Any health problem related to digestive system is hard to handle as the complications could be much severe. Same is the case with diverticulitis, a digestive disorder with symptoms ranging from range from mild to severe. Read through this HealthSpectra post to get a thorough understanding of Diverticulitis diet and treatment.
What Is Diverticulitis?
Diverticulitis is a medical condition where pouches, called as diverticula, are formed on the walls of the colon and get swollen, inflamed or infected. It is a painful condition commonly observed in aged people.
Causes Of Diverticulitis:
No specific cause for diverticulitis has been identified. It is a most common condition observed in people above the age of 60. Doctors assume that the condition may be a result of low fiber content in the diet. In case of the diet low in fiber content, colon has to play a harder role in pushing the stools forward. The resulting pressure is assumed as one of the reasons for the formation of pouches on the walls of the colon. And the inflammation or infection happens when the bacteria grows in the diverticula.
Who Is At Increased Risk Of Diverticulitis?
The major risk factor for diverticulitis is age, which means the older you get, the higher is the risk. Several other risk factors supported by recent research include:
- One of the most-suspected risk factors is the lack of dietary fiber (12).
- Genetic link may be associated with diverticulitis. According to a study on siblings and twins, around 50% have the potential risk of diverticular disease through genetics (13).
- In most cases, obesity is the clear risk factor for diverticulitis. Several studies reveal that obesity increases the diverticulitis risk and bleeding as well (14).
- A sedentary lifestyle may also be a risk factor for diverticulitis. Exercise may reduces the risk of diverticular disease.
- Several studies indicate that smoking raises the risk of symptomatic and complicated diverticular disease (16).
- Also, regular use of drugs like aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) increase the diverticulitis risk.
- As per the results from a study, people with complicated diverticulitis show lower vitamin D levels, compared to people with uncomplicated diverticulosis.
- The disease is more common in men than women among people below 50 years. In people more than 50 years, the condition is seen more common in women (19).
Diverticulosis vs Diverticulitis
Diverticulosis is a common digestive disorder manifested in the form of symptomatic uncomplicated diverticular disease (SUDD) that causes abdominal pain, irritable bowel syndrome, bloating, etc. Diverticulosis is the precursor to diverticulitis.
Diverticulitis occurs when the diverticula get inflamed. In people more than 70 years, 60% have diverticulosis, where as 75% percent of people with 80 years have diverticulitis. According to a study, even younger people diagnosed with diverticulosis are at high risk for the condition to progress to diverticulitis.
Symptoms Of Diverticulitis:
Diverticulitis typically causes symptoms and can lead to serious health complications. Below listed are most significant symptoms of Diverticulitis, which usually range from mild to severe. Moreover, the symptoms can appear suddenly or gradually over a few days (20).
The most common symptoms of diverticulitis:
- Pain on the left side of the lower abdomen
- Increased urge to urinate
- Burning sensation while urinating
- Blood in the stool
- Bleeding from the rectum
More severe complications of diverticulitis include:
- Collection of pus (abscess) in the pelvis region at the place where the diverticulum has ruptured
- Extensive inflammation causing colonic obstruction
- Generalized infection of the abdominal cavity
- Bleeding into the colon
- Spread of the bacteria within the colon into the surrounding tissues
- Constipation or diarrhea along with the inflammation
- Rupture of diverticulum into the abdominal cavity causing a life threatening infection called bacterial peritonitis.
- Erosion of the inflamed diverticulum into the urinary bladder, leading to the bladder infection.
When To See Your Doctor?
Patients with wild mild episodes of pain can be treated at home with enough rest. However, a doctor should be visited immediately at the first sign of diverticulitis as he may possibly suggest antibiotics after a thorough examination.
Call the doctor right away if :
- abdominal pain doesn’t go away
- bleeding or more severe symptoms show up
Diagnosis For Diverticulitis:
Doctor may ask for several types of tests to diagnose the condition. He would ask for health history, symptoms and ongoing medications.
A physical examination will help check the abdomen for tenderness. A digital rectal exam checks for pain, bleeding, masses, or other problems.
Your doctor may also order other tests like:
- Blood tests – check for anemia, inflammation, liver or kidney problems
- Imaging tests – abdominal CT scan, an abdominal ultrasound for gastrointestinal tract pictures.
- Urine tests- check different infections
- Stool tests – GI infections
- Pelvic examination in women
- Pregnancy test in women to rule out pregnancy.
Treatment for Diverticulitis:
The treatment depends on the severity of the condition. In case of uncomplicated diverticulitis, possibly home treatment or remedies are suggested. The home treatment for diverticulitis usually include rest and fluids with required follow-ups. Doctor may also prescribe some medications along with low-fiber diet, a liquid diet, etc.
