Symptoms of diverticulitis and treatment

Could a Home Remedy for Diverticulitis Be the Answer to Your Abdominal Pain?

Many people feel better without any treatment, but many need antibiotics. Your doctor may recommend dietary changes to help treat your symptoms, especially if your condition is mild. There are other home remedies for diverticulitis that may help as well.

Liquid diet

For an acute episode of diverticulitis, your doctor may recommend a liquid diet. You may also be asked to follow a clear liquid diet for a couple of days before switching to a low-fiber diet to help rest your digestive system.

Clear liquid diet

  • broth
  • ice popsicles without fruit pieces or pulp
  • gelatin
  • pulp-free juice, such as apple
  • water
  • coffee or tea without milk or cream

Follow your doctor’s instructions, and don’t stay on the liquid diet longer than recommended. Begin adding low-fiber foods to your diet as you start feeling better.

Low-fiber foods

  • cooked or canned fruits without skin or seeds
  • cooked or canned vegetables without skin
  • pulp-free fruit and vegetable juice
  • eggs and poultry
  • fish
  • milk, yogurt, and cheese
  • white pasta and rice
  • refined white bread

Over-the-counter medications

Over-the-counter (OTC) medications, such as acetaminophen (Tylenol), may help relieve some of your pain. Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) aren’t recommended because they increase the risk of bleeding and other complications.

A fiber supplement, such as psyllium (Metamucil) or methylcellulose (Citrucel), may help with constipation and diarrhea. They help by bulking up your stool and making it easier to pass. Fiber supplements can cause gas and bloating when you first begin taking them. Speak to your doctor before adding a fiber supplement to your diet.

Shop for fiber supplements.

Probiotics

Some studies show that probiotics reduce symptoms of diverticulitis, though more research is needed.

Probiotics are “good” bacteria similar to those that occur in your digestive tract to keep you healthy. They’re available OTC in capsule, tablet, and powder form. They’re also found in some foods, such as yogurt and fermented vegetables.

There are different types of probiotics and each has different strains. Strains of the bacteria, mainly Lactobacillus casei, appear to be the most effective according to research.

Shop for probiotics.

High-fiber diet

The American Gastroenterological Association suggests that people with a history of acute diverticulitis eat a diet rich in fiber or add a fiber supplement to their diet. A high-fiber diet may help ease or prevent symptoms of diverticulitis, though currently there’s only low-quality evidence of its benefits.

Foods that are high in fiber may cause gas and pain, so gradually increasing your fiber intake is important. The current Dietary Guidelines of Americans recommends 14 grams of dietary fiber per 1,000 calories consumed. That would be 28 grams of fiber per day for a diet of 2,000 calories.

High fiber foods

  • fruits, such as raspberries, apples, and pears
  • vegetables, including broccoli, green peas, and artichoke
  • cereals and grains, such as oatmeal, bran flakes, and barley
  • legumes, including lentils, split peas, and black beans

Aloe

Aloe vera is believed to have many health benefits, including preventing constipation. It may also be effective in relieving pain and cramping.

You can buy aloe vera juice in most grocery and health food stores. Drink two ounces of aloe a day to help soothe and prevent symptoms.

Shop for aloe vera juice.

Digestive enzymes

Digestive enzymes are proteins produced by your stomach, small intestine, salivary glands, and pancreas. They help break down food during digestion and kill toxins. The enzymes found in papayas and pears are believed to help reduce intestinal inflammation and speed up healing.

While there’s no scientific evidence available on the benefits of digestive enzymes specifically for diverticulitis, a 2014 study found that they can relieve abdominal pain and other common stomach complaints.

Digestive enzymes are sold online and in stores with other supplements and are found in foods like papayas, pears, and pineapples.

Shop for digestive enzymes.

Herbs

Some herbs have been shown to be effective in reducing inflammation and fighting infection. Some herbs that may be helpful for diverticulitis include:

  • Garlic. Studies have found that garlic has antimicrobial and antiviral effects that may help prevent infection. There’s also evidence that garlic may improve digestion and constipation.
  • Green tea. Green tea is known to have many health benefits, some of which may be helpful in relieving or preventing symptoms. Green tea has anti-inflammatory, antiviral, and antibacterial properties which can reduce inflammation and lower your risk of infection.
  • Ginger. Ginger has been used as an herbal medication for the treatment of various gastrointestinal ailments for centuries, including nausea, vomiting, and diarrhea.
  • Turmeric. Turmeric has been used an herbal remedy in China and India for centuries. In recent years, clinical studies have shown it to have several benefits, many related to the digestive system. The anti-inflammatory effect of turmeric may protect the digestive tract, increase the secretion of some enzymes, and relieve pain.

Acupuncture

Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into strategic points on the body. It’s most commonly used to treat pain and stress, but some evidence suggests that it may also treat constipation.

Essential oils

While there’s no evidence to support online claims that essential oils have any effect on diverticulitis, they can promote relaxation, relieve stress, and improve pain.

