Diverticulosis is a condition in which small pouches or sacs develop in the weak areas of the intestinal walls. These are known as diverticula. Diverticulosis is a common condition, especially in those over the age of 50. In fact, over one-third of Americans between the ages of 50 and 59 have diverticulosis, with numbers growing in those over 80.
Diverticulitis vs. Diverticulosis
Diverticulosis itself is asymptomatic and doesn’t impact the quality of life, although some may experience bloating, constipation, diarrhea, or abdominal cramping.
Unfortunately, diverticula are prone to infection and inflammation which does cause acute symptoms and complications. This condition is called diverticulitis, or diverticular disease.
Although an acute attack of diverticulitis can be treated with antibiotics and fasting, roughly 80% of patients suffer a reoccurrence within 5 years.
Symptoms of Diverticulitis
- Pain in the lower left abdomen
- Rectal bleeding
- Fever and/or chills
- Nausea or vomiting
- Constipation or diarrhea
- Swelling or bloating of the abdomen
- Increased urgency, frequency, or discomfort when urinating
What does Diverticulitis Feel Like?
The common sign of a diverticulitis flare is constant abdominal pain, soreness, or sensitivity that may last days. This pain is usually felt on the lower left side of the belly (although some may experience it on the lower right side).
A diverticulitis flare will cause changes in bowel movements, such as diarrhea or constipation.
The Causes & Risk Factors of Diverticulitis
Understanding the risk factors of Diverticulitis can help you find strategies for its prevention. Several factors have been identified, including a diet high in red meat and low in dietary fiber, which is linked to an increased risk of diverticulitis.
Obesity and physical inactivity are recognized as risk factors for this condition, underscoring the importance of dietary choices and maintaining a healthy weight. Research also shows that individuals living in urban areas are more likely to be hospitalized for diverticulitis compared to their rural counterparts.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly non-aspirin NSAIDs, has been consistently associated with an elevated risk of diverticulitis in prospective cohort and case-control studies. Prescription opioids and corticosteroids have also been linked to diverticulitis and perforated diverticulitis, highlighting the potential risks of these medications in susceptible individuals.
A noteworthy study investigating the cumulative impact of multiple lifestyle risk factors found that adhering to a low-risk lifestyle could decrease the risk of diverticulitis by nearly 75%. A low-risk lifestyle in this context was defined as consuming fewer than four servings of red meat per week, ingesting at least 23 grams of fiber daily, engaging in a minimum of two hours of vigorous physical activity per week, maintaining a body mass index (BMI) within the range of 18.5 to 24.9, and having no history of smoking.
Assuming causal associations, this study estimated that adopting a low-risk lifestyle could potentially prevent half of diverticulitis cases.
Pathophysiology of Diverticulitis
The standing theory is that diet and lifestyle raise the risk of diverticulitis through their effects on the intestinal microbiome and inflammation.
The theory is that a complex interaction of genetics, diet, lifestyle, and medication alters the microbiome. This not only negatively affects the microbial metabolism of short-chain fatty acids that are vital in regulating tight junctions (which fortify the mucosal barrier) but also raises the risk of bacterial infection and disrupts immune regulation, resulting in inflammation.
Preliminary studies found that the composition and function of the gut microbiome differ between individuals with or without diverticulitis. Findings from a case series study indicated that patients with diverticulosis, particularly those with abdominal symptoms or SUDD (symptomatic uncomplicated diverticula disease), show microscopic inflammation.
Studies also show that patients with a history of diverticulitis have lower levels of the bacteria Clostidiales (which produces SCFAs) and Lachnospiraceae than those with asymptomatic diverticulosis.
How is Diverticilitis Different from Other GI Conditions?
IBS vs. Diverticulitis
Distinguishing between irritable bowel syndrome (IBS) and diverticulitis can present a challenge due to the overlapping symptoms of each condition. Both may present with abdominal pain, constipation, and bloating. However, key differentiators include IBS-related symptoms such as cramping, mucus in stool, diarrhea, and pain relief after a bowel movement.
In contrast, diverticulitis is characterized by symptoms like fever, chills, nausea, vomiting, abdominal tenderness, and more persistent and consistent pain than IBS.