Medications To Treat Diverticulitis:
Along with the normal fiber diet that helps prevent constipation and further formation of diverticula, anti-spasmodic drugs may be the part of the treatment for diverticulitis. Drugs commonly prescribed for diverticulitis include:
- chlordiazepoxide (Librax),
- atropine, scopolamine, phenobarbital (Donnatal)
- dicyclomine (Bentyl),
- hyoscyamine (Levsin).
Oral antibiotics prescribed for mild symptoms include:
- ciprofloxacin (Cipro)
- metronidazole (Flagyl)
- cephalexin (Keflex)
- doxycycline (Vibramycin)
Over-the-counter medications like acetaminophen (Tylenol) may be taken to ease the discomfort.
Surgical Treatment For Diverticulitis:
If medical treatment fails, surgical intervention is required. Surgery involves drainage of pus cells and surgical removal of the colon segment containing diverticula. In people with persistent bleeding, surgical removal of the bleeding diverticulum is done. Hence, it is important to accurately diagnose where the bleeding happens.
Also, surgery is required in cases where:
- Diverticula erode into the adjacent urinary bladder
- Recurrent urine infection
- Passage of gas during urination
- Frequent, recurrent diverticulitis attacks
- leading to multiple courses of antibiotics, hospitalizations, and days The surgery can mostly be done laparoscopically that limits post-operative pain and recovery time.
As a part of the treatment, doctor may also suggest a colonoscopy six to eight weeks after your first episode of diverticulitis. This test would confirm if the episode was not related to other problems. Meanwhile, doctor may also suggest
Home Treatment With Diet For Diverticulitis:
Doctor may suggest liquid-diet until diverticulitis symptoms subside. It is called a short-term clear liquid diet that offers rest to the digestive system during the recovery. Liquids to include in the diet are:
- Ice chips
- Fruit juices without pulp, such as apple juice
- Ice pops without bits of fruit or fruit pulp
- Tea or coffee without cream
A low-fiber diet for diverticulitis: Doctor may then recommend a low-fiber diet while your digestive system is recovering (24). Foods included in the low-fiber diet include:
- white bread
- white rice
- foods made with refined white flour
- low-fiber hot and cold cereal
- white pasta
- potatoes without the skin
- well-cooked canned or fresh vegetables
- fats like olive oil, mayonnaise, gravy, and butter
- dairy products (if tolerable)
- tender protein sources like eggs, chicken, tofu and fish
- creamy peanut butter
Fruits included under low-fiber fruits:
- fruit juices without pulp
- canned fruit
- honeydew melon
What Foods Can You Eat With Diverticulitis?
After considering a few factors, pick suitable foods for Diverticulitis. The factors to be considered include:
- Fiber: A high-fiber diet can help reduce the diverticulitis risk, and the diet rich in fiber may help reduce symptoms of diverticular disease (10).
- Vitamin D: As per a study, among people with complicated diverticulitis and hospitalized with low vitamin D levels, diet rich in vitamin D might help. (12). As the higher vitamin D levels help reduce the risk of diverticular complications.
- Low-FODMAP diet: Prefer foods rich in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs ) (34). Some of them include some fruits, dairy foods, fermented foods, garlic, and onions. A low-FODMAP diet is believed to benefit people with diverticulitis.
- Probiotics: Probiotics are believed to help reduce diverticulitis symptoms, besides encouraging remission. However, consult with your doctor before adding it to your diet.
Foods To Avoid With Diverticulitis:
Foods rich in insoluble fibers may be avoided when suffering from Diverticulitis. They include:
- whole wheat bread and baked goods
- vegetables and fruits, especially the skins
- whole grain breads
- Brazil nuts
- brown rice
A Diverticulitis diet may act as a temporary measure to offer the digestive system a chance to rest. Usually, doctors recommend resting the oral intake until bleeding and diarrhea subside.
However, there are some risks linked to the diverticulitis diet like continuing a clear liquid diet for more time may lead to clear weakness and other complications. The simple reason is that enough nutrients would not be supplied to the body. Hence, getting back to normal diet as soon as the patient can tolerate is quite important. Hence, before taking any call on the diverticulitis diet, check with your doctor.
1. What is the Difference Between Diverticulosis and Diverticulitis?
A. Diverticula are the main cause for diverticulosis and diverticulitis. Diverticulosis is the precursor to diverticulitis. Around 10% to 20% people with this condition of Diverticula progresses to SUDD – symptoms exhibited by diverticulosis, where as 4% get acute diverticulitis.
2. How Does Diet Affect Diverticulitis?
A. Certainly, diet plays a prominent role in maintaining the health of the digestive system. However, it is less clear if it plays an equally good role preventing and managing diverticulitis.
According to the National Institutes of Health (NIH), unlike before, eating seeds and nuts is not a problem. And hence, people with diverticulitis need not avoid any particular foods and in contrary fiber can indeed be a good choice if you have diverticulitis (6, 29).