A 2015 study found that diluted lavender oil applied topically provides pain relief similar to that of tramadol, a prescription pain medication. A systematic review published in 2016 found that aromatherapy has a significant positive effect on pain.

Essential oils shouldn’t be taken by mouth. Some diluted oils can be applied to your skin, added to your bathwater, or diffused.

Symptoms & Causes of Diverticular Disease

In this section:

  • What are the symptoms of diverticulosis?
  • What are the symptoms of diverticular bleeding?
  • What are the symptoms of diverticulitis?
  • What causes diverticulosis and diverticulitis?

What are the symptoms of diverticulosis?

Most people with diverticulosis do not have symptoms. If your diverticulosis causes symptoms, they may include

  • bloating
  • constipation or diarrhea
  • cramping or pain in your lower abdomen

Other conditions, such as irritable bowel syndrome and peptic ulcers, cause similar symptoms, so these symptoms may not mean you have diverticulosis. If you have these symptoms, see your doctor.

If you have symptoms such as bloating, constipation or diarrhea, or pain in your lower abdomen, see your doctor.

If you have diverticulosis and develop diverticular bleeding or diverticulitis, these conditions also cause symptoms.

What are the symptoms of diverticular bleeding?

In most cases, when you have diverticular bleeding, you will suddenly have a large amount of red or maroon-colored blood in your stool.

Diverticular bleeding may also cause dizziness or light-headedness, or weakness. See your doctor right away if you have any of these symptoms.

What are the symptoms of diverticulitis?

When you have diverticulitis, the inflamed pouches most often cause pain in the lower left side of your abdomen. The pain is usually severe and comes on suddenly, though it can also be mild and get worse over several days. The intensity of the pain can change over time.

Diverticulitis may also cause

  • constipation or diarrhea
  • fevers and chills
  • nausea or vomiting

What causes diverticulosis and diverticulitis?

Experts are not sure what causes diverticulosis and diverticulitis. Researchers are studying several factors that may play a role in causing these conditions.

Fiber

For more than 50 years, experts thought that following a low-fiber diet led to diverticulosis. However, recent research has found that a low-fiber diet may not play a role. This study also found that a high-fiber diet with more frequent bowel movements may be linked with a greater chance of having diverticulosis.4 Talk with your doctor about how much fiber you should include in your diet.

Genes

Some studies suggest that genes may make some people more likely to develop diverticulosis and diverticulitis. Experts are still studying the role genes play in causing these conditions.

Other factors

Studies have found links between diverticular disease—diverticulosis that causes symptoms or problems such as diverticular bleeding or diverticulitis—and the following factors:

  • certain medicines—including nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, and steroids
  • lack of exercise
  • obesity
  • smoking

Diverticulitis may begin when bacteria or stool get caught in a pouch in your colon. A decrease in healthy bacteria and an increase in disease-causing bacteria in your colon may also lead to diverticulitis.

When to Go to the Emergency Room for Diverticulitis

Diverticulitis is a potentially serious condition that occurs when pockets of diverticula form in the colon and then become inflamed. These pockets can cause serious pain in the abdomen and can have deadly consequences if not treated properly and promptly. While it is common for this condition to be treated simply with medication and diet change, there are symptoms that you should look for that tell you when to go to the emergency room for diverticulitis.

Symptoms that mimic Diverticulitis

There are multiple other conditions that show the same symptoms as diverticulitis. Some of these conditions can be deadly if not treated right away; these conditions include:

• Appendicitis
• IBS (Irritable Bowel Syndrome)
• Various trauma to rectum and bowl such as fishbones or toothpicks
• Colon Cancer
• Urinary Tract Infection
• Pelvic Inflammatory Disease

While conditions like IBS or UTI can be treated easily with antibiotics, it is important to seek emergency treatment right away if the symptoms could be appendicitis (pain in the lower right side of the abdomen), Colon cancer (pain with bowel movements, lack of bowel movements or blood in stool). Blockages can also be either similar or secondary to that of diverticulitis and require immediate medical treatment.

When to go to the ER For Diverticulitis

There are a few symptoms of Diverticulitis that should never be ignored. These symptoms point to a more serious complication of the condition and typically require a 2-day stay in the hospital for IV antibiotics and in more serious cases, surgery. These symptoms include excessive vomiting and severe nausea, fever of over 100 with or without chills or loss or sudden change in appetite.

The emergency room can be a scary place which is why more and more patients are finding stand-alone emergency departments are a better fit for their needs. Places like Physicians Premier offer the same treatments as those found in hospitals, but without the hospital environment. If a hospital stay is required for treatment, the facility will arrange transport to the hospital. In any case, if you experience any of the severe symptoms of diverticulitis or one of the symptoms that mimic something potentially more serious, you should go to the emergency room for treatment as soon as possible.

