why constipation is rarely down to too little fibre alone, that is in the article on constipation. Here it stays with these two sentences.

Now the other side. And in terms of numbers it is the stronger one.

The British EPIC-Oxford cohort shows the same with a figure I like better, because it is absolute rather than relative. 47,033 people, a third of them eating vegetarian, mean follow up 11.6 years, 812 cases. Vegetarians had a 31 percent lower risk, relative risk 0.69 with 0.55 to 0.86. And now the part that grounds the order of magnitude: the cumulative probability of being admitted to hospital for diverticular disease or dying from it between the ages of 50 and 70 was 4.4 percent in meat eaters and 3.0 percent in vegetarians.

That is a real difference. And it is not a switch.

What I am deliberately not doing here: a second explanation of the fibre types, a food list with gram figures or a discussion of whether the number 30 is the right target at all. That is set out at length in the article about the fibre myths, and rolling it out again here would have helped nobody.

One boundary does belong here, though, because it is often blurred. Everything said so far applies to primary prevention, that is to the time before anything has ever happened. For the time after an episode the same guideline says something different. There the evidence for a high fibre diet or for fibre supplements is explicitly not sufficient, and the American technical review remained uncertain on all four questions examined. At the same time the guideline explicitly does not advise against it. This double statement stands like that in the original, and I pass it on like that, because it is honest.

And now you know why two serious studies on the same topic can lead to opposite headlines without either of them being wrong.

The second shift: the antibiotic question in uncomplicated diverticulitis

This section is the most delicate of the whole text, and I will say right at the start why.

It is about a treatment decision. That belongs in medical hands, it depends on imaging, laboratory values and comorbidities, and it is not something you make yourself after a blog article. If an antibiotic has been prescribed for you, you take it. Full stop. What is written here is meant to let you ask the right questions in conversation, not to change the therapy.

Now to the matter itself.

For decades it was clear: diverticulitis is an inflammation, so you give an antibiotic. That was so self evident that it was never tested. The authors of the first large trial write this out explicitly in their abstract: there were no controlled trials supporting this approach.

Seven years later the same group looked at how the participants had fared. 556 of the 623 people could be followed for a median of eleven years, that is 89.2 percent. Recurrences in both groups 31.3 percent. Complications 4.4 versus 5.0 percent. Operations for diverticulitis 6.2 versus 7.1 percent. In no dimension of the quality of life measurement was there a difference. Eleven years is an unusually long follow up for a surgical trial.

After 24 months a further look was taken. Recurrence 15.4 versus 14.9 percent, complicated diverticulitis 4.8 versus 3.3 percent, sigmoid resection 9.0 versus 5.0 percent with a p value of 0.085. People under fifty and people with a pain score of 8 or higher at presentation more often had unfavourable courses. The type of treatment was not an independent predictor in the analysis. The authors write themselves that the trial was not large enough for these secondary endpoints and that a residual uncertainty therefore remains.

At this point a text could celebrate. I am not doing so, and the reason is in the next study.

That is how it stands today in the German S3 guideline, recommendation 5.20, modified in 2021, evidence level 1, recommendation grade 0, strong consensus.

Read the sentence again slowly. It contains four conditions: acute and uncomplicated, left sided, without risk indicators, under close clinical monitoring. And it says "may", not "should". Recommendation grade 0 is the weakest level a guideline awards.

There is one more paper that I consider the most honest in the whole field. Two independent readers went through the CT scans from AVOD again in a blinded fashion. Of 602 assessable examinations, 44, that is 7 percent, showed signs of complications that had been overlooked the first time: 27 with extraluminal air, 17 with an abscess. Four of these people deteriorated and had to be operated on. The rest recovered without complications. Of the 18 affected people with overlooked signs in the group without an antibiotic, 15 recovered without an antibiotic. And not a single CT finding could predict who would develop complications or a recurrence.

And now you know why two people with similar symptoms can be treated differently without either of them being treated wrongly.

When it becomes urgent: the signs of complicated diverticulitis

Up to here it was about relief. This section is the counter check, and it belongs just as much.

Because there are courses in which waiting is the wrong decision. They are rare, but they exist, and they can be recognised by certain signs.

Complicated means, in the CDD system: the inflammation does not stay in the bowel wall. It forms a microabscess up to 3 centimetres, a macroabscess larger than 3 centimetres, or it breaks through, with purulent or faecal peritonitis. Added to this are the chronic forms: a narrowing of the bowel, a fistula to a neighbouring organ, an inflammatory conglomerate mass. And, as its own category, bleeding.

