To prevent progression of diverticular disease, patients should increase their dietary fiber intake or begin fiber supplementation (32 g per day), and increase their level of physical activity.38–40 Obesity (body mass index greater than or equal to 30 kg per m2) is a significant risk factor for diverticular bleeding (relative risk = 2.0).41 Avoidance of certain nuts, corn, or popcorn to prevent complications is no longer recommended in patients with diverticular disease.42

Treatment

If bleeding stigmata, such as a protuberant vessel or pigmented spots, associated with a diverticulum are visualized during colonoscopy, therapy can be applied directly to this area. A small, retrospective study of endoscopic therapy in 10 patients found no rebleeding episodes using a combination of epinephrine injection and electrocautery therapy.12,25 Endoscopically placed clips (endoclips), fibrin sealant, and band ligation were shown to be effective in controlling diverticular bleeding in three small case series.26–28 If colonoscopy is not available or if it fails to reveal or control the bleeding source, further intervention is required. A tagged red blood cell scan is typically performed with attempts to localize the bleeding source and assist with targeted therapy by arteriography or surgery.

Intra-arterial vasopressin infusion during arteriography is successful in identifying bleeding in 72 percent of patients and controlling bleeding in 90 percent of patients. However, it is complicated by a 50 percent rebleeding rate and is seldom used in practice.29 Selective arteriography with therapeutic embolization is effective (76 to 100 percent of patients had controlled hemorrhage) and safe (less than 20 percent of patients experienced ischemia following embolization).30,31

Surgical intervention is rarely required because the bleeding is self-limited in 86 percent of patients, and there is a high rate of success at controlling bleeding by nonsurgical means.

Active bleeding or stigmata of hemorrhage (visible vessel or pigmented protuberance) are identified in only 10 to 20 percent of colonoscopic examinations for diverticular bleeding.14 When present, these findings are associated with a high risk of continued or recurrent bleeding.

no medical therapy is specific or effective for the prevention of diverticular re-
bleeding. Definitive diverticular hemorrhage is a serious clinical problem, especially in elderly patients with signif-icant comorbidities in which the rates of more bleeding are high with medical therapy.

How Can Diverticulosis Be Prevented?

To prevent diverticular disease or reduce the complications from it, maintain good bowel habits. Have regular bowel movements and avoid constipation and straining. Eating appropriate amounts of the right types of fiber and drinking plenty of water and exercising regularly will help keep bowels regulated.

The American Dietetic Association recommends 20 to 35 grams of fiber a day. Every person, regardless of the presence of diverticula, should try to consume this much fiber every day. Fiber is the indigestible part of plant foods. High-fiber foods include whole grain breads, cereals, and crackers; berries; fruit; vegetables, such as broccoli, cabbage, spinach, carrots, asparagus, squash, and beans; brown rice; bran products; and cooked dried peas and beans, among other foods.

Drinking eight 8-ounce glasses of water a day, monitoring changes in bowel movements (from constipation to diarrhea) and getting enough rest and sleep, are other ways to prevent diverticular disease.

What to do. You can't get rid of diverticulosis, but you can do things that may reduce the chance that it will progress to diverticulitis and other complications. Chief among them is eating a high-fiber diet. It hasn't been proved that fiber prevents diverticulitis, but evidence suggests that people who eat more fiber are less likely to develop the problem. Fiber absorbs water as it passes through the intestine, producing bulky stools that move through more quickly, reducing the likelihood of constipation and the resulting pressure in the colon. When fiber is inadequate, stools are small and hard, and the colon must contract with greater force to expel them, putting extra pressure on the colon walls.

A high-fiber diet should include a mix of whole grains, nuts, seeds, fruits, legumes (such as dried beans), and vegetables. (See "Fiber content of various foods.") At one time, people with diverticular disease were told to avoid popcorn, nuts, and seeds because of concern that these foods might become trapped in diverticula and trigger diverticulitis. However, this idea has been disproved.

Diverticula develop at weak spots, such as where arteries that nourish the colon penetrate the muscle wall. The inner layers of the wall balloon outward, like an inner tube poking through a tire, forming sacs on the outside of the colon. Most diverticula are about the size of a pea, though some can be much larger. When many occur in one area, the colon wall in that area may thicken and narrow the passageway. Most diverticula are found on the lower left side — in the sigmoid, or descending, colon — where the colon is the narrowest and pressure on the colon walls is the greatest.

BMI, waist circumference, and waist-to-hip ratio significantly increased the risks of diverticulitis and diverticular bleeding.

A common clinical observation is that patients presenting with complications of diverticular disease are obese. The aetiological relationship between obesity and diverticular complications remain unclear.
he incidence of diverticular disease of the colon has been rising in recent years, and the associated factors are: low ingestion of fibre, age, lack of physical activity, and obesity.