Other Locations:

  • Saratoga Emergency Room
  • Staples Corpus Christi Emergency Room
  • Ennis Joslin South Padre Island Emergency Room
  • Portland Texas Emergency Room
  • Calallen Texas Emergency Room
  • San Antonio Emergency Room
  • New Braunfels Emergency Room
  • Bryan Emergency Room
  • Bulverde Emergency Room

UCLA researchers interviewed people with diverticulitis and confirmed that many suffer psychological and physical symptoms long after their acute illness has passed.

For the study, published this week in the peer-reviewed journal Quality of Life Research, a UCLA team led by Dr. Brennan Spiegel interviewed patients in great detail about the symptoms they experience weeks, months or even years after an acute diverticulitis attack. Their striking findings add to growing evidence that, for some patients, diverticulitis goes beyond isolated attacks and can lead to a chronic condition that mimics irritable bowel syndrome.

As they age, most people develop diverticulosis, a disorder characterized by the formation of pouches in the lining of the colon. More than 50 percent of people over 60 have the condition, but the pouches usually don’t cause any problems. Occasionally, however, the pouches become inflamed, leading to a related disorder called diverticulitis, which causes pain and infection in the abdomen. Doctors usually treat diverticulitis with antibiotics, or in more severe cases, surgery.

The condition has long been thought to be acute with periods of relative silence in between attacks, but according to researchers, that’s not true for everyone. Some patients experience ongoing symptoms.

In an earlier study, Spiegel and colleagues found that people suffering from diverticulitis have a four-fold higher risk of developing IBS after their illness, a condition called post-diverticulitis irritable bowel syndrome, and that patients had anxiety and depression long after the initial attack. However, that study was based on a database of more than 1,000 patients and did not draw from personal testimonials from people living with diverticulitis.

In the latest research, patients described feelings of fear, anxiety and depression, and said they had been stigmatized for having the condition. Interviewees also said they live in constant fear of having another attack, are scared to travel and feel socially isolated. In addition, many patients continue to experience bothersome physical symptoms such as bloating, watery stools, abdominal pain, incomplete evacuation and nausea.

“We dug deeper into identifying the chronic physical, emotional and behavioral symptoms that can profoundly change people’s lives after an attack of diverticulitis,” said Spiegel, a professor of medicine at the David Geffen School of Medicine at UCLA and the Fielding School of Public Health. “Our findings reveal that many people suffer silently with severe quality-of-life problems long after an acute diverticulitis attack.”

The researchers used those insights to develop a questionnaire to help doctors better assess the long-term impact of diverticulitis, which ultimately could lead to better understanding and management of the disease.

“Doctors often don’t know to ask about these ongoing symptoms,” Spiegel said. “We hope that our findings and new tool will help physicians better tailor individual treatment and reassure patients that they aren’t alone.”

To help them develop the new screening tool, researchers reviewed literature on quality-of-life measures used to gauge diverticulitis and related gastrointestinal conditions, and they interviewed experts and conducted focus groups with people who had suffered diverticulitis attacks. The team then developed a framework for the tool based on the most commonly described physical, social and psychological symptoms.

The researchers created a draft survey and tested it on 197 patients who had reported symptoms after an acute diverticulitis attack. Then, using feedback from those patients, the team refined the survey to create the final 24-question version.

“This new screening tool will help clinicians better define and manage diverticulitis,” said study author Mark Reid, principal statistician at the UCLA/VA Center for Outcomes Research and Education. “We can now screen patients for poor quality of life based on their condition and then actively manage their diverticulitis like other chronic gastrointestinal conditions.”

Spiegel said that more study is needed to help researchers understand how diverticulitis can trigger the longer-lasting symptoms.

The study was funded by Shire Pharmaceuticals.

Diverticulosis and Diverticulitis

Medically reviewed by Drugs.com. Last updated on Aug 26, 2019.

  • Health Guide
  • Disease Reference
  • Care Notes
  • Medication List
  • Q & A

What Is It?

In diverticulosis, small pouches develop and bulge out through weak spots in the walls of the colon, typically in the part of the colon called the sigmoid colon on the left side of the abdomen. These small, balloonlike pouches are called diverticula.

The condition is more prevalent as people age. For example, it is estimated that half of people in the United States aged 60 to 80 have diverticulosis, but only one person in 10 develops it by age 40. It is equally common in women and men.

If the diverticula become inflamed or infected, the condition is called diverticulitis.

Diverticulitis can lead to serious complications such as abscess, perforation, intestinal blockage from internal scarring, or fistula, which is an abnormal connection between two organs. A rare but life-threatening complication called peritonitis can occur when diverticula rupture, leaking infection into the abdominal cavity.

Symptoms

Most people who have diverticulosis don’t have any symptoms, but some have mild cramps, constipation or bloating. Diverticulitis causes more severe symptoms, including any of the following, but particularly the first two:

  • Steady abdominal pain

  • Tenderness to pressure in the lower abdomen, especially on the left side

  • Fever

  • Nausea

  • Vomiting

  • Chills

  • Cramping

  • Change in bowel habits (constipation or diarrhea)

  • Sharper pain with breathing or jarring movements such as walking.

