Chatting about your diverticulitis isn’t exactly party talk. This unpleasant condition, which occurs when tiny pouches inside the large intestine become inflamed, can cause intense lower abdominal pain, diarrhea, constipation, a fever, and sometimes a good deal of rectal bleeding. Following a liquid diet for a while can help treat diverticulitis, but antibiotics, and sometimes even surgery, may be needed. A few years ago, a study published in The Journal of the American Medical Association found that hospital admissions for elective surgery for diverticulitis had increased 25% to 30% and that surgery for diverticulitis may was likely overused.
The researchers reviewed the results of 80 studies of diverticulitis and its treatment. While the team agreed that antibiotic use and surgery are sometimes necessary for diverticulitis, it concluded that there should be a lesser role for aggressive antibiotic or surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary.
“I’d be loath to say don’t give antibiotics to patients with diverticulitis. It depends if they have clear cut diverticulitis accompanied by pain, fever, elevated white blood cell count, and an abnormal physical exam. You have to see if they have these findings,” says Dr. Norton Greenberger, a gastroenterologist and professor of medicine at Harvard Medical School. “If these are absent, the patient may have just symptomatic diverticular disease.”
“Likewise, some people need surgery, especially if they’ve had two episodes of diverticulitis in a six-month period,” says Dr. Greenberger. He feels the study isn’t clear on how many people who received surgery had recurring bouts of diverticulitis.
In other words, treatments for diverticulitis need to be individualized.
It’s also helpful to learn more about diverticulitis, because, while not entirely common, it happens to be the end stage of a common condition known as diverticulosis, which a third of all American adults have and likely don’t even realize.
You have diverticulosis if you have diverticula, pouch-like structures that form in the muscular wall of the colon. They’re usually harmless. In some people, though, the pouches become inflamed and infected (called diverticulitis), or they may bleed.
How often does diverticulosis morph into diverticulitis? Thankfully, not often. A recent study in Clinical Gastroenterology and Hepatology found that it happens only about 4% of the time. That contradicts prevailing thinking that 10% to 25% of people with diverticulosis go on to develop diverticulitis.
We don’t know who will develop diverticulitis or a diverticular bleed, but there are some factors that increase the odds of that happening. One is age: 70% of people age 80 and older have the condition. Other risk factors include obesity, a lack of exercise, and a diet low in fiber.
Will exercising, controlling your weight, and eating a high-fiber diet prevent diverticular disease? Possibly, but there isn’t yet convincing proof of it. But we do know that diet plays an important role in colon health. It brings relief from constipation, better cholesterol control, and makes for more filling meals that help you maintain a healthy weight.
How much fiber should you aim for? Adults should get 25 to 30 grams of dietary fiber every day. It’s best to get it from high-fiber foods, such as beans, whole grains, vegetables, and fruits. If you can’t get that amount from food, talk with your doctor or a nutrition professional about taking a fiber supplement. Add the fiber gradually, since adding it to your diet too fast can cause gas and bloating.
Sugar is another big culprit. It plays a part in symptomatic diverticular disease and may mimic irritable bowel syndrome. “I can’t tell you how many patients with irritable bowel drink two to three cans of cola a day,” says Dr. Greenberger.
More fiber can also bring relief to a condition with symptoms similar to diverticulosis and diverticulitis called myochosis, which is part of the spectrum of diverticular disease. It’s a thickening of the circular and longitudinal muscle layers of the colon and is often responsible for lower abdominal pain, passage of pencil thin stools, and pain with defecation.
Dr. Greenberger points to other foods and drinks that can cause problems in people with underlying diverticular disease and irritable bowel, which have overlapping symptoms. These include:
- Brussels sprouts
- cola beverages
- foods and drinks with added sugar (including syrup and orange juice)
- dairy products
You can read more about improving digestive health in Dr. Greenberger’s book, 4 Weeks to Healthy Digestion: A Harvard Doctor’s Proven Plan for Reducing Symptoms of Diarrhea, Constipation, Heartburn, and More, or in The Sensitive Gut, a Special Health Report from Harvard Medical School.
Both publications can help you feel better. And that will give you something to talk about at your next party.
- Diverticular Disease and Diet
- Diet for Diverticulosis
- Diet for Diverticulitis
- Diverticular disease and diverticulitis
- What’s the difference between diverticulitis and diverticulosis?
- What causes diverticulitis?
- Risk factors
- Symptoms of diverticulosis
- Diverticulitis symptoms
- Treatment of diverticulosis
- Treatment of diverticulitis
- What to eat if you have diverticular disease
- Does diverticular disease cause cancer?
- Remember …
- Diverticulosis and Diverticulitis
- Diverticulitis: What You Need to Know
- The Problem: Diverticulitis
- Diverticulitis: What’s the Cause?