How often does that happen? The German guideline names two figures that lie far apart, and they stay here explicitly as a range. From the DIABOLO population, 16 of 528 people initially classified as uncomplicated later developed complicated forms, that is 3.0 percent. The guideline itself writes that this is highly likely an underestimate, because it was a trial population. American guidelines assume 15 to 30 percent among people admitted to hospital. A single reliable figure for how often an initially uncomplicated diverticulitis turns into an abscess does not exist on this evidence. It stays a range here on purpose.

And now the paragraph that is rarely written this openly on the subject of laboratory values. Many people hope for a number that decides. With CRP that number does not exist.

The best cut off for predicting a perforation is, according to the guideline, 150 mg/l. At this value the sensitivity is 44 percent and the specificity 81 percent. A sensitivity of 44 percent means: fewer than half of perforations are picked up by it. At a CRP below 50 mg/l the negative predictive value is 0.79. And the guideline records explicitly that perforations were found even with a normal CRP. That is why there is the 48 hour rule, that is clinical and laboratory reassessment after two days, and that is why there is imaging.

One more word about bleeding, because it feels completely different from inflammation. It usually comes without pain, often suddenly and in an amount that is frightening. By the account of the German S3 guideline the great majority come to a stop on their own. The smaller remainder can become threatening. In older people with diverticula, diverticular bleeding counts on the same account as one of the most common causes of bleeding from the lower digestive tract. One point belongs here without fail: if you take blood thinning medicines, for example a vitamin K antagonist such as phenprocoumon, a direct oral anticoagulant or a platelet inhibitor such as acetylsalicylic acid, such a bleed can be heavier and last longer. These medicines are almost all prescription only, they usually have an important reason, and they are therefore never stopped on your own initiative. That belongs in the conversation with the prescribing practice. Even so, the sentence from above applies: visible blood from the bowel is never attributed to the diverticula without checking. It belongs in a medical assessment, and with heavy or persistent bleeding together with circulatory weakness, via the emergency number 112.

The complete list of red flags is in the box at the beginning of this text. I am deliberately not repeating it here but asking you to scroll back up once. If complicated diverticulitis is suspected, the route is not an appointment on the next working day. With a hard, board like rigid abdomen, a sudden sharp rise in pain, circulatory weakness or high fever with chills, call the emergency number 112 or go straight to an emergency department. Without these signs and outside consulting hours, the medical on call service on 116 117 will help.

And now you know why medicine places so much weight on imaging in this field, even though most courses are harmless.

After an episode: what is documented, what is popular, and what the difference is

Suppose you have diverticulitis behind you. The pain is gone, the values are back, and now comes the question that is rarely answered in the discharge letter: what do I do so that this does not come back?

I go through this question in two columns. First what is well documented. Then what is popular without the data carrying it. The difference between the two is the core of this section.

How often it comes back at all

Four documented figures are available. 16 percent after one year in AVOD. 15.4 percent after two years in DIABOLO. 31.3 percent after a median of eleven years in the AVOD follow up. And the guideline adds from other sources that the risk of recurrence rises with every episode, from around 8 percent after the first up to around 45 percent after the fifth. After the first uncomplicated episode it names a range of 15 to 30 percent, a population based study found 11.2 percent, though only for recurrences treated in hospital.

Alongside this, one sentence from the guideline that contains a lot of reassurance: the first episode is usually the most severe, subsequent episodes are clinically milder.

Eating after an episode, the honest version

Here the guideline separates carefully, and this separation gets blurred on many pages. For primary prevention, recommendation 5.1 carries the highest recommendation grade A: at least 30 grams of fibre a day. For secondary prevention after an episode, recommendation 5.23 states that the evidence for a high fibre diet or for fibre supplements is not sufficient. And at the same time, in its own words: given the general health benefit and the high plausibility, one should not advise against it here.

Both belong said together. Anyone telling you that psyllium prevents diverticulitis is going beyond the data. The only study this could be based on is an older small retrospective paper with 72 participants.

Patterns rather than single foods

What is better documented than any single food is the dietary pattern as a whole.

On red meat the guideline gets specific in recommendation 5.3. From around 105 to 135 grams per week the risk appears to rise linearly in the observational cohorts that were evaluated, until it reaches a plateau at around 540 grams per week at roughly 50 percent risk increase. These are associations from observational data, not proof of a cause, and they are study and guideline numbers, not a meal plan.

Movement, smoking, weight

Recommendation 5.9 of the guideline rests on a meta-analysis: relative risk 0.76 for high versus low physical activity and 0.74 for vigorous activity in relation to diverticulitis. The most favourable range was above 50 MET hours per week. As a rough conversion that corresponds to around twelve hours of brisk walking, six hours of cycling or four and a half hours of jogging. That conversion is mine and does not appear in that form in the paper. The German guideline names 30 to 60 minutes of moderate activity daily as the minimum.