Lower intestinal bleeding can occur in people with diverticulosis. The loss of blood can cause weakness and dizziness.

Diagnosis

If you are older than 60, you quite likely have diverticulosis. It’s that common. However, unless you have had a colonoscopy, CT scan of your abdomen or barium enema, you would not be aware they exist.

On the other hand, diverticulitis almost always causes symptoms. Your doctor will ask about your medical history, bowel habits and diet and will conduct a physical examination. Your doctor will press on your abdomen to check for tenderness.

Based on the location of your symptoms and the location of abdominal pain and tenderness, your doctor may be able to make the diagnosis without further testing. If your doctor is unsure or concerned that you may have an abscess or other complication, he or she will likely order additional studies. These usually include blood tests for signs of infection and an abdominal computed tomography (CT) scan.

Lower intestinal bleeding is commonly caused by a broken blood vessel within a diverticula. But it is often very difficult to identify the exact bleeding site, even with colonoscopy.

Expected Duration

Diverticula do not disappear unless the section of colon is removed surgically. Diverticulosis is a lifelong condition that can be managed, primarily with adjustments in diet.

Symptoms of diverticulitis or bleeding from diverticulosis may subside within a few days after treatment, may continue, or may get worse in the case of severe illness or complications.

Prevention

People whose diets contain large amounts of fiber are less likely to develop diverticular disease. The American Dietetic Association recommends 20 grams to 35 grams of fiber a day, preferably from fruits, vegetables and grains. Your doctor also may recommend unprocessed bran or a fiber product. It is important to increase fiber intake gradually and to drink more water to increase the bulk of the bowel movements, which reduces pressure inside the bowel.

Physical activity also may lower the risk of diverticulosis. Many doctors previously recommended that people with diverticulosis avoid eating nuts, popcorn and foods with seeds. This restriction has not been proven to prevent diverticulitis.

Treatment

The only possible treatment for diverticulosis is to increase fiber in the diet. Fiber will not heal existing diverticula, but it may prevent more from forming.

If you have diverticulitis, your doctor will prescribe antibiotics, and may recommend a liquid diet and bed rest to help your colon recover. If you have severe pain or an infection, you may need to be treated in a hospital so that antibiotics can be given intravenously (into a vein).

If fever continues, you may have an abscess, which can develop when a diverticulum becomes perforated (develops a hole). An abscess is a collection of pus. A surgeon then will help your doctor plan the next step: drainage or surgery. The choice depends on the extent of the problem and your overall health. Drainage means that the surgeon cleans out the pus.

Emergency surgery is required to treat peritonitis, the most serious potential complication of diverticulitis. Peritonitis requires surgical repair as well as intravenous antibiotics.

Surgery also may be required during the hospital stay to treat a particularly severe episode of diverticulitis. These include continuous bleeding, perforation of an abscess, attachment of two organs by a fistula, or colon obstruction caused by scarring from previous episodes of diverticulitis.

For persistent or recurrent bleeding from diverticulosis, surgery may be the only option.

The most common procedure, known as a colon resection, involves removing the part of the colon that contains diverticula and reattaching the ends.

When done during emergencies, a colon resection is a two-stage process. First, a section of colon is removed, but because of infection, it is not safe to rejoin the ends. Instead, the surgeon creates a temporary hole, or stoma, in the abdomen and connects the colon to it, a procedure called a colostomy. A bag is attached to collect the stool. Later, a second operation is done to reattach the end of the colon, and remove the colostomy.

After successful treatment for diverticulitis, your doctor normally will recommend a high-fiber diet. Later, you may need to have a procedure called a colonoscopy, which is an internal examination of the colon.

Surgery usually is not recommended after only one attack without complications. However, it may be recommended after a second episode occurs in the same location within the colon.

Repeated episodes of diverticulitis can lead to internal scarring and narrowing of the colon, which also may require surgery to remove a piece of the colon.

When To Call a Professional

Call your doctor if abdominal pain in one spot lasts for longer than a few hours, especially if it becomes worse or is accompanied by fever.

Prognosis

With proper treatment and a high-fiber diet, the outlook for people with diverticulosis and uncomplicated diverticulitis is excellent. Most people with diverticulosis never have symptoms.

People who are hospitalized for diverticulitis usually improve within two to four days after treatment begins. Over 85% of patients recover with bed rest, liquid diet and antibiotics, and most never have a second episode of diverticulitis.

The prognosis varies if complications develop and is particularly serious in the case of peritonitis.

About 90% of people who have a colon resection do not have symptoms return after the surgery.

External resources

National Institute of Diabetes & Digestive & Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone: 301-496-4000
http://www.niddk.nih.gov/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Diverticulitis has various symptoms that can mimic other conditions. With a thorough evaluation of your symptoms and testing, your gastroenterologist can reach a diagnosis and start a treatment plan for you.

