Diverticular Bleeding: Causes, Symptoms, and Treatment

I'll never forget that moment: the shocking sight of bright red blood in the toilet bowl. My heart raced as panic set in—was this the diverticular bleeding my gastroenterologist had warned me about? After multiple diverticulitis flares, this was an entirely new and terrifying experience.

If you're living with diverticulosis or diverticulitis, understanding diverticular bleeding—one of the most common complications—is essential for your health journey. While frightening, knowledge is power, and knowing what to expect can make all the difference in how quickly you seek treatment and your peace of mind day-to-day.

In this comprehensive guide, we'll explore everything you need to know about diverticular bleeding, from its causes and symptoms to treatment options and prevention strategies—all from the perspective of someone who's been there.

What is Diverticular Bleeding?

Diverticular bleeding occurs when a blood vessel within a diverticulum (one of those small pouches that form in your colon wall) ruptures and causes bleeding into your digestive tract. While diverticulitis involves inflammation and infection of these pouches, diverticular bleeding is a separate complication that can occur with or without inflammation.

It's important to understand that:

Diverticular bleeding accounts for about 40% of all lower gastrointestinal bleeding cases in adults
It's the most common cause of significant lower GI bleeding in people over 60
About 15-25% of people with diverticulosis will experience a bleeding episode at some point

How Diverticular Bleeding Happens

To understand how diverticular bleeding occurs, let's break down the anatomy involved:

Diverticula form at weak points in your colon wall, usually where blood vessels penetrate the muscle layer. These blood vessels can become stretched and exposed as they run over the dome of the diverticulum. Over time, these vessels may erode or rupture, leading to bleeding.

Unlike the gradual onset of diverticulitis symptoms, diverticular bleeding typically occurs suddenly and without warning. What makes it particularly concerning is that it can happen even if you've never had a diverticulitis flare-up before.

My Experience: When my bleeding episode happened, it was completely out of the blue on an otherwise normal day. I hadn't been experiencing any diverticulitis symptoms—no pain, no fever, nothing to suggest trouble was brewing. This is typical of diverticular bleeding; it often occurs without the usual warning signs of infection or inflammation.

Diverticular Bleeding vs. Other Types of GI Bleeding

It's important to differentiate diverticular bleeding from other causes of gastrointestinal bleeding:

Type of Bleeding	Typical Location	Common Causes	Characteristics
Diverticular Bleeding	Lower GI (colon)	Ruptured blood vessel in diverticulum	Painless, bright red or maroon blood
Hemorrhoidal Bleeding	Anal area	Swollen blood vessels in rectum/anus	Bright red blood, often on toilet paper
Upper GI Bleeding	Esophagus, stomach, duodenum	Ulcers, varices, gastritis	Dark, tarry stools (melena)
Inflammatory Bowel Disease Bleeding	Throughout GI tract	Crohn's disease, ulcerative colitis	Often mixed with mucus, can be chronic

While other causes of bleeding like hemorrhoids are more common, diverticular bleeding tends to be more substantial and may require immediate medical attention.

Causes and Risk Factors for Diverticular Bleeding

Understanding what triggers diverticular bleeding can help you assess your own risk and take appropriate precautions.

Direct Causes

The immediate cause of diverticular bleeding is the rupture of a blood vessel within or adjacent to a diverticulum. This can happen due to:

Vascular Erosion: Over time, the blood vessel that runs over the dome of a diverticulum can weaken and eventually rupture
Mechanical Trauma: Hard stool or increased pressure within the colon can damage the blood vessel
Inflammation: Though less common than with diverticulitis, low-grade inflammation may weaken blood vessel walls

Risk Factors That Increase Your Chances of Bleeding

Several factors can increase your risk of experiencing diverticular bleeding:

Medications

Certain medications significantly increase the risk of diverticular bleeding by affecting blood clotting or the integrity of your digestive tract lining:

Blood thinners (anticoagulants like warfarin, direct oral anticoagulants)
Antiplatelet medications (aspirin, clopidogrel)
NSAIDs (ibuprofen, naproxen)
Steroids

My Story: My gastroenterologist believes my own bleeding episode was likely triggered by the regular aspirin I had been taking for heart health. After the bleeding incident, we worked together to reassess the risks and benefits of continuing aspirin in my specific case. This experience is part of my broader diverticulitis journey.

