What is diverticulosis?
Diverticulosis is a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. These pockets occur when the inner layer of the digestive tract pushes through weak spots in the outer layer. A single pouch is called a diverticulum. The pouches associated with diverticulosis are most often located in the lower part of the large intestine (the colon). Some people may have only several small pouches on the left side of the colon, while others may have involvement in most of the colon.
Who gets diverticulosis?
Diverticulosis is unusual in people under 40 years of age.
What causes diverticulosis?
Because diverticulosis is uncommon in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables, most doctors believe this condition is due in part to a diet low in fiber. A low-fiber diet leads to constipation, which increases pressure within the digestive tract with straining during bowel movements. The combination of pressure and straining over many years likely leads to diverticulosis.
What are the symptoms of diverticulosis?
Most people who have diverticulosis are unaware that they have the condition because it usually does not cause symptoms. It is possible that some people with diverticulosis experience bloating, abdominal cramps or constipation due to difficulty in stool passage through the affected region of the colon.
What are the more serious complications of diverticulitis?
More serious complications of diverticulitis include:
Collection of pus (abscess) in the pelvis where the diverticulum has ruptured
Colonic obstruction due to extensive inflammation
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. This is then called diverticulitis. Constipation or diarrhea also may occur with the inflammation. 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 bacterial peritonitis. On rare occasions, the inflamed diverticulum can erode into the urinary bladder, causing bladder infection and passing of intestinal gas in the urine. Even more rarely the diverticulum can rupture into the vagina.
Diverticular bleeding occurs when the expanding diverticulum erodes into a blood vessel within the wall of 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 cause the stool to become 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 diverticulum although several nonsurgical treatments have been suggested.
How is the diagnosis of diverticulosis made?
Because most people do not have symptoms, diverticulosis is often found incidentally during evaluation for another condition or during a screening exam for polyps. Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen using other imaging tests, for example by computed tomography (CT) scan or barium x-ray.
What is the treatment for diverticulosis?
Once diverticula form, they do not disappear by themselves. Fortunately, most patients with diverticulosis do not have symptoms and, therefore, do not need treatment.
When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount. The easiest way to increase fiber intake is to eat more fruits, vegetables and grains. Apples, pears, broccoli, carrots, squash, baked beans, kidney beans, and lima beans are a few examples of high-fiber foods. As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose, or poly-carbophil. These products come in various forms including pills, powders and wafers. Supplemental fiber products help to bulk up and soften the stool, which makes bowel movements easier to pass. Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort.
Are there complications from diverticulosis?
Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer.
Diverticulitis occurs when the pouches become infected or inflamed. This condition usually produces localized abdominal pain, tenderness to touch and fever. A person with diverticulitis may also experience nausea, vomiting, shaking, chills or constipation. Your doctor may order a CT scan to confirm a diagnosis of diverticulitis. Minor cases of infection are usually treated with oral antibiotics and do not require admission to the hospital. If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis. Usually a CT scan is required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the abscess. Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum. Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding. Occasionally, surgery or other procedures may be necessary to stop bleeding that cannot be stopped by other methods. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. In this case, surgery may be necessary to remove the involved area of the colon.
What foods should I avoid if I have an acute bout of diverticulitis?
Because the exact root cause of diverticulitis isn’t yet known, there’s no list of foods that are known to ease symptoms of this condition. Also, the National Institutes of Health states that you don’t need to avoid certain foods if you have diverticulitis.
However, you may want to consider keeping certain foods to a minimum. Talk to your doctor about whether you should avoid the following foods or reduce the amounts you consume.
High-FODMAP foods
Research has found that a diet that limits foods that are high in FODMAPs — fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — can benefit people with irritable bowel syndrome. Researchers have suggested people with diverticulitis may also benefit from this diet.
Some examples of foods high in FODMAPs include:
certain fruits, such as apples, pears, and plums
dairy foods, such as milk, yogurt, and ice cream
fermented foods, such as sauerkraut or kimchi
beans
cabbage
Brussels sprouts
onions and garlic
High-fiber foods
Foods that are high in fiber may be helpful for people with diverticulosis who aren’t having an acute flare up and may even help prevent diverticulitis in the first place.
A 2017 systematic review of studies on diverticulosis and the occurrence of acute diverticulitis showed a “reduction of abdominal symptoms and the prevention of acute diverticulitis” with the intake of fiber.