Understanding Diverticulosis and Diverticulitis

Before you understand diverticulitis, you must first understand it occurs from a related condition, diverticulosis. Diverticulosis occurs when there are weak spots in the wall of the colon. These weak spots are called diverticula. When the weakened areas become infected or inflamed, sometimes due to trapped stool, the condition is called diverticulitis. A flare-up of diverticulitis occurs when symptoms return after a period of no symptoms.

Symptoms of Diverticulitis

Diverticulitis symptoms include pain or discomfort in the abdominal area, most commonly in the left lower quadrant. Constipation, diarrhea, fever and painful urination can occur. In severe flare-ups, nausea and vomiting are present. You should go to the ER if you experience symptoms of diverticulitis with a fever of 100.1F or more, worsening or severe abdominal pain, or if you are unable to tolerate fluids. Many of the symptoms associated with diverticulitis can mimic other conditions. Therefore, you will need medical tests for a definitive diagnosis.

Diverticulitis can be divided into simple and acute types, depending on the severity of symptoms.

Diagnosing Diverticulosis and Diverticulitis

Diverticulosis typically has no symptoms and is usually found during imaging tests to diagnose other gastrointestinal problems. Diverticulitis is diagnosed based on symptoms, laboratory tests, and an abdominal CT scan. A complete blood count (CBC) is a laboratory test used to check for an elevated white blood cell count, which can signal infection or inflammation. A urinalysis helps rule-out stones in the urinary tract. If you are a woman, a gynecological exam can rule-out ovarian or uterine growths, which can cause similar symptoms. An abdominal CT confirms a diagnosis of diverticulitis. Once a diagnosis is made, patients stay on a restricted diet varying from nothing at all by mouth to clear liquids along with antibiotics.

Risk Factors for Diverticulosis and Diverticulitis

Constipation and eating a highly-processed and low-fiber diet appear to increase the risk of developing diverticulosis. The risk of developing diverticulosis also increases as you age. Aside from constipation and having diverticulosis, there are no other known risk factors for developing diverticulitis.

Diverticulosis can be associated with large amounts of bleeding, with or without a bowel movement. Call for emergency assistance or visit the ER if you experience significant bleeding. Most episodes of bleeding resolve spontaneously but still require medical attention. A CT angiogram helps determine the site and cause of bleeding. A colonoscopy may be used to aid in diagnosis. You should always consult your doctor if you experience bleeding, with or without a bowel movement, since no amount of bleeding is normal.

Living with Diverticulitis

For those who have previously experienced a diverticulitis flare-up, one-third never have another attack, one-third may have milder attacks that do not progress to another full-blown attack, and one-third will progress to a more advanced form of diverticulitis. If you experience bleeding, you have a higher risk for subsequent bleeding episodes.

Previously, patients were mistakenly encouraged to stay away from nuts, seeds, and corn after resolution of a diverticulitis flare-up. There is no proof these foods contribute to flare-ups and this dietary change is no longer recommended. In fact, the recommendation remains a diet high in fiber once the acute attack has resolved.

Concerned your symptoms may be a diverticulitis flare-up? Contact us at Richmond Gastroenterology Associates and schedule an appointment.

Diverticular Disease (Diverticulitis) vs. IBS (Irritable Bowel Syndrome)

What Is the Treatment for Diverticular Disease vs. IBS?

Diverticular Disease

A high-fiber diet is the mainstay of diverticulosis and diverticulitis prevention.

  • Start a high-fiber diet because it will decrease the risk of complications and the accompanying symptoms; however, will not make the diverticula a person has go away. Foods high in fiber include:
    • Whole-grain cereals and breads
    • Fruits (apples, berries, peaches, pears)
    • Vegetables (squash, broccoli, cabbage, and spinach)
    • Beans, peas, and lentils.
  • Drinking plenty of fluids will also help the stool stay soft and pass quickly to prevent constipation and decrease the risk for diverticulosis.
  • Get plenty of physical activity to keep bowels functioning properly.

In the past patients with diverticulosis/diverticulitis were told that foods to avoid included seeds, corn, and nuts because it was thought fragments of these foods would get stuck in the diverticula and cause inflammation. However, current research has not found this to be the case, and the fiber content of such foods may actually benefit individuals with diverticulosis/diverticulitis. Discuss your diet or potential diet changes with your doctor.

Treatment for diverticulitis depends on the severity of the condition.

  • Simple cases can be treated by a health-care professional at his or her office, and by a patient following a high fiber diet.
  • Treatment for uncomplicated cases usually consists of antibiotics and bowel rest. This usually involves two to three days of bowel rest, taking in only clear fluids (no food at all), so the colon may heal without having to work.
  • Complicated cases typically involve severe pain, fever, or bleeding. If an individual has any of these symptoms, he or she will probably be admitted to the hospital. Treatment consists of IV or oral antibiotics, bowel rest, and possibly surgery.
  • If diverticulitis attacks are frequent or severe, the doctor may suggest surgery to remove a part of the patient’s colon.
  • As with any surgery, there are risks the patient should discuss with his or her doctor.
  • Sometimes the operation requires at least two separate surgeries on different occasions.

