Diverticulitis Diet, Symptoms, and Treatment: What is Diverticulitis?
What is Diverticular Disease?
Diverticular disease affects the colon. The colon is part of the large intestine that removes waste from your body. Diverticular disease is made up of two conditions: diverticulosis and diverticulitis. Diverticulosis occurs when pouches, called diverticula, form in the colon. These pouches bulge out like weak spots in a tire. Diverticulitis occurs if the pouches become inflamed.
Most patients with diverticulosis (diverticular disease) have few or no symptoms.
Abdominal pain, constipation, and diarrhea, can occur with diverticulosis.
Diverticulosis can be diagnosed with barium X-rays or with sigmoidoscopy or colonoscopy.
Treatment of diverticulosis can include high fiber diet, and anti-spasmodic drugs.
When diverticulosis is associated with inflammation and infection the condition is called diverticulitis. Together, diverticulosis and its complications, including diverticulitis, sometimes are referred to as diverticular disease.
Complications of diverticulosis and diverticulitis include rectal bleeding, abdominal infections, and colon obstruction.
Diverticulitis Symptoms and Diagnosis
Diverticulitis is a common digestive disease found most often in the large intestine. It's basically a swelling of an abnormal pouch in the intestinal wall. The abnormal pouch is called diverticulum, and when these pouches are formed it's called diverticulosis. Diverticulitis occurs if one of these pouches becomes swollen, which is typically due to bacteria getting trapped there.
How do you know if you have diverticulitis? Well, it's not always easy to tell. This is because the most common symptoms can mean a number of different things. You might have the pouches present (diverticulosis) and not have any discomfort at all. However, it's also possible that you might have symptoms like mild cramps, bloating and constipation. These same symptoms are common with other diseases such as IBD (inflammatory bowel disease) and stomach ulcers, so you cannot say for sure without your doctor running some tests.
For diverticulitis, the single most common symptom is stomach pain, particularly around the lower left side of the abdomen. If there's an infection present from bacteria in the diverticula, then there might be a more severe set of symptoms like: chills, fever, nausea, vomiting, weight loss, loss of appetite, diarrhea or constipation.
The symptoms of diverticulitis might last anywhere from a few hours to a week or more. It's typical that the symptoms will get worse as the day goes on. What might start out in the morning as slight pain may turn into sharper pain and/or vomiting by the evening.
The depth of the problem really depends on the extent of the infection and whether there are any complications. If you have any of these symptoms you really need to see a doctor to be tested to know for sure. Prescribed tests may include a blood test (to look for signs of an infection), x-ray, CT scan or colonoscopy.
The most common symptom of diverticular disease is intermittent (stop-start) pain in your lower abdomen (stomach), usually in the lower left-hand side.
The pain is often worse when you are eating, or shortly afterwards. Passing stools (poo) and breaking wind (flatulence) may help relieve the pain.
Common signs and symptoms of diverticulitis include:
Pain that's often sudden, severe and located in the lower left side of the abdomen
Less commonly, abdominal pain that may be mild at first and become worse over several days, possibly fluctuating in intensity
Change in bowel habits
Nausea and vomiting
Bleeding from your rectum (less common)
Other symptoms of diverticular disease include:
a change in your normal bowel habits, such as constipation or diarrhea, or episodes of constipation that are followed by diarrhea
bleeding from your rectum (back passage)
The main symptom of diverticulitis is a constant and severe pain. The pain usually starts below your belly button, before moving to the lower left-hand side of your abdomen.
In Asian people, the pain may move to the lower right-hand side of your abdomen. This is because Asian people tend to develop diverticula in a different part of their colon. The reason for this is thought to be genetic (certain genes found in Asian people may change the natural course of the condition).
Besides severe stomach pain, other symptoms of diverticulitis include:
a high temperature (fever) of 38ºC (100.4ºF) or above
bleeding from your rectum
When to seek medical advice
Contact your Doctor as soon as possible if you think you have symptoms of diverticulitis. The sooner diverticulitis is treated with antibiotics, the lower the risk of complications developing.
If you have symptoms of diverticular disease and the condition has previously been diagnosed, you do not usually need to contact your Doctor because the symptoms can be treated at home. Read more about treatment of diverticular disease below.
If you have not been diagnosed with the condition, contact your Doctor so they can rule out other conditions with similar symptoms, such as irritable bowel syndrome (IBS).
What are the Causes?
The truth is that the reason the pouches (diverticula) form in the colon is not entirely understood.
