What changes the next step?
Diverticula found during a well-prepared colonoscopy are often an incidental finding. If you later develop new pain, I do not assume the pockets explain it. The assessment considers the pain, examination, blood tests and whether imaging is needed. Severe illness needs urgent care, even if you have had a mild episode before.
After an attack, the reason for any colonoscopy is to check for another condition when your symptoms, scan or previous examination leave uncertainty. It is not to remove the diverticula. New Zealand primary care guidance and international advice support selective treatment, including selective antibiotics. Follow-up should reflect your episode and previous tests, rather than an automatic repeat after every attack.
Guidance behind this advice
A pouch and an inflamed pouch are different
Macroscopic view
Diverticulosis means that small pouches are present in the colon wall. The sigmoid colon is the most common area for diverticulosis. The next view magnifies how one pouch forms.
Macroscopic view
Diverticulosis means that small pouches are present in the colon wall. The sigmoid colon is the most common area for diverticulosis. The next view magnifies how one pouch forms.
Diverticulosis
The inner lining and supporting layer push outward through a weak point in the deeper muscle. Many people have pouches without symptoms.
Diverticulitis
One or more pouches become inflamed. Rarely, an inflamed pouch can perforate (split open), causing serious infection and requiring hospital admission.
Bleeding
A diverticulum can erode a small blood vessel in the bowel wall and bleed, sometimes without diverticulitis. Heavy or ongoing bleeding needs urgent assessment.
Simplified illustrations, not to scale. These show an example, not your own anatomy or test result.
Read every diagram explanation
Macroscopic view
Diverticulosis means that small pouches are present in the colon wall. The sigmoid colon is the most common area for diverticulosis. The next view magnifies how one pouch forms.
Diverticulosis
The inner lining and supporting layer push outward through a weak point in the deeper muscle. Many people have pouches without symptoms.
Diverticulitis
One or more pouches become inflamed. Rarely, an inflamed pouch can perforate (split open), causing serious infection and requiring hospital admission.
Bleeding
A diverticulum can erode a small blood vessel in the bowel wall and bleed, sometimes without diverticulitis. Heavy or ongoing bleeding needs urgent assessment.
What are diverticula?
The colon is your large bowel. Its inner lining and the supporting layer underneath can push out through weak points in the muscular wall, forming small pockets called diverticula. One pocket is a diverticulum. These pockets open into the bowel; they are not polyps and do not need to be removed like polyps.
They often occur in the sigmoid colon, the lower part on the left side of your abdomen, but can occur elsewhere, including on the right. They become more common with age. Finding diverticula does not mean you have bowel cancer or an active infection.
What if diverticula were found during colonoscopy?
Diverticulosis describes the presence of these pockets. If you feel well, you usually do not need medicines or another colonoscopy just because they were found.
Bloating, constipation or abdominal discomfort can have other causes. I do not assume that every bowel symptom is caused by diverticula. If symptoms continue, I assess them alongside your examination and other findings.
What does diverticulitis feel like?
Diverticulitis can cause new, constant abdominal pain, often on the lower left, with tenderness, fever or a change in bowel motions. Some people feel sick or vomit. Right-sided diverticulitis can cause pain on the right. These symptoms need medical assessment because other conditions can look similar.
An examination, blood tests and sometimes a CT scan help establish the diagnosis and check how severe it is. An uncomplicated episode has no abscess or other major complication. Severe attacks or an abscess may need hospital treatment.
Does every attack need antibiotics?
No. Some people who are otherwise well with a mild, uncomplicated episode recover with supportive treatment and close review. Antibiotics are more likely to be needed if you are generally unwell, have complications, reduced immunity or other health concerns. This decision needs an individual clinical assessment.
Follow the treating team's advice about pain relief, food and fluids. There is no need to stop eating for every mild episode if you can tolerate food. If treatment is at home, make sure you know when you will be reviewed, usually within about 48 hours, and seek help sooner if you deteriorate.
Can diverticula bleed?
A small blood vessel in a diverticulum can bleed into the bowel. This is a separate problem from diverticulitis and can happen without abdominal pain. Bleeding can be brisk. New bleeding needs medical advice rather than being assumed to come from known diverticula or piles.
Food, prevention and follow-up
When you are well, I recommend a balanced diet with fruit, vegetables and whole grains. Increase fibre gradually if your diet is low in fibre, and drink enough fluid. Sometimes soluble fibre, such as psyllium husk, can be helpful too. You do not generally need to avoid nuts, seeds, popcorn or fruit skins. Regular activity and avoiding smoking are useful too.
After diverticulitis, I consider your scan, symptoms and previous colonoscopy before deciding whether you need another colonoscopy. It is usually arranged after the acute inflammation has settled, and not every uncomplicated episode needs one.
If you have an endoscopy, the recommended follow-up will be recorded in your endoscopy and/or histology report once tissue results are available.
When to get help
Arrange prompt medical assessment for new persistent abdominal pain, particularly with fever. Seek urgent help for severe or worsening pain, persistent vomiting, inability to keep fluids down, heavy or ongoing bleeding, or feeling faint or very unwell.
Call 111 for an ambulance if you collapse, have heavy bleeding with faintness, or are too unwell to travel safely. Do not wait for a routine appointment or an email reply.
Three things to remember
- Diverticulosis means pockets in the bowel wall. Most people with them have no symptoms.
- Diverticulitis means inflammation. Treatment and any follow-up investigation depend on your assessment.
- You usually do not need to avoid nuts or seeds. New pain or bleeding should be assessed rather than blamed on known diverticula.
Related information
Sources and further reading
English clinical master checked 15 October 2026.