Age and Disease Factors

Advanced age (risk increases significantly after age 60)
Hypertension (high blood pressure)
Atherosclerosis (hardening of the arteries)
History of previous diverticular bleeding (about 25% of people will have a recurrence)
Extensive diverticulosis (having many diverticula)

Lifestyle Factors

Low-fiber diet (contributes to constipation and increased strain)
Obesity
Sedentary lifestyle
Smoking (affects blood vessel health)
Excessive alcohol consumption

Understanding your personal risk factors is crucial for prevention and for making informed decisions with your healthcare provider about medications and lifestyle changes.

Recognizing the Symptoms of Diverticular Bleeding

Diverticular bleeding presents with distinct symptoms that set it apart from other digestive issues. Knowing these signs can help you seek timely medical care.

Primary Symptoms

The hallmark symptoms of diverticular bleeding include:

Bright red or maroon-colored blood in your stool – The most obvious sign
Passing large amounts of blood from your rectum – Can occur with or without stool
Dark, tarry stools (melena) – If the blood has been in your digestive system longer
Blood clots in your stool

What makes diverticular bleeding particularly distinctive is that it's usually:

Painless – Unlike diverticulitis, which typically causes significant abdominal pain
Sudden – Occurs without warning
Self-limiting – In about 75% of cases, bleeding stops on its own

My Experience: The absence of pain was what confused me initially. I'd experienced diverticulitis flares before and expected pain with any complication. Instead, I felt physically fine—except for the alarming amount of blood I was seeing and the growing light-headedness as my body responded to blood loss.

Associated Symptoms

Depending on the severity of bleeding, you may also experience symptoms related to blood loss:

Lightheadedness or dizziness – Especially when standing up
Weakness or fatigue
Rapid heart rate (tachycardia)
Shortness of breath
Pale skin
Cold, clammy skin
Confusion (in severe cases)

When It's An Emergency

Certain symptoms indicate a medical emergency requiring immediate attention:

Heavy or continuous bleeding that doesn't slow down
Feeling faint or actually fainting
Rapid heart rate (over 100 beats per minute)
Low blood pressure
Severe weakness
Confusion or disorientation

If you experience any of these emergency symptoms, call 911 or have someone take you to the emergency room immediately. Don't drive yourself—blood loss can impair your ability to drive safely. These symptoms can also be signs of a more serious complication like sepsis.

Diagnosis of Diverticular Bleeding

If you're experiencing rectal bleeding and suspect diverticular bleeding, here's what to expect during the diagnostic process.

Initial Emergency Evaluation

When you arrive at the emergency room with rectal bleeding, the medical team will:

Take vital signs – Blood pressure, heart rate, respiratory rate, and temperature
Insert an IV line – For fluids and potential blood transfusions
Draw blood samples for:
- Complete blood count (to check for anemia from blood loss)
- Coagulation studies (to assess blood clotting ability)
- Blood type and crossmatch (in case you need a transfusion)
Perform a physical examination – Including a rectal exam to look for hemorrhoids or other obvious sources of bleeding

My Experience: When I arrived at the ER, everything happened quickly. Multiple team members worked simultaneously—one starting an IV, another drawing blood, a third asking me questions. The urgency was both reassuring and frightening. They explained that with GI bleeding, they needed to determine quickly how much blood I'd lost and whether the bleeding was continuing.

Diagnostic Procedures

Several procedures may be performed to identify the source and severity of bleeding:

Colonoscopy

Timing: Often performed within 24-48 hours, once the patient is stable
Process: A flexible tube with a camera is inserted through the rectum to examine the entire colon
Benefits: Can identify the exact location of bleeding and potentially treat it during the same procedure
Preparation: May require bowel preparation, though sometimes limited in acute situations

If you've had diverticulitis, you might already be familiar with this procedure from a follow-up colonoscopy after a flare-up.

CT Angiography

When used: For active, more severe bleeding when the source isn't easily identified
Process: Contrast dye is injected into your bloodstream, and CT imaging can detect where the dye leaks out
Benefits: Can detect bleeding rates as low as 0.3-0.5 mL/minute

You may be familiar with CT scans from previous diverticulitis diagnoses, though the protocol is slightly different for bleeding evaluation.

