Diverticular Hemorrhage:Bleeding may occur from the diverticulum in 5% of patients. It is usually sudden in onset, painless and substantial. Diverticulosis is the cause in 30 to 50 percent of cases with massive bleeding from the colon. However, the bleeding stops spontaneously in most patients. In some cases, the bleeding may continue intermittently for a few hours to a few days before resolving. Chronic intermittent bleeding due to diverticulosis is unusual. Blood transfusions are required in less than 5% of these cases. Some people believe that the diverticula bleed when they are inflamed. Actually, it is quite the opposite. Bleeding is usually not seen during an acute episode of acute diverticulitis. Diverticula bleed when they are otherwise healthy.
Diagnostic strategy in cases of rectal bleeding is directed at localizing the site and the cause since there are no clinical features to reliably distinguish diverticular bleeding from other causes of gastrointestinal hemorrhage. Various combinations of tests including a colonoscopy, bleeding scan and angiogram of the colon (just like cardiac cath) are used depending upon the clinical situation. Treatment includes intravenous fluids and blood products, plus attempts to stop bleeding if it persists. As many as 80% patients do not have any recurrence of bleeding. Surgery may be needed in 50% of cases of massive diverticular bleeding.
Role of diet in preventing complications: Until a few decades ago, dietary restrictions were practiced in patients with asymptomatic diverticulosis in order to prevent diverticulitis and diverticular bleeding. "Irritating food" such as grape skin, corn and seeds were avoided. We now know that problems due to diverticulosis occur infrequently regardless of the type of food ingested. As such, most physicians prescribe a high fiber diet without insisting on any dietary restrictions.
In summary, diverticulosis is a very common, and usually a very benign condition. Complications occur only in a minority of patients, and most of them get well with medical treatment alone without any need for surgery.
What is diverticular bleeding?
Diverticular bleeding occurs when pouches (diverticula 
) that have developed in the wall of the large intestine (colon) bleed. If you have these pouches, you have a condition called diverticulosis.
Diverticular bleeding causes a large amount of blood to appear in your stool. Bleeding starts suddenly and usually stops on its own. Abdominal pain usually does not occur with the bleeding.
If you have a large amount of blood in your stool, see a doctor right away. It is possible, but not common, to quickly lose so much blood that you become lightheaded or weak.
What causes diverticular bleeding?
The reason pouches (diverticula) form in the colon wall is not completely understood. Doctors think diverticula form when high pressure inside the colon pushes against weak spots in the colon wall.
Normally, a diet with enough fiber (also called roughage) produces stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move small, hard stool. A low-fiber diet also can increase the time stool remains in the bowel, adding to the high pressure.
Pouches may form when the high pressure pushes against weak spots in the colon where blood vessels pass through the muscle layer of the bowel wall to supply blood to the inner wall.
Bleeding occurs when the blood vessel going to the pouch breaks open.
What are the symptoms?
Diverticular bleeding usually causes sudden, severe bleeding from the rectum. The blood may be dark red or bright red clots. In most cases there is no pain, and the bleeding stops on its own.
How is diverticular bleeding diagnosed?
Diverticular bleeding is diagnosed by ruling out other causes of the bleeding. Your doctor will do a medical history and physical exam, along with some tests. Imaging tests such as angiography (also known as arteriography) may be done to find the location of persistent bleeding. Colonoscopy, the inspection of the entire large intestine (colon) using a long, flexible, lighted viewing scope (colonoscope), is considered one of the most useful tests for finding the source of bleeding in the lower intestines.
Your doctor might do a test called a technetium-labeled red blood cell bleeding scan to look for the source of bleeding. In this test, some blood is taken from you, and a small amount of radioactive material called technetium is added to the blood. The blood containing the technetium is then injected back into your bloodstream and traced to the source of bleeding.
How is it treated?
Bleeding from diverticula often will stop on its own. If it does not, treatment may be needed to stop it and to replace lost blood, and you may need to be hospitalized. Treatment may include intravenous fluids, blood transfusions, injection of medicines, and in some cases surgery to remove the diseased part of the colon.
Can diverticular bleeding be prevented?
Eating a high-fiber diet, getting plenty of fluid, and exercising regularly may help prevent the formation of diverticula. But if you already have diverticulosis, diet may not help prevent bleeding.
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