Doctors believe that diverticula form when high pressure inside the large intestine pushes against weak spots in the intestine wall. Spastic movements of the colon can also lead to the development of diverticula. It is not known why some people with diverticulosis develop diverticulitis and why others do not.
Not too surprisingly, it's thought that diet may play a role in this disease. Usually a diet with enough fiber creates stool that is bulky and can easily move through the colon. If a diet is low in fiber, the colon must work harder to move a smaller and harder stool. A diet low in fiber also increases the amount of time that the stool remains in the bowel, which also increases the pressure.
Interestingly enough the disease was first noticed in the United States in the early 1900's. At around that time processed foods were first introduced in the American diet. For the most part processed foods contain refined flour, which does not contain wheat bran and as is low in fiber.
Diverticular disease is much more common in countries that have low fiber diets. The disease is rare in countries like Africa and Asia where the typical diet is mainly fruits and vegetables.
Fiber is the part of grains, fruits and vegetables that the body cannot digest. There are two types of fiber: soluble fiber which dissolves in water and takes on a jelly like texture in the intestines, and insoluble which simply passes as is through the intestines. Both types makes stool softer and easier to pass.
Prevention of Diverticular Disease
The simplest way to prevent diverticula and the chance of developing diverticulosis is to maintain a diet that is high in fiber. High fiber diets increases stool bulk and the prevailing theory is that it may help to prevent further diverticular formation or worsening of an existing condition.
The pouches (diverticula) occur more often after the age of 40. Once formed, diverticula are permanent. No treatment has been discovered to prevent complications from diverticular disease.
If you already have diverticula, some doctors recommend avoiding nuts, seeds or corn which can block diverticular openings and ultimately cause diverticulitis. However, it has not been scientifically proven that avoiding these foods can make a difference.
Maintaining a diet to prevent diverticulitis is not easy. This requires a lifestyle change: a conscious effort to eat more whole grain breads, high fiber fruits and vegetables, oatmeal and bran cereals. You might also want to consider finding a pharmaceutical grade fiber supplement as this can prove to be another effective way to get the daily fiber that you need.
Another prevention method includes increasing beneficial bacteria in the intestines by eating foods like "live" yogurt, and unpasteurized sauerkraut. There are pro-biotic supplements that can be just as effective in introducing this healthy bacteria. There are also some natural supplements that can suppress the bad bacteria. These include concentrated extracts of garlic, gentian, olive leaf, oregano or golden-seal.
Treatment of Diverticulitis
How diverticulitis is treated depends on the severity of the symptoms and whether there are any other complications. If the pain is mild and you have the ability to drink liquids, most likely your doctor will prescribe antibiotics, pain killers and an all liquid (clear broth) diet. The all liquid diet gives the colon a chance to rest, and a bland diet is introduced shortly after until the pain goes away. Once there's improvement, fiber is slowly added back into to the diet.
If the case is more severe and you do not have the ability to drink liquids, the treatment usually involves a hospital stay. The doctor will most likely prescribe IV antibiotics and intravenous nutrition (nothing by mouth) for a week to give the bowel a chance to rest. After leaving the hospital doctors will typically place their patients on a low fiber diet to give the colon adequate time to heal without being stressed. Patients are then switched over to a high fiber diet to try to prevent recurrence.
In severe cases, surgery might be needed to remove the section of colon that contains the diverticula. Patients with a first case of diverticulitis typically do not need surgery unless the case is severe or there are other complications. Patients with chronic (repeating) diverticuitis might benefit from the surgery as in these cases the risks associated with diverticulitis outweigh the risks of complications from surgery.
Most cases of simple diverticulitis respond well to antibiotics and bowel rest and do not require surgery.
So what is diverticulitis? A potentially avoidable disease given the right kind of diet. The maxim "an ounce of prevention is worth a pound of cure" certainly true in this case. While it's unknown why some people who have diverticula develop diverticulitis, a good strategy would be to try to prevent the diverticula from occurring in the first place. This can be accomplished by simply maintaining a diet that is high in fiber.
Sometimes, especially as they get older, people can develop little bulging pouches in the lining of the large intestine. These are called diverticula, and the condition is known as diverticulosis.
When the pouches become inflamed or infected, it leads to a sometimes very painful condition called diverticulitis. In addition to having abdominal pain, people with diverticulitis may experience nausea, vomiting, bloating, fever, constipation, or diarrhea.
Many experts believe that a low-fiber diet can lead to diverticulosis and diverticulitis. This may be why people in Asia and Africa, where the diet tends to be higher in fiber, have a very low incidence of the condition.