- Diagnosing and Treating Diverticulitis
- When Should I go to the Emergency Department?
Diverticular Disease and Diet
Diverticulosis is a condition in which small, bulging pouches (diverticuli) form inside the lower part of the intestine, usually in the colon. Constipation and straining during bowel movements can worsen the condition. A diet rich in fiber can help keep stools soft and prevent inflammation.
Diverticulitis occurs when the pouches in the colon become infected or inflamed. Dietary changes can help the colon heal.
Fiber is an important part of the diet for patients with diverticulosis. A high-fiber diet softens and gives bulk to the stool, allowing it to pass quickly and easily.
Diet for Diverticulosis
Eat a high-fiber diet when you have diverticulosis. Fiber softens the stool and helps prevent constipation. It also can help decrease pressure in the colon and help prevent flare-ups of diverticulitis.
High-fiber foods include:
- Beans and legumes
- Bran, whole wheat bread and whole grain cereals such as oatmeal
- Brown and wild rice
- Fruits such as apples, bananas and pears
- Vegetables such as broccoli, carrots, corn and squash
- Whole wheat pasta
If you currently don’t have a diet high in fiber, you should add fiber gradually. This helps avoid bloating and abdominal discomfort. The target is to eat 25 to 30 grams of fiber daily. Drink at least 8 cups of fluid daily. Fluid will help soften your stool. Exercise also promotes bowel movement and helps prevent constipation.
When the colon is not inflamed, eat popcorn, nuts and seeds as tolerated.
Diet for Diverticulitis
During flare ups of diverticulitis, follow a clear liquid diet. Your doctor will let you know when to progress from clear liquids to low fiber solids and then back to your normal diet.
A clear liquid diet means no solid foods. Juices should have no pulp. During the clear liquid diet, you may consume:
- Clear juices such as apple, cranberry and grape. (Avoid orange juice)
When you’re able to eat solid food, choose low fiber foods while healing. Low fiber foods include:
- Canned or cooked fruit without seeds or skin, such as applesauce and melon
- Canned or well cooked vegetables without seeds and skin
- Dairy products such as cheese, milk and yogurt
- Low-fiber cereal
- Meat that is ground or tender and well cooked
- White bread and white rice
After symptoms improve, usually within two to four days, you may add 5 to 15 grams of fiber a day back into your diet. Resume your high fiber diet when you no longer have symptoms.
Diverticular disease and diverticulitis
Diverticular disease is a condition in which small pockets or out-pouchings called diverticula occur in the wall of the bowel. Diverticula can remain trouble-free or they can become inflamed or infected and cause symptoms, which is known as diverticulitis. Diverticulitis can be a medical emergency.
What’s the difference between diverticulitis and diverticulosis?
- Diverticulitis is when the out-pouchings become inflamed or infected.
- Diverticulosis is when the out-pouchings are present without any inflammation.
What causes diverticulitis?
Eating a low-fibre (‘Western’) diet results in stools with a hard consistency that require high pressures to be generated in the bowel in order to push stools along and pass them. Diverticular disease is thought to result from these high pressures in the bowel forcing the lining of the bowel to pocket outwards through the surrounding muscle layer of the bowel, causing pouches.
Diverticulitis occurs when faecal matter becomes lodged in the pouches and causes inflammation or infection.
Diverticular disease is common, especially in countries like Australia where people generally eat a low-fibre diet. A third of Australian adults aged over 45 have it and about half of Australians older than 75 years, although for most their diverticula cause them no problems and they don’t know they have it. People who eat a diet high in fibre are much less likely to develop diverticular disease.
Young people who are obese have a raised risk, and more women than men have diverticular disease.
Symptoms of diverticulosis
Diverticular disease generally causes no symptoms – only 1 in 4 people with it will have symptoms. Some people have:
- Alternating bowel habit that alternates between constipation and diarrhoea.
- Intermittent lower abdominal pain, usually on the left side, brought on by eating and that’s relieved by passing wind or going to the toilet.
A mild attack of diverticulitis may come and go of its own accord in a few days. However, diverticulitis can be a medical emergency. If the pouches retain faeces they can become inflamed and infected causing signs and symptoms of diverticulitis that may include:
- Left-sided abdominal pain: The most common symptom of diverticulitis is left-sided abdominal pain that doesn’t go away. It may persist for several days. Asian people may experience pain on the right-hand side.
- Tender abdomen: especially on the lower left side.
- Mild cramping.
- Fever or high temperature.
- Constipation or diarrhoea
- Nausea, feeling sick and/or vomiting.
- Loss of appetite.
- Change in bowel habit.
- Rectal bleeding: bright red blood passed from the rectum.
Some of these symptoms are common to many conditions, so their presence does not always mean you have diverticular disease, but you should see your doctor as soon as possible for advice if they occur. Some people with diverticulitis will go on to develop complications.