Nuclear Medicine Scan (Tagged Red Blood Cell Scan)

When used: When bleeding is intermittent or slower
Process: A small amount of radioactive material is attached to your blood cells to track where bleeding occurs
Benefits: Can detect slower bleeding rates than angiography

Conventional Angiography

When used: For severe, active bleeding, particularly when intervention is planned
Process: Contrast dye is injected directly into blood vessels via a catheter
Benefits: Allows for immediate treatment through the same procedure

In my case, after stabilizing me with IV fluids, the doctors performed a CT angiography first to rule out massive active bleeding, followed by a colonoscopy the next day that confirmed diverticular disease with evidence of recent bleeding.

Treatment Approaches for Diverticular Bleeding

Treatment for diverticular bleeding depends on the severity of bleeding, your overall health status, and whether the bleeding continues or stops on its own.

Emergency Management

The immediate goals are to stabilize your condition and stop the bleeding:

Resuscitation and Stabilization

Intravenous fluids to restore blood volume and maintain blood pressure
Blood transfusions if hemoglobin levels are low or dropping
Monitoring of vital signs, including continuous heart rate and blood pressure checks
Correction of any coagulation abnormalities if you're on blood thinners

Personal Insight: During my bleeding episode, I received two units of blood. The improvement in how I felt afterward was dramatic—from weak and dizzy to almost normal within hours. The nurses explained that each unit of blood should raise hemoglobin by about 1 g/dL, and they were right: my levels improved from 7.8 to 9.7 after transfusion.

Interventional Treatments

If bleeding doesn't stop on its own or is severe, several interventions can help:

Endoscopic Treatments

During colonoscopy, gastroenterologists can:

Apply clips to bleeding vessels
Use thermal coagulation to seal bleeding points
Inject medications that constrict blood vessels
Place bands around bleeding sites

Angiographic Embolization

If bleeding can't be controlled endoscopically:

A catheter is inserted through an artery (usually in the groin)
The catheter is guided to the bleeding vessel
Materials (coils, particles, or glue) are deployed to block the bleeding vessel
Success rate is about 85-90% for active bleeding

Surgical Intervention

Reserved for cases where bleeding is severe and can't be controlled by other means:

Segmental colectomy – Removal of the portion of colon containing the bleeding diverticula
Subtotal colectomy – Required in rare cases where the bleeding source can't be precisely located

Surgery is typically a last resort, needed in only about 5-10% of diverticular bleeding cases. If you're concerned about potential surgery, our article on surgical options for diverticulitis provides helpful information on what to expect, though focused on inflammatory rather than bleeding complications.

Conservative Management

For many patients, diverticular bleeding stops spontaneously (about 75% of cases). In these situations:

Hospital observation for 24-72 hours
Clear liquid diet initially, advancing to low-fiber and then high-fiber diet as tolerated
Discontinuation of high-risk medications when possible
Correction of underlying factors like constipation or high blood pressure

My own bleeding stopped spontaneously after about 12 hours. I was kept in the hospital for three days for observation and to make sure the bleeding didn't recur. During this time, my diet progressed from clear liquids to soft foods before discharge. If you're facing hospitalization, our guide on what to expect during a hospital stay for diverticulitis might be helpful.

Prevention and Long-Term Management

After experiencing diverticular bleeding, preventing recurrence becomes a priority. Here are strategies to reduce your risk of future bleeding episodes.

Dietary Modifications

A high-fiber diet is the cornerstone of prevention:

Fiber Intake

Goal: 25-35 grams of fiber daily
Benefits: Softens stool, decreases pressure in the colon, and reduces strain
Sources:
- Whole grains (oats, brown rice, whole wheat)
- Fresh fruits with skins
- Vegetables (especially leafy greens)
- Legumes (beans, lentils, peas)
- Seeds (chia, flax)

Our complete diverticulitis diet guide provides more detailed information on transitioning through different dietary stages.

Anti-Inflammatory Foods

Some evidence suggests that chronic inflammation may contribute to vessel weakening:

Fatty fish rich in omega-3s (salmon, mackerel)
Olive oil
Nuts and seeds
Fruits and vegetables rich in antioxidants
Turmeric and ginger

For more detailed guidance, check out our article on anti-inflammatory foods that may help diverticulitis.