Colitis vs. Diverticulitis
Like IBS, ulcerative colitis and diverticulitis share certain symptoms. The main way to tell the difference is that diverticulitis is more likely to cause constipation whereas UC is more likely to cause diarrhea, fatigue, and arthritis symptoms.
Complications of Diverticulitis
Complications of diverticulitis can occur in roughly 12% of patients, the most common being phlegmon (a localized area of acute inflammation in soft tissue) or abscess. More rarely, patients can develop peritonitis, stricture, fistula, or obstruction. Some may also suffer rectal bleeding.
According to a 2019 meta-analysis, a higher risk of colon cancer is also associated with complications of diverticulitis, so it’s wise to get screened regularly.
When evaluating diverticulitis, your doctor will likely perform a physician examination and review your medical history, as well as perform several lab and imaging tests:
- Blood tests to check for infection or inflammation markers.
- Stool tests to assess for blood, infection, or other abnormalities.
- Computed Tomography (CT), which utilizes X-rays and computer technology for detailed organ images.
- Ultrasound, utilizing sound waves to create organ images.
- Magnetic Resonance Imaging (MRI), a non-x-ray method for capturing internal organ and soft tissue images.
These diagnostic tools will help your doctor pinpoint the condition and tailor a treatment plan accordingly.
Treatment Options for Diverticulitis
Recent research has prompted a reevaluation of treatment strategies for diverticulitis. Two multicenter, randomized trials have demonstrated that antibiotics do not expedite recovery or prevent subsequent complications in patients with uncomplicated diverticulitis.
As a result, current guidelines recommend antibiotic treatment for specific cases only, underscoring the importance of personalized care and a comprehensive approach to disease management.
Diet & Nutrition for Diverticulitis
For those experiencing mild cases of diverticulitis, a combination of antibiotics and a low-fiber diet is a common approach. Interestingly, while diverticulitis may initially arise due to insufficient fiber intake, experts advise temporarily reducing fiber intake during treatment to alleviate discomfort during flares. Once symptoms have subsided, a gradual increase in fiber consumption is recommended. However, more severe cases may necessitate hospitalization and more intensive interventions.
Diet and nutrition play a pivotal role in managing diverticular disease. Tailoring dietary approaches to the individual is crucial. During a diverticulitis flare, a clear liquid diet may be prescribed to provide relief. This diet typically includes clear liquids like soup broth, gelatin, clear electrolyte drinks, water, and ice chips.
Some individuals may benefit from following a low FODMAP diet, which restricts certain carbohydrates to reduce colon pressure. This involves avoiding fermentable oligosaccharides, disaccharides, monosaccharides, and polyols found in dairy products, fermented foods, beans, specific fruits, legumes, soy, trans fats, onions, and garlic.
Given that a diet high in red and processed meats may increase the risk of developing diverticulitis, it is advisable to limit the consumption of these foods, as well as foods high in sugar and fat.
Diet Tips for Diverticulitis
- Dry, low-fiber cereals
- Olive oil
- Processed fruits
- Cooked spinach
- Potatoes (no skin)
- Fruit and vegetable juices
- White rice, white bread, white pasta.
- Animal proteins such as fish, eggs or poultry
Supplements & Natural Medicine for Diverticulitis
Of the several natural remedies for diverticulitis currently under clinical investigation, berberine and curcumin show the most promise, especially for Post-Diverticulitis Syndrome which presents with IBS-like symptoms after an acute episode.
Berberine appears especially beneficial, as it increases the production of butyrate, a vital short-chain fatty acid for regulating the intestinal environment, alleviating mucosal inflammation, and fortifying the gut walls. Butyrate was even found in human trials to lower the recurrence of diverticulitis episodes.
Curcumin supplementation has also been found to neutralize the decrease of butyric acid-producing bacteria, leading to improved tight junction expression. Whether by preventing low levels of butyrate or by other mechanisms, curcumin has been found to restore impaired intestinal permeability by preventing tight junction protein disruption.
Understanding the nuances of diverticulosis and diverticulitis, including its symptoms, risk factors, and treatment options, can empower you to make informed decisions about your health and well-being, reducing the impact of this condition on your life.