IBS

Most people with IBS have symptoms only occasionally and the following measures may treat or soothe symptoms during a flare:

  • Add fiber to the diet: Fiber theoretically expands the inside of the digestive tract, reducing the chance it will spasm as it transmits and digests food. Fiber also promotes regular bowel movements, which helps reduce constipation. Fiber should be added gradually, because it may initially worsen bloating and gassiness. People with IBS-D should look for foods with more soluble fiber, the type that takes longer to digest (such as that found in oats, beans, barley, peas, apples, carrots, and citrus fruits).
  • Reduce stress and anxiety: Stress and anxiety may cause IBS “flares.” Health-care professionals may offer specific advice on reducing stress. The following may help reduce stress and problems associated with IBS:
    • Eat regular balanced meals.
    • Reduce caffeine intake.
    • Exercise may help reduce stress.
    • Smoking may worsen symptoms of IBS, which is another good reason to quit.

Other home remedies to soothe and lessen IBS symptoms include:

  • Increase fiber in the diet
  • Drink plenty of water
  • Avoid soda, which may cause gas and abdominal discomfort
  • Eat smaller meals to help lessen the incidence of cramping and diarrhea.
  • Low fat and high carbohydrate meals such as pasta, rice, and whole grain breads may help IBS symptoms (unless the person has celiac disease).
  • Antispasmodic drugs
  • Antispasmodic medicines, such as dicyclomine (Bemote, Bentyl, Di-Spaz) and hyoscyamine (Levsin, Levbid, NuLev), are sometimes used to treat symptoms of irritable bowel syndrome. Antispasmodic medicines help slow the movements of the digestive tract and reduce the chance of spasms. They may have side effects and are not for everyone. Other treatment plans are available, depending on the symptoms and condition.
  • Antidiarrheal drugs
  • Antidiarrheal medicines, such as loperamide (Imodium), a kaolin/pectin preparation (Kaopectate), and diphenoxylate/atropine (Lomotil), are sometimes used when diarrhea is a major feature of IBS. Do not take these on a long-term basis without first consulting a doctor.
  • Antidepressants
  • Antidepressants may be very effective in smaller doses than those typically used to treat depression. Imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin) are some commonly used medicines that may alleviate irritable bowel syndrome symptoms. Some other antidepressants are more commonly prescribed when depression and IBS coexist.

The following medications are typically reserved for patients with symptoms that do not improve with the previously mentioned treatments:

  • Alosetron (Lotronex) is a restricted drug approved only for short-term treatment of women with severe, chronic, diarrhea-predominant IBS (IBS-D) who have failed to respond to conventional IBS therapy. Fewer than 5% of people with irritable bowel syndrome have the severe form, and only a fraction of people with severe IBS have the diarrhea-predominant type. Alosetron was removed from the United States market but was reintroduced with new restrictions approved by the FDA in 2002. Physicians must be registered with the pharmaceutical manufacturer in order to prescribe the medication. Serious and unpredictable gastrointestinal side effects (including some that resulted in death) were reported in association with its use following its original approval. The safety and efficacy of alosetron has not been sufficiently studied in men; therefore, the FDA has not approved the drug for treatment of IBS in men.
  • Rifaximin (Xifaxan) is an antibiotic medication for IBS-D that works by reducing or altering gut bacteria, and it can improve symptoms of bloating and diarrhea after a 10 to 14 day course of treatment. Some patients require retreatment at higher doses for symptom relief.
  • Eluxadoline (Viberzi) is another newer medication for IBS-D that helps reduce abdominal pain and improves stool consistency in adults.
  • Linaclotide (Linzess) is a kind of drug that relieves constipation and pain for some adults with irritable bowel syndrome (IBS). In drug trials, people with IBS with constipation (a subtype of IBS called IBS-C) had more frequent and better bowel movements and less abdominal pain after taking daily doses of Linzess. The drug often began working within the first few days of treatment.
  • Lubiprostone (Amitiza) is a type of laxative used to treat severe irritable bowel syndrome with constipation (IBS-C) in women who are at least 18 years of age. It is a capsule taken orally, twice a day with food. It is used to relieve stomach pain, bloating, and straining; and produce softer and more frequent bowel movements in people who have chronic idiopathic constipation.
  • Tegaserod (Zelnorm) was a medication used to treat IBS but was removed from the market in 2008 due to increased risk of heart attack, stroke, and ischemic colitis.
  • New medications for IBS-D are also being developed or are in clinical trials. Those that are most promising include:
  • Serotonin synthesis inhibitors may help reduce pain and improve stool consistency
  • Ramosetron, similar to alosetron (Lotronex). This is reported to relieve symptoms with less constipation.
  • Spherical carbon adsorbent offers short-term relief from pain and bloating, but no improvement in stool consistency.
  • Benzodiazepine receptor modulator (dextofisopam) has the potential to reduce colonic motility and gut sensitivity reactions in response to stress.
  • Peripheral k-agonist (asimadoline, a kappa-opioid agonist) is in clinical trials and it shows reduced pain, urgency and stool frequency.