My Approach: After my bleeding episode, I worked with a dietitian to gradually increase my fiber intake. I found that adding ground flaxseed to my morning oatmeal and incorporating a large salad daily were easy ways to boost my fiber consumption without causing digestive upset.

Medication Management

Working with your healthcare providers to review your medications is crucial:

Medications to Discuss

Anticoagulants: Sometimes unavoidable for conditions like atrial fibrillation or blood clots
Aspirin: Risk vs. benefit assessment needed, especially for those with heart disease
NSAIDs: Consider alternatives for pain and inflammation
Steroids: Minimize use when possible

Potential Alternatives

Acetaminophen (Tylenol) instead of NSAIDs for pain
Alternative anti-inflammatory approaches like physical therapy or heat therapy
Enteric-coated aspirin or lower doses if aspirin is necessary

Lifestyle Modifications

Several lifestyle changes can reduce your risk:

Regular physical activity promotes healthy bowel function (aim for 30 minutes daily)
Adequate hydration helps prevent constipation (minimum 8 cups of fluid daily)
Weight management reduces strain on your digestive system
Smoking cessation improves blood vessel health
Stress reduction may help decrease intestinal contractions and pressure

For more comprehensive advice on daily management, see our guide on living with diverticulitis.

Follow-Up Care

Regular medical follow-up is important after a bleeding episode:

Colonoscopy: If not performed during hospitalization, usually recommended within 2-3 months
Regular check-ups with your gastroenterologist or primary care physician
Blood count monitoring if you had significant blood loss
Blood pressure control through regular monitoring and medication if needed

I now see my gastroenterologist every six months for regular monitoring. We've developed a solid plan that includes colonoscopy every 3-5 years and prompt attention to any rectal bleeding, no matter how minor it seems. Building a good healthcare team is essential for long-term management.

When to Seek Emergency Care

Knowing when to go to the emergency room can be lifesaving with diverticular bleeding.

Red Flag Symptoms Requiring Immediate Care

Call 911 or go to the emergency room immediately if you experience:

Continuous or heavy rectal bleeding (more than a few tablespoons)
Blood clots in your stool
Lightheadedness, dizziness, or fainting
Rapid heart rate or palpitations
Shortness of breath
Confusion or altered mental status
Severe weakness
Cold, clammy skin

How to Prepare for an Emergency

Keep an updated emergency information card with you that includes:

Your diagnosis of diverticular disease
Current medications, especially blood thinners
Previous history of diverticular bleeding (if applicable)
Allergies
Emergency contact information
Healthcare provider contact information

For more comprehensive preparation, download our printable emergency card template and consider developing a complete diverticulitis emergency plan.

Practical Tip: I keep a "Diverticular Disease Emergency Card" in my wallet with all this information. I also have a more detailed version in a note on my phone, including my gastroenterologist's contact information and my recent hemoglobin values as a baseline comparison.

What to Tell Emergency Personnel

Be sure to communicate:

That you have diverticular disease
Whether you're on blood thinners or medications that increase bleeding risk
The amount and color of blood you've passed
When the bleeding started and whether it's continuing
Any associated symptoms (dizziness, weakness, pain)
Previous episodes of diverticular bleeding (if any)

Being specific about your symptoms helps emergency providers make faster, more accurate assessments about your condition.

Living with the Risk of Diverticular Bleeding

Learning to live with the possibility of recurrent bleeding can be challenging. Here are strategies for maintaining quality of life while managing this risk.

Managing Anxiety and Fear

It's normal to worry about another bleeding episode:

Education: Understanding the condition often reduces fear
Control what you can: Follow prevention strategies diligently
Develop an action plan: Knowing exactly what to do if bleeding recurs can provide peace of mind
Consider therapy: Cognitive-behavioral therapy can help with health anxiety
Relaxation techniques: Meditation, deep breathing, and progressive muscle relaxation can reduce stress

The psychological impact of diverticular disease shouldn't be underestimated. For more on this topic, read our article on diverticulitis and mental health.