On smoking the data point in both relevant directions. A meta-analysis of five prospective studies with 6076 new cases among 385,291 participants found a relative risk of 1.36 for current smokers, 1.17 for former and 1.29 for ever smokers. The German guideline adds, from a Swedish construction worker cohort, a relative risk of 2.73 for complicated courses with perforation or abscess in men who had ever smoked. That is the hardest single figure in the whole lifestyle section, which is why abstinence from nicotine appears in recommendation 5.5 with grade A.

On weight, the most important paper is in women, which is rare in this field. 46,079 women of the Nurses' Health Study, 1084 new cases over six years. Women with a BMI of 35.0 or more had, compared with women below 22.5, a hazard ratio of 1.42. And women who had gained 20 kilograms or more since the age of 18 had a 73 percent higher risk compared with weight stable women. I deliberately leave this here without a target value and without a diet instruction. It is an observation about courses, not an assignment.

Pain medicines, and why you still stop nothing

The medication finding with the greatest practical consequence concerns NSAIDs, that is non steroidal painkillers and anti-inflammatories such as ibuprofen or diclofenac. Depending on the substance, the strength and the pack size they are available over the counter or on prescription. Quite apart from the diverticula, they can irritate the lining of the stomach and bowel, encourage bleeding, put a strain on kidney function and influence cardiovascular risk. I deliberately give no doses here.

Alcohol

The German guideline is remarkably sober here. Statement 5.6 records that a raised risk is documented for acute alcohol intoxication, for harmful use and for a dependence syndrome. In a Danish cohort the relative risk with alcohol use disorder was 2.0 for men and 2.9 for women, in a Taiwanese cohort after intoxication a hazard ratio of 3.21. And then follows the sentence that is honest in both directions: at present no data show that low risk or even risky alcohol consumption raises the risk of diverticular disease. That sentence says something about diverticula only and nothing about the other consequences of alcohol, which are well documented. So it is not an all clear for drinking, it is a statement about exactly one question.

I neither moralise about this nor play it down. If you yourself have the feeling that your consumption is an issue, addiction counselling services and your general practice are the right addresses. That is a field of its own and does not belong in a text about diverticula.

Lifestyle as a whole, with one important limitation

What is popular without the data carrying it

Now the part where a text shows whether it stays honest when a substance would be likeable.

Mesalazine. Two identical, double blind, placebo controlled phase 3 trials with 1182 people in total examined whether mesalazine prevents a second episode. In PREVENT 1, 53 to 63 percent of the mesalazine groups stayed free of recurrence after 104 weeks, under placebo it was 65 percent. In PREVENT 2 it was 59 to 69 percent versus 68 percent. No advantage in time to recurrence, no advantage in the need for surgery. The guideline adds a detail missing from the abstract: in PREVENT 2 the time to recurrence under the lower mesalazine doses was statistically even shorter than under placebo. An independent meta-analysis of eight randomised trials confirms this with a pooled risk ratio of 0.86 and a confidence interval of 0.63 to 1.17. The German guideline therefore says in recommendation 5.31, at evidence level 1 and grade A: mesalazine should not be used for secondary prevention.

One nuance I do not want to withhold: for symptomatic uncomplicated diverticular disease of type CDD 1a, recommendation 5.16 gives a may recommendation at evidence level 2. The whole frame belongs with it. Mesalazine is prescription only, and the same guideline notes that it is not licensed in Germany for this indication. Any use would therefore be off label, with everything that entails: separate medical explanation and consent, no automatic reimbursement, greater medical responsibility. Mesalazine can also have unwanted effects, among them effects on the kidneys, the liver, the pancreas and the blood count, and it must not be given where there is hypersensitivity to salicylates. I deliberately give no doses here. That belongs in the hands of the treating practice.

Rifaximin. Here it becomes instructive. An Italian meta-analysis of four randomised trials with 1660 participants found a rate difference of 29.0 percent in favour of rifaximin plus fibre for freedom from symptoms after one year, with a number needed to treat of 3, and a rate difference of minus 1.7 percent for complications. That sounds very good. The German guideline judges exactly the same studies differently and gives its reasons: three of the four trials were open label, only one was placebo controlled, and in precisely that one there was no difference in the first three months. For maintaining remission, no controlled trial of rifaximin monotherapy exists to this day. Recommendation 5.32 therefore reads: should not be used, at evidence level 5.

An Italian review article assesses the same situation differently and regards combination therapies with rifaximin as the best documented result currently available. The frame belongs with it: rifaximin is prescription only and is not licensed in Germany for diverticular disease, so any use would be off label. As with every antibiotic, unwanted effects can occur, and repeated courses can encourage resistance and bowel infections with Clostridioides difficile. I name this controversy because it belongs to the subject, not as a recommendation. It also shows that the German restraint is a reasoned decision and not a lack of knowledge. Two professional societies, the same studies, two assessments, and the difference lies in the blinding.