Diet and lifestyle changes are important in decreasing the frequency and severity of IBS symptoms. The first thing your doctor may suggest is to keep a food diary. This will help you figure out foods that trigger your symptoms.

  • Limit foods that contain ingredients that can stimulate the intestines and cause diarrhea, such as:
    • Caffeine
    • Alcohol
    • Dairy products
    • Fatty foods
    • Foods high in sugar
    • Artificial sweeteners (sorbitol and xylitol)
  • Some vegetables (cauliflower, broccoli, cabbage, Brussels sprouts) and legumes (beans) may worsen bloating and gassiness and should be avoided.
  • A high fiber diet may lessen symptoms of constipation.
  • Drink plenty of water, and avoid carbonated drinks such as soda, which may cause gas and discomfort.
  • Eat smaller meals and eat slowly to help reduce cramping and diarrhea.
  • Low fat, high carbohydrate meals such as pasta, rice, and whole-grain breads may help (unless you have celiac disease).
  • Probiotic supplements such as lactobacillus acidophilus or prebiotics may help alleviate IBS symptoms including abdominal pain, bloating, and bowel movement irregularity.
  • A diet low in FODMAPs (Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides And Polyols), a group of short-chain carbohydrates, may help relieve IBS symptoms. Consult your doctor for more information.

Diverticulosis & Diverticulitis

This is a benign condition caused by “diverticula” or balloon-like pockets or crevices that develop in the weak points of the bowel wall, usually the colon. These pockets can cause discomfort, diarrhea and/or constipation. About half of all Americans age 60 to 80 (and nearly everyone over 80 years of age) have diverticulosis. The pockets develop because of the pressure exerted within by the contracting colon.

“Diverticulitis” is a complication of Diverticulosis that occurs when a tiny hole in a diverticulum or pocket allows bacteria in the colon to seep through its wall and cause inflammation or infection outside the colon. It can be painful and may require surgery, and is more prevalent in patients over age 80.

Both conditions may be treated successfully through diet, medication and/or surgery.

This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

On the Rise: Understanding Diverticulitis and Why It’s Affecting More of Us

Our gut is lined with muscles that help move food through our digestive system. But like other muscles in our body, these digestive muscles can develop weakness.

Muscle tone varies throughout the length of the gastrointestinal tract, with weakness often occurring in the later sections of the colon; typically the result of blood vessels making connections through the muscular tissue. It’s at these sites (or weak spots) that little pouches, known as diverticula, can form.1

Never heard of diverticular disease? It’s extremely common over the age of 50, but many of us don’t realize we have it until those little pouches become infected and inflamed. This is when diverticular disease becomes diverticulitis.

If you have diverticulitis, the symptoms are often hard to ignore: it may cause abdominal pain and tenderness, a bloated or distended abdomen, in addition to diarrhea, chills and fever. These symptoms occur as a result of inflammation brought on by an immune response. Your body is trying to fight off the infection, often caused by waste trapped in the diverticula.

The most common treatment for diverticulitis is antibiotics to counter the infection. However, in some more severe cases, tears in the bowel wall can occur, causing a systemic infection that requires hospitalization. In Canada alone, over 3000 surgeries are performed each year to manage diverticulitis.2 Rates of this disease are on the rise, and affecting younger adults as well.1 The widespread prevalence of the disease and the necessary hospitalization (if disease progression occurs) makes the diverticulitis a burden on both the health care system and our quality of life. So, it’s worth asking… why do diverticula form?

A Closer Look at Diverticulitis

The prevailing thought about what causes diverticula to form is that high pressure in the sigmoid colon – which is located at the end of the digestive tract – is to blame.1 A high-pressure environment makes it more likely that pouches will form in the weakest areas of the colon. The culprit behind that increased pressure is the bowel working to eject hard to pass stools most often brought about by a low fibre diet. Looking to constipation as a culprit makes sense considering that diverticular disease is most common in countries with more ‘Westernized’ dietary habits; a trend we’re seeing mirrored around the world with the global dietary transition to a hyper-processed diet.1

However, as our understanding of the disease increases, we are uncovering new factors at play, although whether they occur as a result of the disease or are part of the cause is still unknown. The first has to do with the ‘second brain’ nature of the gut; inflammation can alter the nervous system within the digestive tract, which could lead to higher contractile pressure and experience of pain1. It also appears that microscopic inflammation plays a role in disease severity, flare up recurrence, and response to treatment1. Levels of fecal calprotectin, a marker of gut-level inflammation, are typically elevated in symptomatic disease1.