If complications develop, symptoms can include bleeding from the bowel (when a blood vessel in the pouch breaks), or increasing and persistent pain and fever (when an abscess develops and/or ruptures or the pouch itself ruptures into the abdominal cavity). Although rare, these complications of diverticulitis are serious and usually require emergency treatment in hospital.
The most common serious complications of diverticulitis are:
- Sudden and significant bleeding from the bowel. This is usually bright red blood and painless, but requires admission to hospital. Many cases stop bleeding spontaneously, but a blood transfusion is sometimes necessary.
- Abscess: This is a collection of pus that forms in the infected pouch. Antibiotics may clear up the abscess, or it may need to be drained surgically.
- Perforated bowel: This is when a hole develops in the infected pouch in the bowel wall.
- Peritonitis: If the perforation in the bowel wall leaks pus into the abdominal cavity, it will cause peritonitis. Peritonitis can be fatal and needs immediate attention. Fortunately, peritonitis from diverticulitis is rare.
- Fistulas: A fistula is an abnormal connection or channel that forms between 2 organs of the body or an organ and the outside of the body. Diverticulitis may cause fistulas between the bowel and the bladder, or the bowel and the vagina. They arise in diverticulitis if infection causes the organs to stick together. Fistulas may need surgical repair.
- Bowel obstruction: this is when the bowel (colon) becomes blocked either partially or completely. It is caused by scarring from the infection. If the bowel is totally blocked emergency surgery will be necessary.
Diverticulosis, when the pouches are not inflamed or infected, is often diagnosed by chance during investigations for other bowel problems.
These may include:
- Colonoscopy: a thin tube with a lighted camera is inserted into your rectum and the doctor can see the pouches, if there are any.
- Barium enema: pouches can be easily seen on a barium enema test, although this test is rarely done now.
Diverticulitis is usually diagnosed during investigation for an attack that’s in progress. To diagnose diverticulitis your doctor will first discuss your medical history and your symptoms and do a physical examination. They may suggest you first have tests to exclude other diseases as the cause of your symptoms.
Some of the tests and examinations that may be done are:
- Pelvic examination: Women may need a pelvic examination to rule out any problems in the pelvis.
- Digital rectal examination: The doctor inserts a gloved finger into your rectum to check for any tenderness or blockage.
- Blood test: This may be done to check your white cell count, to see if there are any signs of infection and to check your red cell count, to see if you are losing blood somehow.
- CT scan of the abdomen: a CT scan is a type of X-ray – this can show up inflamed pouches of the bowel and confirm a diagnosis of diverticulitis. This is usually the definitive investigation to confirm diverticulitis.
Colonoscopy and barium enema are not usually done when a person is having an attack of diverticulitis because of the risk of perforating the bowel or spreading infection.
Treatment of diverticulosis
People with bowel pouches which have not become inflamed are generally recommended to:
- Change to a high-fibre diet (see below) to reduce the risk of symptoms and complications developing.
- Consume plenty of fluids (to avoid constipation).
- Take bulk-forming laxatives, if they cannot achieve a high-fibre diet otherwise, or they get constipation or diarrhoea. Examples are unprocessed wheat bran or psyllium seed husks (available from pharmacies under various brand names).
Treatment of diverticulitis
When the bowel pouches have become inflamed (diverticulitis), treatment is aimed at:
- Resting the bowel, initially with a low-residue diet (low fibre or fluid-only).
- Relieving pain with analgesic medicines (painkillers), usually paracetamol. Don’t take aspirin or ibuprofen as they increase the risk of internal bleeding and stomach upsets.
If there are signs of a generalised infection, such as a raised white cell count or fever, then also:
- Fighting infection with antibiotics.
Treatment of a mild attack of diverticulitis may be carried out at home, and if caught early enough may respond to antibiotics in a few days.
If there are serious complications of diverticulitis, such as significant bleeding, an abscess that isn’t healed with antibiotics, rupture of pouches, or pain that can’t be managed, then hospital treatment will be required, which may include transfusion to replace lost blood, stronger painkillers (than paracetamol) and intravenous fluids, given by a drip. A small number of people will require emergency surgery to remove the affected area of bowel. This may result in them having a temporary colostomy.
Sometimes non-emergency surgery is planned to remove an area of bowel containing diverticula which have caused recurring diverticulitis in the past or which have joined onto another structure such as the bladder.
Keyhole (laparoscopic) surgery can sometimes be carried out for non-urgent removal of diseased areas.
There are some lifestyle changes you can make that will reduce the likelihood of you getting diverticular disease and that will lessen the chance of an attack of diverticulitis.