My Journey: After my bleeding episode, I experienced significant anxiety any time I used the bathroom. Working with a therapist helped me develop coping strategies and put the risk in perspective. I've learned that preparation and knowledge reduce my anxiety more effectively than avoidance or worry.

Communicating with Loved Ones

Sharing information with family and close friends is important:

Educate your inner circle about diverticular disease and bleeding risks
Create an emergency plan that includes who to call and what to do
Designate a health advocate who can speak for you in an emergency
Be open about your concerns without letting them dominate your relationships

My wife and I have developed a simple code word that means "I need to go to the ER now." This prevents panic but ensures quick action when needed. We've also made sure our adult children understand the condition and know what to do if they're visiting when a problem occurs.

Finding Community Support

Connecting with others who understand can be invaluable:

Online support groups like the Diverticulitis Support Group on Facebook
Patient forums where experiences and coping strategies are shared
Local support groups through hospitals or community centers
One-on-one connections with others who have experienced diverticular bleeding

For help finding these resources, check out our guide on finding a diverticulitis support group. Hearing others' stories of successful management and long periods without recurrence can provide hope and practical strategies for your own journey.

Conclusion: Knowledge is Power

Diverticular bleeding can be frightening, but understanding what's happening in your body, recognizing symptoms, and knowing when to seek help can make all the difference in outcomes and quality of life.

Remember:

Most diverticular bleeding stops on its own without surgical intervention
The risk of rebleeding is about 25%, meaning 75% of people never have another episode
Mortality from diverticular bleeding is low when prompt medical attention is received
Preventive strategies can significantly reduce your risk

As someone who's been through it, I can tell you that while diverticular bleeding is undoubtedly scary, it's also manageable. With the right knowledge, medical care, and lifestyle adaptations, you can continue to live a full, active life despite this risk.

If you have diverticular disease, talk to your healthcare provider about your personal risk factors and develop a tailored prevention plan. And if you ever experience rectal bleeding, don't hesitate to seek medical attention—early intervention saves lives and prevents complications.

Have You Experienced Diverticular Bleeding?

I'd love to hear about your experiences in the comments below. Sharing our stories helps others feel less alone and provides valuable real-world insights that complement medical advice.

Frequently Asked Questions About Diverticular Bleeding

Q: Can diverticular bleeding be fatal?
A: While diverticular bleeding can be serious, it is rarely fatal when treated promptly. The mortality rate is less than 5% with appropriate medical care. However, if left untreated, it can lead to serious complications like sepsis.

Q: How long does diverticular bleeding typically last?
A: Most episodes of diverticular bleeding (about 75%) stop spontaneously within 24-48 hours. Persistent bleeding beyond this timeframe usually requires intervention.

Q: Can I prevent diverticular bleeding entirely?
A: While no prevention strategy is 100% effective, maintaining a high-fiber diet, staying well-hydrated, exercising regularly, and managing medications that increase bleeding risk can significantly reduce your chances of experiencing diverticular bleeding.

Q: Will I need surgery if I have diverticular bleeding?
A: Surgery is required in only about 5-10% of cases, typically when bleeding is severe, recurrent, or cannot be controlled by other means. Learn more about surgical options for diverticular disease.

Q: Does diverticular bleeding always require hospitalization?
A: Yes, any significant rectal bleeding should be evaluated in a hospital setting. Even if the bleeding appears to stop, medical monitoring is important to ensure stability and determine the cause. Our guide on hospitalization for diverticulitis can help you prepare.

Disclaimer: This article is based on personal experience and medical research but is not a substitute for professional medical advice. Always consult with a healthcare provider regarding your specific health situation.

References:

American Society for Gastrointestinal Endoscopy. "The Management of Diverticulitis." Gastrointestinal Endoscopy, 2020.
American College of Gastroenterology Guidelines for Management of Acute Lower Gastrointestinal Bleeding, 2023.
Mayo Clinic. "Diverticular Bleeding," Mayo Foundation for Medical Education and Research, 2022.
Strate, L.L., et al. "The Role of Colonoscopy in the Management of Patients with Lower GI Bleeding," Gastrointestinal Endoscopy, 2021.
National Institute of Diabetes and Digestive and Kidney Diseases. "Diverticular Disease." 2023.