What Causes a Diverticulum?

Pictured are different ways diverticula may appear in the intestine -- the black line shows a fistula, or abnormal connection between parts of the bowel.

A diverticulum is an abnormal sac or pouch that forms in the wall of a major organ in the body. 

Types of diverticulum include: 

• Small intestine (Meckel's diverticulum) 
• Esophageal diverticula       
  • Pharynx  (Zenker's diverticulum)  
  • Midesophageal
  • Epiphrenic (lower esophageal sphincter)
  • Killian-Jamieson diverticulum 
• Colon (diverticulitis/diverticulosis) 
• Duodenal and jejunal diverticulum (congenital lesions) 
• Gallbladder (Rokitansky-Aschoff sinuses)
• Kidney (calyceal diverticulum)
• Bladder  
• Urethra (tends to occur following infectious in females, and are congenital in males)
• Cardiac (rare malformation of the heart present at birth that is usually benign) 
• Aorta (diverticulum of Kommerell)

Symptoms of a diverticulum vary depending on the organ involved. Symptoms of some common types of diverticula include:

• Large intestine (diverticulitis or diverticulosis)
  • Abdominal pain
  • Bloating
  • Constipation (less often, diarrhea)
  • Cramping
  • Fever
  • Nausea
  • Vomiting
  • Chills
• Small intestine (Meckel’s diverticulum) 
  • Often has no symptoms
  • Blood in stool
  • Abdominal pain
  • Not being able to pass gas or have a bowel movement
• Urethra
  • Post-urination dribbling 
  • Pain or discomfort when urinating
  • Pain with sexual intercourse
  • Chronic or recurrent urinary tract infections (UTIs)
  • Urinary frequency and/or urgency
  • Blood in urine
  • Blood discharge
  • Urinary incontinence
  • Urinary retention
  • Pelvic pain
  • Vaginal mass
• Pharynx and esophagus (Zenker's diverticulum) 
  • Food may get stuck in the diverticulum
  • Bad breath
  • Gurgling in the throat
  • Appearance of a mass in the neck
  • Regurgitation of food into the mouth
  • Weight loss and malnourishment in patients with chronic difficulty swallowing

Causes for diverticulum vary. 

Causes of diverticulum in the colon (diverticulitis/diverticulosis) include:

• Increased pressure on the intestinal wall from inside the intestine due to 
  • Age
  • Hard stools
  • Frequent straining during bowel movements
  • Diets low in fiber 
• Meckel’s diverticulum in the small intestine is caused by a bulge left over from the umbilical cord. It is present from birth. 

Causes of diverticulum in the urethra include:

• Chronic or recurrent bladder or urinary tract infections (UTIs) in women
• Birth defect in men

Diverticulum in the pharynx and esophagus (Zenker's diverticulum) involve malfunctioning of the cricopharyngeal muscle and weakness of the esophagus wall caused by:

• Aging 
• Neurologic problems such as a stroke

A medical history and physical exam can help diagnose diverticulum. In addition, tests for various diverticulum depend on the organ suspected and may include:

• Barium enema  
• Flexible sigmoidoscopy 
• Colonoscopy 
• “Meckel scan” – type of imaging for small intestine
• Ultrasound
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Urine tests
• Urethroscopy 

Treatment for diverticulitis/diverticulosis includes:

• Increased fiber in the diet 
• Clear liquid diet
• Oral antibiotics
• Surgery

Treatment for Meckel's diverticulum includes:

• Surgical removal if it is causing symptoms

Treatment for urethral diverticulum includes:

• Applying pressure with the fingers on the suburethral mass after urinating
• Periodic needle aspiration 
• Antibiotic prophylaxis for recurrent UTIs
• Surgery

Treatment for diverticulum in the pharynx and esophagus (Zenker's diverticulum) includes: 

• Surgery
• Non-surgical endoscopic technique

Complications of a diverticulum include:

• Recurrent symptoms
• Need for additional surgery 
• Bowel perforation (diverticulitis/diverticulosis)
• Peritonitis - serious infection of the abdominal cavity (diverticulitis/diverticulosis)
• Blockage or obstruction of the intestine (diverticulitis/diverticulosis)
• Bleeding in the intestine (diverticulitis/diverticulosis)
• Abscess (pocket of infection) 
• Fistula (abnormal connection between one organ and another organ – often causes a severe infection)
• Kidney stones (urethral diverticulum)
• Urinary tract infections (UTIs caused by urethral diverticulum)

The main way to prevent diverticulosis and diverticulitis (diverticulum in the colon) is by consuming a high fiber diet. 

Some cases of urethral diverticulum in women may be prevented by properly treating urinary tract infections (UTIs) if they develop.