clinical features

Last edited 08/2018 and last reviewed 01/2020

Diverticular disease is often asymptomatic (75-80%) and can be an incidental finding during assessment of a patient for another reason (1).

In uncomplicated symptomatic patients, the following may be present:

  • non-specific abdominal complaints
    • lower abdominal pain
      • usually left sided and colicky, but can be constant
      • may be aggravated by eating and diminished with defecation or flatus (suggests colonic wall tension due to raised pressure inside the bowel)
  • other symptoms such as bloating and constipation may be seen in some patients
  • assessment may reveal fullness or mild tenderness in the lower left quadrant (frank rebound or guarding should be absent) (1)

Complicated diverticular disease

  • acute diverticulitis
    • abdominal pain
      • may present as mild intermittent pain or as chronic severe unrelenting    pain
      • usually left sided (in Asian patients, right lower quadrant pain due to right sided diverticula)
    • change in bowel habits – constipation (in 50%) and diarrhoea (in 25-30%)
    • systemic features such as fever
    • other symptoms
      • nausea, vomiting
      • urinary symptoms – dysuria and increased frequency related to bladder irritation
    • abdominal examination may reveal rigidity, rebound tenderness and guarding (1,2)

The diagnosis is made by the appearance of the bowel on barium enema.


  1. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363(9409):631-9
  2. Feuerstein JD, Falchuk KR. Diverticulosis and Diverticulitis. Mayo Clin Proc. 2016 Aug;91(8):1094-104