However, every individual is different, and your specific fiber needs will vary based on your condition and symptoms. If you’re having pain or other symptoms, your doctor may suggest that you limit your intake of these foods for a while.
Fiber adds bulk to stool and may increase peristalsis or colon contractions. This may be painful and uncomfortable if you’re having a flare up.
Avoiding high-fiber foods, particularly if you’re inflamed, may ease symptoms and give your system a temporary rest. In addition, whether including higher or lower amounts of fiber, you should also drink plenty of water.
Fiber-rich foods you might want to limit or avoid, especially during a flare up, include:
Colonoscopy
This is a special test using a flexible tube to look at the internal lining of the colon and rectum. It also allows biopsies to be taken.
Your doctor may recommend a colonoscopy examination if you have symptoms suggesting possible problems in the colon or rectum. Some symptoms include bleeding, change in your bowel habits, unexplained abdominal symptoms. Colonoscopy is also used to monitor patients with inflammatory bowel disease, and for follow-up of patients with history of colon cancer or polyp.
Procedure
The bowel must first be thoroughly cleaned before a colonoscopy. This is done either the day before or the same morning as your colonoscopy. You will be asked to drink medication that would make you have diarrhoea to pass out all the stools inside.
The colonoscope is inserted through the anus and advanced to the portion of the colon where the small intestine enters. Your doctor will remove any polyps or take biopsies if necessary.
Bleeding into the colon
A diverticulum can rupture, and the bacteria within the colon can spread into the tissues surrounding the colon. This is then called diverticulitis. Constipation or diarrhea also may occur with the inflammation. 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 bacterial peritonitis. On rare occasions, the inflamed diverticulum can erode into the urinary bladder, causing bladder infection and passing of intestinal gas in the urine. Even more rarely the diverticulum can rupture into the vagina.
Diverticular bleeding occurs when the expanding diverticulum erodes into a blood vessel within the wall of 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 cause the stool to become 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 diverticulum although several nonsurgical treatments have been suggested.
How is the diagnosis of diverticulosis made?
Because most people do not have symptoms, diverticulosis is often found incidentally during evaluation for another condition or during a screening exam for polyps. Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen using other imaging tests, for example by computed tomography (CT) scan or barium x-ray.
What is the treatment for diverticulosis?
Once diverticula form, they do not disappear by themselves. Fortunately, most patients with diverticulosis do not have symptoms and, therefore, do not need treatment.
When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount. The easiest way to increase fiber intake is to eat more fruits, vegetables and grains. Apples, pears, broccoli, carrots, squash, baked beans, kidney beans, and lima beans are a few examples of high-fiber foods. As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose, or poly-carbophil. These products come in various forms including pills, powders and wafers. Supplemental fiber products help to bulk up and soften the stool, which makes bowel movements easier to pass. Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort.
Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer.
Diverticulitis occurs when the pouches become infected or inflamed. This condition usually produces localized abdominal pain, tenderness to touch and fever. A person with diverticulitis may also experience nausea, vomiting, shaking, chills or constipation. Your doctor may order a CT scan to confirm a diagnosis of diverticulitis. Minor cases of infection are usually treated with oral antibiotics and do not require admission to the hospital. If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis. Usually a CT scan is required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the abscess. Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum. Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding. Occasionally, surgery or other procedures may be necessary to stop bleeding that cannot be stopped by other methods. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. In this case, surgery may be necessary to remove the involved area of the colon.
What foods should I avoid if I have an acute bout of diverticulitis?
Because the exact root cause of diverticulitis isn’t yet known, there’s no list of foods that are known to ease symptoms of this condition. Also, the National Institutes of Health states that you don’t need to avoid certain foods if you have diverticulitis.
However, you may want to consider keeping certain foods to a minimum. Talk to your doctor about whether you should avoid the following foods or reduce the amounts you consume.
High-FODMAP foods
Research has found that a diet that limits foods that are high in FODMAPs — fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — can benefit people with irritable bowel syndrome. Researchers have suggested people with diverticulitis may also benefit from this diet.
Some examples of foods high in FODMAPs include:
certain fruits, such as apples, pears, and plums
dairy foods, such as milk, yogurt, and ice cream
fermented foods, such as sauerkraut or kimchi
beans
cabbage
Brussels sprouts
onions and garlic
High-fiber foods
Foods that are high in fiber may be helpful for people with diverticulosis who aren’t having an acute flare up and may even help prevent diverticulitis in the first place.