Probiotics. In recommendations 5.17 and 5.19 the guideline can give no recommendation, neither for acute uncomplicated diverticular disease nor for diverticulitis. The studies are heterogeneous, mostly preliminary, a meta-analysis was not feasible. For stage 3b it records that dependable studies are not available. That does not mean there is nothing to it. It means that the data do not yet form a picture. What is generally known about selection and dosage form is in the article about probiotics in spore form and capsule.

The colonoscopy afterwards

Statement 4.12 of the German guideline says: after a conservatively treated diverticulitis has settled, as a rule after six to eight weeks, the indication for colonoscopy should be set depending on clinical and history based factors. So according to the course, according to persistent symptoms, according to age and according to the imaging.

Why is this decided individually and not across the board? A meta-analysis of eleven studies from seven countries supplies the numbers. In a pooled population of 1970 people, a carcinoma was found in 22, pooled 1.6 percent. Broken down: 0.7 percent after uncomplicated diverticulitis, which was 5 findings among 1497 people, and 10.8 percent after a complicated course, which was only 6 findings among 79 people, which is why that second value is given with a range of about 5 to 21 percent. The difference is nonetheless clear, and it is the reason for setting the indication individually.

When the symptoms stay

There are people in whom something remains after an episode. The guideline describes this openly: in a large study, 40 percent of those affected had mild pain or an altered bowel movement in the following year, and the risk of irritable bowel syndrome after acute diverticulitis is clearly raised. Mechanistically it fits that in chronic courses one finds raised pain mediating neurotransmitters and an increase in pain conducting nerve fibres, that is a visceral hypersensitivity similar to that after a bowel infection.

If that applies to you, two routes are worth taking. One goes via nutrition, and there a time limited attempt along the FODMAP principle may help to sort the symptoms out. The other goes via the search for causes, as described in the irritable bowel article and in the overall gut concept. If persistent diarrhoea rather than abdominal pain is in the foreground, bile acid can belong in the consideration too, and with additional upper abdominal symptoms the question of stomach acid can make sense. There are no robust studies on either of these in connection with diverticula. I am describing a consideration here, not a result. None of these routes replaces the assessment of an acute episode.

One thing belongs before every dietary attempt, and it is often overlooked in this order. If coeliac disease is in the room at all, it belongs assessed before you reduce wheat or gluten. The reason is unpleasantly practical: under a gluten free or strongly wheat reduced diet, antibodies and mucosal findings can recede, and then the diagnosis can no longer be made. Anyone who first removes and then tests ends up without an answer. A FODMAP attempt reduces wheat along the way, which is why this sentence stands exactly here. And if you take medicines permanently, for example acid blockers or laxatives: whether and how anything changes about that is a medical decision and not the first step of a self experiment.

A side note that rarely appears anywhere: there is a separate entity called SCAD, a segmental colitis associated with diverticulosis. Its frequency is around 1 percent, and endoscopically it can look like inflammatory bowel disease. If this suspicion is in the room, the route leads into the diagnostics described in the article on Crohn's disease and colitis.

And now you know why the section about the time after an episode contains so many more question marks than the one about the time before. For prevention there are large cohorts. For preventing recurrence there are not, so far.

When surgery is discussed, and why no longer by episode count

There is a rule of thumb in this field that many people still carry in their heads. From the second episode onwards, you operate.

This rule no longer applies, and the reasoning behind it is one of the most elegant in the whole guideline.

So what is the decision based on? On quality of life. Recommendation 6.13 says that the impairment of quality of life should be the essential decision aid. And on this there is in fact a randomised trial.

After five years another measurement was taken. The quality of life value was 118.2 after surgery and 108.5 with conservative management, mean difference 9.7. All secondary measures also came out in favour of surgery, on the physical and the mental summary score, on the general quality of life measure and on the pain score. Of those operated on, 8 people, that is 11 percent, had an anastomotic leak, and in 11 people, that is 15 percent, reinterventions were necessary.

And then this follow up contains a figure that points in both directions and that I consider the most honest of the section: 26 of those managed conservatively, that is 46 percent, were operated on within five years after all because of persistent severe symptoms.

The question stands differently with the complicated forms. With a narrowing of the bowel, with a fistula or after a larger abscess, surgery may be offered in an inflammation free interval. That is a different situation from recurrent uncomplicated diverticulitis, and it follows different considerations.

And now you know why the question of surgery is no longer answered today with a number, but with a question back: how much does this restrict you?

Frequently asked questions about diverticula and diverticulitis

Where this topic connects to the rest of the body

Diverticula do not stand on their own. They hang on connective tissue, on decades of eating, on movement and sleep, on the question of how a bowel reacts to inflammation, and on how a person deals with an unclear finding.