Diverticulosis usually causes no or few symptoms; leaving many people unaware that they even have diverticula present.
Diverticulitis may need to be treated with antibiotics or, in severe cases, surgery.
Diet for Diverticulitis
If you're experiencing severe symptoms from diverticulitis, your doctor may recommend a liquid diverticulitis diet as part of your treatment, which can include:
Gradually you can ease back into a regular diet. Your doctor may advise you to start with low-fiber foods (white bread, meat, poultry, fish, eggs, and dairy products) before introducing high-fiber foods.
Fiber softens and adds bulk to stools, helping them pass more easily through the colon. It also reduces pressure in the digestive tract.
Many studies show that eating fiber-rich foods can help control diverticular symptoms. Try to eat at least 25-35 grams of fiber a day.
Here are a few fiber-rich foods to include in meals:
Whole-grain breads, pastas, and cereals
Beans (kidney beans and black beans, for example)
Fresh fruits (apples, pears, prunes)
Vegetables (squash, potatoes, peas, spinach)
If you're having difficulty structuring a diet on your own, consult your doctor or a dietitian. They can set up a meal plan that works for you.
Your doctor may also recommend a fiber supplement, such as psyllium (Metamucil) or methylcellulose (Citrucel) one to three times a day. Drinking enough water and other fluids throughout the day will also help prevent constipation.
Foods to Avoid With Diverticulitis
In the past, doctors had recommended that people with diverticular disease (diverticulosis or diverticulitis) avoid hard-to-digest foods such as nuts, corn, popcorn, and seeds, for fear that these foods would get stuck in the diverticula and lead to inflammation. However, recent research has noted that there is no real scientific evidence to back up this recommendation.
In fact, nuts and seeds are components of many high-fiber foods, which are recommended for people with diverticular disease.
Diverticulitis Diet Guidelines
Foods to Eat
Eat raw or dried fruits and raw vegetables if possible – chopping, peeling, cooking, pureeing, juicing, and processing fruit and vegetables may reduce fiber content.
Fats and Snacks
Foods to Avoid
Any hard or difficult-to-digest foods such as;
stringy fiber foods like sweet potato
Diverticulosis is a condition in which the inner lining layer of the large intestine or colon bulges out (herniates) through the outer, muscular layer. These ‘outpouchings’ are called diverticula.
Diverticulitis is the term for inflammation and infection in one or more diverticula.
A person having diverticulosis (the condition), and perhaps diverticulitis (the inflammation) as well, is said to have diverticular disease.
Diverticula occur in a colon weakened by age, when increased pressure inside the colon (usually due to constipation) causes little pea-shaped pouches of weakness in the intestine wall.
The chance of developing diverticula increases with age, so that by age 50 between 20 and 50 percent of all people will have some diverticula, and by age 90 virtually everyone will.
Diverticulosis is usually symptom-free, so that most people do not realize they have it. However, a few people will experience cramps, spasms, constipation, and pain.
Relieving the constipation, primarily by increasing fiber in the diet, can reduce the problems associated with diverticulosis. If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, many medications cause the colon to empty, an undesirable side effect for people with diverticulosis.
What is Diverticulosis?
The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material left over after digestion of food in the small intestine takes place. Pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to in the plural as diverticula. Diverticula can occur throughout the colon but are most common near the end of the left colon, referred to as the sigmoid colon, in Western countries. In Asia, the diverticula occur mostly on the right side of the colon. The condition of having these diverticula in the colon is called diverticulosis.
Diverticula are common in the Western world but are rare in areas such as Asia and Africa. Diverticula increase with age. They are uncommon before the age of 40, and are seen in more than 40% of people over the age of 60 years in the U.S. A person with diverticulosis usually has few or no symptoms. The most common symptoms associated with diverticulosis are abdominal pain, constipation, and diarrhea. In some of these patients the symptoms may be due to the concomitant presence of irritable bowel syndrome or abnormalities in the function of the muscles of the sigmoid colon; simple diverticula should cause no symptoms. Occasionally, bleeding originates from a diverticulum, and it is referred to as diverticular bleeding.
What are diverticulitis symptoms?
Most patients with diverticulosis have few or no symptoms. The diverticulosis in these individuals is found incidentally during tests for other intestinal problems. Twenty percent of patients with diverticulosis will develop symptoms related to diverticulosis, primarily diverticulitis.
The most common signs and symptoms of diverticulitis include:
Abdominal pain (left lower abdomen)
Abdominal tenderness (left lower abdomen)
Constipation or, sometimes, diarrhea.