A 2017 systematic review of studies on diverticulosis and the occurrence of acute diverticulitis showed a “reduction of abdominal symptoms and the prevention of acute diverticulitis” with the intake of fiber.
However, every individual is different, and your specific fiber needs will vary based on your condition and symptoms. If you’re having pain or other symptoms, your doctor may suggest that you limit your intake of these foods for a while.
Fiber adds bulk to stool and may increase peristalsis or colon contractions. This may be painful and uncomfortable if you’re having a flare up.
Avoiding high-fiber foods, particularly if you’re inflamed, may ease symptoms and give your system a temporary rest. In addition, whether including higher or lower amounts of fiber, you should also drink plenty of water.
Fiber-rich foods you might want to limit or avoid, especially during a flare up, include:
beans and legumes such as navy beans, chickpeas, lentils, and kidney beans
whole grains such as brown rice, quinoa, oats, amaranth, spelt, and bulgur
vegetables
fruits
Foods high in sugar and fat
A standard diet high in fat and sugar and low in fiber may be linked with an increased incidence of diverticulitis. Research suggests that avoiding the following foods may help prevent diverticulitis or reduce its symptoms:
red meat
refined grains
full-fat dairy
fried foods
Other foods to avoid
In the past, doctors recommended that people with diverticulitis avoid eating nuts, popcorn, and most seeds. It was thought that the tiny particles from these foods might get lodged in the pouches and lead to an infection.
More recently, most doctors have moved away from this advice. Modern researchTrusted Source has shown no evidence linking those foods with increased diverticular issues.
Some research has also suggested that people with diverticulitis avoid alcohol.
What foods should I eat if I have diverticulitis?
Treatment and disease management approaches for diverticulitis vary from person to person. However, your doctor will likely suggest that you adopt certain dietary changes to make the condition easier to tolerate and less likely to worsen over time.
If you’re having an acute attack of diverticulitis, your doctor may suggest either a low-fiber diet or a clear liquid diet to help relieve your symptoms. They may recommend following one of these diets until you’ve recovered.
Low-fiber foods
Low-fiber foods to consider eating if you have symptoms of diverticulitis include:
A standard diet high in fat and sugar and low in fiber may be linked with an increased incidence of diverticulitis. Research suggests that avoiding the following foods may help prevent diverticulitis or reduce its symptoms:
red meat
refined grains
full-fat dairy
fried foods
Other foods to avoid
In the past, doctors recommended that people with diverticulitis avoid eating nuts, popcorn, and most seeds. It was thought that the tiny particles from these foods might get lodged in the pouches and lead to an infection.
More recently, most doctors have moved away from this advice. Modern researchTrusted Source has shown no evidence linking those foods with increased diverticular issues.
Some research has also suggested that people with diverticulitis avoid alcohol.
What foods should I eat if I have diverticulitis?
Treatment and disease management approaches for diverticulitis vary from person to person. However, your doctor will likely suggest that you adopt certain dietary changes to make the condition easier to tolerate and less likely to worsen over time.
If you’re having an acute attack of diverticulitis, your doctor may suggest either a low-fiber diet or a clear liquid diet to help relieve your symptoms. They may recommend following one of these diets until you’ve recovered.
Low-fiber foods
Low-fiber foods to consider eating if you have symptoms of diverticulitis include:
white rice, white bread, or white pasta, but avoid gluten-containing foods if you’re intolerant
dry, low-fiber cereals
processed fruits such as applesauce or canned peaches
cooked animal proteins such as fish, poultry, or eggs
olive oil or other oils
yellow squash, zucchini, or pumpkin: peeled, seeds removed, and
cooked spinach, beets, carrots, or asparagus
potatoes with no skin
fruit and vegetable juices
Clear liquid diet
A clear liquid diet is a more restrictive approach to relieving diverticulitis symptoms. Your doctor may prescribe it for a short period of time. A clear liquid diet usually consists of:
cooked animal proteins such as fish, poultry, or eggs
olive oil or other oils
yellow squash, zucchini, or pumpkin: peeled, seeds removed, and
cooked spinach, beets, carrots, or asparagus
potatoes with no skin
fruit and vegetable juices
Clear liquid diet
A clear liquid diet is a more restrictive approach to relieving diverticulitis symptoms. Your doctor may prescribe it for a short period of time. A clear liquid diet usually consists of:
water
ice chips
ice pops with frozen fruit puree or pieces of finely chopped fruit
soup broth or stock
gelatin, such as Jell-O
tea or coffee without any creams, flavors, or sweeteners
clear electrolyte drinks
Other dietary considerations
Whether on a clear liquid diet or not, it’s generally helpful to drink at least eight cups of fluid daily. This helps keep you hydrated and supports your gastrointestinal health.