Research on the role of gut bacteria in diverticulitis is in its early stages, and it will be interesting to see what conclusions will be drawn, especially around inflammation and infection. A recent trial found bacterial differences between inflamed and non-inflamed tissue in diverticular disease, including a type of bacteria known to release destructive enzymes and methane-producing organisms commonly associated with constipation3.

Living Well with Diverticular Disease

Without complications, diverticular disease can have IBS-like flare-ups that make it difficult to diagnose1. When talking to your doctor about your digestive health, especially if you are over the age of 40, consider diverticular disease alongside irritable bowel syndrome; often diagnostic tools like CT scans and ultrasound can be used to spot the presence of diverticula.

If you are diagnosed with diverticular disease (barring complications), it would be wise to take a ‘food as medicine’ approach. While the research base is surprisingly minimal to guide nutrition interventions, a high fibre dietary pattern is generally agreed to be the best course of action. Begin swapping out low fibre, hyper-processed food stuffs such as pastries and fast foods for whole food options. Consume smaller portions of red meat and eat more plant proteins, poultry and fish. Put a bounty of high fibre whole grains, legumes, fruits and vegetables on your plate as a high fibre, plant-centred diet is thought to decrease your risk of acute disease1. Women should aim for at least 25 grams of fibre per day while men need 38 grams.

If your first hint of diverticular disease was a flare up, antibiotics and a clear liquid diet is usually necessary to fight infection and let the inflammation subside. Once the infection has been successfully treated with antibiotics, gradual adoption of a high fibre diet is recommended to improve gut health and decrease the risk of relapse1. However, the challenge is navigating bowel tolerance to such a diet. Traditionally, we have recommended the avoidance of corn, seeds and nuts thinking they could become caught in the diverticula; however, this is not supported by modern research. Which makes sense, when you think about it: as the disease typically occurs in the distal sections of the digestive tract, adequate chewing should lead to digestion and absorption of the foods in question. The key phrase here is adequate chewing. Many of us rush through our meals and do not use our teeth to grind down plant foods, so they are digested properly. Take your time at meals and thoroughly chew until food is a uniform pulp before swallowing.

That said, there are a few exceptions to the above. For example, whole flax seeds almost always pass through undigested and can be consumed only in ground form. And some hardier plant foods, including things like popcorn, may simply be irritating to a sensitive post-flare gut. In fact, in the early stages of as adjusting to life post flare, eating blended forms of harder to digest foods, such as nut butter, hummus or blending seeds into smoothies, is an excellent strategy for better nourishment and tolerance, as the blender does the work of chewing for you.

Fibre, Bacteria, and a Healthier Gut

Post-flare-up, moving through a soft, low fibre diet before gradually working up to more high fibre plant foods takes time, particularly after severe flares (although everyone is unique). Fibre adds bulk to the stool, making it easier to pass, and helps feed beneficial bacteria in the gut. Start with the addition of ground psyllium; a uniquely soluble and low fermentation fibre as the first choice for less irritation. Also take a high-quality probiotic like Bio-K+ as part of the healing process. Bio-K+ is clinically proven to help prevent the side effects of antibiotic use, such as antibiotic-associated diarrhea. The established guidelines for use with antibiotics is as follows: take one Bio-K+ (either our 50 billion capsules or drinkable products), 2 hours after one of your daily antibiotic doses, every day of antibiotic therapy plus five days after.

In practice, I also tend to recommend continued use of Bio-K+ for at least 12 weeks during the healing stage. The reason for this is that probiotics are well-established in their role to support the growth of beneficial bacteria that fight infection and help moderate inflammation within the gut, making them a wise choice in diverticular disease. Research on the role of probiotics specifically in diverticular disease is in early stages, so we have a lot more to learn about specific strains but there are some preliminary trials suggesting their benefit4,5. Probiotics are, in fact, commonly recommended by healthcare professionals to improve digestive health in diverticular disease.

Any digestive disease requires a holistic, individualized approach as the gastrointestinal tract lies at the intersection of digestive, immune and nervous system health. Gentle exercise is critical for improving wellbeing and managing inflammation, as well as encouraging regular elimination. Managing stress is also an essential part of the equation; given the deep brain-gut connection, stress can increase sensations of pain and even trigger flare-ups.

Although many of us may not be currently suffering from diverticular disease, knowing how common is means taking a preventative mindset critical. Given what we currently know about the disease, consuming plenty of high fibre plants and a daily probiotic is a simple strategy to help keep your colon healthy. If you find yourself diagnosed with diverticular disease, a dietitian can help you restore better digestive health.

If you have any other questions about the health of your gut, ask us in comments below. If you are looking to stock up on Bio-K+, head to our store locator. For more information on Bio-K+, probiotics and digestive health, contact us, find us on Facebook and Instagram or join our community.

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