The muscular wall of the colon grows thicker with age, although the cause of this thickening is unclear. It may reflect the increasing pressures required by the colon to eliminate feces. For example, a diet low in fiber can lead to small, hard stools which are difficult to pass and which require increased pressure to pass. The lack of fiber and small stools also may allow segments of the colon to close off from the rest of the colon when the colonic muscle in the segment contracts. The pressure in these closed-off segments may become high since the increased pressure cannot dissipate to the rest of the colon. Over time, high pressures in the colon push the inner intestinal lining outward (herniation) through weak areas in the muscular walls. These pouches or sacs that develop are called diverticula.
Lack of fiber in the diet is considered the most likely cause of diverticula, and there is a good correlation among societies around the world between the amount of fiber in the diet and the prevalence of diverticula. Many patients with diverticular disease have excessive thickening of the muscular wall of the colon where the diverticula form. The muscle also contracts more strongly. These abnormalities of the muscle may be contributing factors in the formation of diverticula. Microscopic examination of the edges of the diverticula show signs of inflammation, and it has been suggested that there may be an inflammatory component to the formation of the diverticula.
What are the more serious complications of diverticulitis?
More serious complications of diverticulitis include:
Collections of pus (abscess) in the pelvis where the diverticulum has ruptured
Generalized infection of the abdominal cavity (bacterial peritonitis)
Bleeding into the colon
A diverticulum can rupture, and the bacteria within the colon can spread into the tissues surrounding the colon (diverticulitis). Constipation or diarrhea also may occur. A collection of pus can develop around the ruptured diverticulum, leading to formation of an abscess, usually in the pelvis. Inflammation surrounding the colon also can lead to colonic obstruction. Infrequently, a diverticulum ruptures freely into the abdominal cavity causing a life threatening infection called peritonitis. On rare occasions, the inflamed diverticula can erode into the urinary bladder, causing bladder infection and passing of intestinal gas in the urine.
Diverticular bleeding occurs when the expanding diverticulum erodes into a blood vessel within the diverticulum. Rectal passage of red, dark or maroon-colored blood and clots occur without any associated abdominal pain if there is no diverticulitis, but bleeding into the colon also may occur during an episode of diverticulitis. Blood from a diverticulum of the right colon may be black in color. Bleeding may be continuous or intermittent, lasting several days.
Patients with active bleeding usually are hospitalized for observation. Intravenous fluids are given to support the blood pressure. Blood transfusions are necessary for those with moderate to severe blood loss. In a rare individual with brisk and severe bleeding, the blood pressure may drop, causing dizziness, shock, and loss of consciousness. In most patients, bleeding stops spontaneously and they are sent home after several days in the hospital. Patients with persistent, severe bleeding require surgical removal of the bleeding diverticula.
How are the diagnosis of diverticulitis and diverticulosis made?
If suspected, the diagnosis of diverticular disease can be confirmed by a variety of tests. Barium X-rays (barium enemas) can be performed to visualize the colon. Diverticula are seen as barium filled pouches protruding from the colon wall.
Direct visualization of the inside of the colon and the openings of the diverticula can be done with flexible tubes inserted through the rectum and advanced into the colon. Either short tubes (sigmoidoscopes) or longer tubes (colonoscopes) may be used to assist in the diagnosis and to exclude other diseases that can mimic diverticular disease.
In patients suspected of having diverticulitis causing persistent pain, tenderness, and fever; ultrasound and computerized tomography (CT) examinations of the abdomen and pelvis can be done to detect inflammation of the tissues surrounding the ruptured diverticulum or collections of pus.
Most patients with diverticulosis have minimal or no symptoms, and do not require any specific treatment. A normal fiber diet is advisable to prevent constipation and perhaps prevent the formation of more diverticula.
Patients with mild symptoms of abdominal pain due to muscular spasm in the area of the diverticula may benefit from anti-spasmodic drugs such as:
atropine, scopolamine, phenobarbital (Donnatal), and
When diverticulitis occurs, antibiotics usually are needed. Oral antibiotics are sufficient when symptoms are mild. Some examples of commonly prescribed antibiotics include:
cephalexin (Keflex), and
Liquid or low fiber foods are advised during acute attacks of diverticulitis. This is done to reduce the amount of material that passes through the colon, which at least theoretically, may aggravate the diverticulitis. In severe diverticulitis with high fever and pain, patients are hospitalized and given intravenous antibiotics. Surgery is needed for patients with persistent bowel obstruction or abscess not responding to antibiotics.