Be sure to talk with your doctor before making any dramatic dietary changes. After your condition improves, your doctor may recommend slowly adding low-fiber foods back into your diet. Once you no longer have symptoms of diverticulitis, your doctor may suggest that you resume a balanced diet.
Does a high-fiber diet reduce risk of diverticulitis?
Even though avoiding high-fiber foods can help relieve symptoms of diverticulitis, research has shown that regularly consuming a high-fiber diet with lots of vegetables, fruits, and whole grains may reduce the risk for acute diverticulitis.
Since fiber can soften your body’s waste material, softer stool passes through your intestines and colon more quickly and easily. This, in turn, reduces the pressure in your digestive system, which helps prevent the formation of diverticula, as well as the development of diverticulitis.
A high-fiber diet is often one of the first things a doctor will recommend if you have diverticulosis or you’ve recovered from diverticulitis.
If you’re not already consuming high-fiber foods, be sure to start slow when adding them to your diet. One study found that those who consumed at least 25 grams of fiber per day had a 41 percent lower risk for developing diverticular disease, compared with those who only consumed 14 grams.
For people without diverticular issues, eating a diet that’s rich in fiber helps promote a healthy digestive system.
Research also shows that gut bacteria play a role in diverticular disease. Though more research is needed, future studies are likely to support the modulation of gut bacteria through a high-fiber diet and probiotic supplementation.
ice chips
ice pops with frozen fruit puree or pieces of finely chopped fruit
soup broth or stock
gelatin, such as Jell-O
tea or coffee without any creams, flavors, or sweeteners
clear electrolyte drinks
Other dietary considerations
Whether on a clear liquid diet or not, it’s generally helpful to drink at least eight cups of fluid daily. This helps keep you hydrated and supports your gastrointestinal health.
Be sure to talk with your doctor before making any dramatic dietary changes. After your condition improves, your doctor may recommend slowly adding low-fiber foods back into your diet. Once you no longer have symptoms of diverticulitis, your doctor may suggest that you resume a balanced diet.
Does a high-fiber diet reduce risk of diverticulitis?
Even though avoiding high-fiber foods can help relieve symptoms of diverticulitis, research has shown that regularly consuming a high-fiber diet with lots of vegetables, fruits, and whole grains may reduce the risk for acute diverticulitis.
Since fiber can soften your body’s waste material, softer stool passes through your intestines and colon more quickly and easily. This, in turn, reduces the pressure in your digestive system, which helps prevent the formation of diverticula, as well as the development of diverticulitis.
A high-fiber diet is often one of the first things a doctor will recommend if you have diverticulosis or you’ve recovered from diverticulitis.
If you’re not already consuming high-fiber foods, be sure to start slow when adding them to your diet. One study found that those who consumed at least 25 grams of fiber per day had a 41 percent lower risk for developing diverticular disease, compared with those who only consumed 14 grams.
For people without diverticular issues, eating a diet that’s rich in fiber helps promote a healthy digestive system.
Research also shows that gut bacteria play a role in diverticular disease. Though more research is needed, future studies are likely to support the modulation of gut bacteria through a high-fiber diet and probiotic supplementation.
This is a special test using a flexible tube to look at the internal lining of the colon and rectum. It also allows biopsies to be taken.
Your doctor may recommend a colonoscopy examination if you have symptoms suggesting possible problems in the colon or rectum. Some symptoms include bleeding, change in your bowel habits, unexplained abdominal symptoms. Colonoscopy is also used to monitor patients with inflammatory bowel disease, and for follow-up of patients with history of colon cancer or polyp.
Procedure
The bowel must first be thoroughly cleaned before a colonoscopy. This is done either the day before or the same morning as your colonoscopy. You will be asked to drink medication that would make you have diarrhoea to pass out all the stools inside.
The colonoscope is inserted through the anus and advanced to the portion of the colon where the small intestine enters. Your doctor will remove any polyps or take biopsies if necessary.