- An adequate intake of dietary fibre keeps stools soft and prevents constipation. Good sources of dietary fibre are apples and pears, along with other fresh fruits, vegetables and wholegrain cereals. Baked beans and legumes, such as kidney beans and lima beans, are very high in fibre, but may cause problems with wind in some people. A simple way to increase the fibre in your diet is to add a bulking agent such as unprocessed wheat bran or psyllium seed husks. Australian recommendations for fibre intake are 30 g fibre/day for men and 25 g fibre/day for women.
- Regular exercise protects against developing it.
- Adequate water intake will help process the fibre and keep stools soft.
What to eat if you have diverticular disease
Sometimes people are given advice to avoid certain foods, such as nuts, pips, seeds and corn, however, there is no real evidence to support this advice. As mentioned above, ensure you have a good fibre intake and drink enough water to keep your stools soft.
Does diverticular disease cause cancer?
There doesn’t seem to be any link between diverticular disease and bowel cancer. Having diverticulosis or diverticulitis does not increase the risk of getting bowel cancer.
- Most people don’t have any symptoms.
- People who develop diverticulitis in most cases get better quickly with antibiotic treatment.
- Complications of diverticulitis that require surgery are serious, but occur in only a minority of people.
- The most important aspect of managing diverticular disease and avoiding both symptoms and complications is eating a diet that is high in fibre.
Last Reviewed: 24/05/2016
Diverticulosis and Diverticulitis
Diverticula are small pouches that bulge outward through the colon, or large intestine. If you have these pouches, you have a condition called diverticulosis. It becomes more common as people age. About half of all people over age 60 have it. Doctors believe the main cause is a low-fiber diet.
Most people with diverticulosis don’t have symptoms. Sometimes it causes mild cramps, bloating or constipation. Diverticulosis is often found through tests ordered for something else. For example, it is often found during a colonoscopy to screen for cancer. A high-fiber diet and mild pain reliever will often relieve symptoms.
If the pouches become inflamed or infected, you have a condition called diverticulitis. The most common symptom is abdominal pain, usually on the left side. You may also have fever, nausea, vomiting, chills, cramping, and constipation. In serious cases, diverticulitis can lead to bleeding, tears, or blockages. Your doctor will do a physical exam and imaging tests to diagnose it. Treatment may include antibiotics, pain relievers, and a liquid diet. A serious case may require a hospital stay or surgery.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Diverticulitis: What You Need to Know
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Diverticulosis is small, bulging sacs or pouches that form in the inner lining of the intestine – usually the colon.
Symptoms of diverticulosis are usually dormant. “Actually, more than half of all patients over the age of 60 have diverticulosis,” explains Carmen Meier MD, a gastroenterologist at the TriHealth Digestive Institute. “Most people who have these pockets never get any trouble with it.”
The Problem: Diverticulitis
The real issue occurs when a small piece of stool becomes trapped in these pouches, causing them to become inflamed or infected, resulting in diverticulitis. That’s when the symptoms start – and they’re usually severe and very sudden. Symptoms of diverticulitis include:
- Tenderness, usually in the left lower side of the abdomen
- Bloating or gas
- Fever and chills
- Nausea and vomiting
- Not feeling hungry and not eating
Diverticulitis: What’s the Cause?
While we do not have a clear understanding of what makes someone predisposed to developing diverticulosis or diverticulitis, eating a low-fiber diet likely plays a role. Eating a diet rich in processed foods, and low in fiber, usually results in harder stools, which are difficult to pass, thus increasing the pressure in the colon or intestines, often resulting in the formation of these pouches.
“We used to think that fiber was sort of protective. Unfortunately, there has recently been a study that has sort of questioned that,” Dr. Meier points out. However, “I think most of us still recommend increased fiber intake because it’s good for a lot of other things, as well.”
Doctors are unsure as to whether genetics play a role in developing diverticulitis; however, they do know that age does. Diverticulitis is especially common in those over age 60, and is equally common in women and men.
Diagnosing and Treating Diverticulitis
If you notice symptoms of diverticulitis, depending on severity, you should either go to the emergency department or schedule an appointment with your doctor right away. From there, your doctor will administer a blood test to see if you have an infection. Other tests that help diagnose diverticulitis include:
- CT scan
- Ultrasound of the abdomen
- X-rays of the abdomen
Most cases of diverticulitis can be treated at home with oral antibiotics. Your doctor will likely recommend resting in bed, taking pain medicines (check with your doctor on which ones to take), and drinking mainly fluids for a day or two to help manage pain.
When Should I go to the Emergency Department?
If you are in severe pain and cannot get in to see your doctor, Dr. Meier says it is best to be evaluated in the emergency department. In this situation, you will probably be treated with intravenous antibiotics. “Also, in these cases, we want to make sure there’s no complications … like an actual hole – a larger hole in the colon – which can form an abscess,” Dr. Meier explains.
In rare cases, surgical intervention is needed.
Last Updated: June 25, 2013