Surgical treatment for diverticulitis
Diverticulitis that does not respond to medical treatment requires surgical intervention. Surgery usually involves drainage of any collections of pus and resection (surgical removal) of the segment of the colon containing the diverticula, usually the sigmoid colon. Surgical removal of the bleeding diverticulum also is necessary for those with persistent bleeding. In patients needing surgery to stop persistent bleeding, it is important to determine exactly where the bleeding is coming from in order to guide the surgeon.
Sometimes, diverticula can erode into the adjacent urinary bladder, causing severe recurrent urine infection and passage of gas during urination. This situation also requires surgery.
Sometimes, surgery may be suggested for patients with frequent, recurrent attacks of diverticulitis leading to multiple courses of antibiotics, hospitalizations, and days lost from work. During surgery, the goal is to remove all, or almost all, of the colon containing diverticula in order to prevent future episodes of diverticulitis. There are few long-term consequences of resection of the sigmoid colon for diverticulitis, and the surgery often can be done laparoscopically, which limits post operative pain and time for recovery.
Once formed, diverticula are permanent. No treatment has been found to prevent complications of diverticular disease.
Diets high in fiber increases stool bulk and prevents constipation, and theoretically may help prevent further diverticular formation or worsening of the diverticular condition. Some doctors recommend avoiding nuts, corn, and seeds which can plug diverticular openings and cause diverticulitis, but there is little evidence to support this recommendation.
Because inflammation has been found at the edges of diverticula, it has been speculated that colonic bacteria may be playing a role in the rupture of diverticula by promoting inflammation. This has led some people to further speculate that changing the bacteria in the colon might reduce inflammation and rupture and to suggest treatment with probiotics; however, there is not enough evidence of a benefit of probiotics yet to recommend treatment with probiotics of patients with diverticular disease.
Diverticulitis Diet, Symptoms, Causes, & Treatment
A person with diverticulosis may get diverticulitis when waste matter and bacteria are trapped in a pouch (diverticula).
This blockage interferes with the blood supply to the area, and infection sets in.
The tissue then becomes inflamed or infected, and in severe cases may even rupture. An attack of diverticulitis can result in fever, pain and tenderness around the left side of the lower abdomen.
The infection and irritation of nearby tissues within the abdomen may cause the abdominal muscles to spasm. About 25 percent of all patients with diverticulitis will have some rectal bleeding, although this rarely becomes severe. Diverticulitis is three times more likely to occur in the left side of the large intestine, and men are three times as likely as women to suffer with diverticulitis.
Treatment for diverticulitis focuses 3 areas.
Clearing up the infection and inflammation with antibiotics.
Resting the colon with a liquid diet plus a pain reliever or a drug such as propantheline (Pro-Banthine) to control muscle spasms.
Preventing or minimizing complications with the proper diet.
This diverticulitis diet is a high fiber diet for managing diverticulosis, and for reducing effects of diverticulitis. The increased fiber (the American Dietetic Association recommends 20 to 35 grams daily, including 6-8 grams of soluble fiber) in this diverticulitis diet plan produces more bulk in the stool, reducing pressure in the colon and assisting the more regular and complete elimination of waste, thereby preventing the formation of further diverticula.
There are other benefits in having different kinds of fiber in a balanced diverticulitis diet:
It helps to protect against cancer of the colon and rectum.
It assists in preventing heart disease and a number of other health problems.
Foods containing fiber also tend to comprise nutrients like vitamins A, C, and E and selenium, useful in fighting cancer.
Increase Fluid and Fiber
Anyone with diverticulitis who increases their fiber intake under this diverticulitis diet plan, should drink at least 1.5 liters (3 pints) daily. Insoluble fiber needs fluid to form stools that are easily passed.
Medical advice may be to take a fiber supplement such as Metamucil daily (for soluble fiber from psyllium), and to use a cholesterol-lowering spread or margarine containing plant sterols. Fiber supplements provide about 2 to 3.5 grams of fiber per tablespoon, which is mixed with a quarter liter (8 ounces) of water before consuming.
Should Seeds Be Eaten?
Until recently, many doctors suggested avoiding foods with small seeds because it was believed that particles could lodge in the diverticula and cause inflammation. However, this is now a controversial point and no evidence supports this recommendation.
So the seeds in tomatoes, zucchini, cucumbers, strawberries and raspberries, as well as poppy seeds, which are part of your diverticulitis diet, are generally considered harmless.