What Is Diverticulitis?

Sometimes tiny, bulging pouches (called diverticula) form in parts of the colon and this condition is called diverticulosis. If the little pouches become inflamed or infected, this is diverticulitis.

Having diverticulosis is very common, and most people never know they have it. It is estimated that half of all people over 60 have it. But of those, only 10%-25% go on to develop diverticulitis. Diverticulitis typically develops when the pouches blocked with waste become inflamed and infected, possibly leading to tears in the bowel wall.

When a hole develops between a pouch and a blood vessel, bleeding can happen. This can cause bright red blood to appear in your stool suddenly. This condition is usually painless, and the bleeding usually stops on its own. But in rare cases, bleeding can be severe enough to require a transfusion or surgery. You should contact your doctor immediately if you see red blood in your stools.

The reason diverticula form in the colon has yet to be understood entirely. Doctors think diverticula form when high-pressure areas inside the colon push against weak spots in the colon wall. These diverticula are most common in the lower part of the large intestine (called the sigmoid colon).

People with diverticulosis usually don't have any apparent symptoms. Still, once inflammation or infection sets in, symptoms are noticeable and can include abdominal bloating, pain, abdominal tenderness, diarrhea, chills, and a low-grade fever.

In severe cases, inflammation of the diverticula can lead to a tear in the intestinal wall allowing infected fluid to leak into the abdominal area, causing peritonitis (a painful infection of the abdominal cavity), abscesses, intestinal obstruction, and an opening (called a fistula) between the bowel and the urinary tract or another organ in the abdomen or pelvis. At this point, surgical intervention will be needed.

Treating Diverticulitis

Most patients with diverticulosis have minimal or no symptoms and do not require specific treatment. A high-fibre diet and fibre supplements are highly recommended to prevent constipation and the formation of more diverticula.

When diverticulitis symptoms -- abdominal pain, cramps, and fever -- are mild, antibiotics taken by mouth are usually enough. When pain is worse, a clear liquid diet to allow the colon and bowel to recover may also be prescribed. When pain is increasingly severe, or when there is a high fever or the inability to drink liquids, a hospital stay may be necessary, along with intravenous antibiotics and not eating or drinking for a few days.

Preventing Diverticulitis?

Once formed, diverticula are permanent. And no treatment has been found to prevent complications of diverticular disease. But diets high in fibre increase stool bulk and prevent constipation, which may help symptoms. 

What about seeds and nuts? There's no evidence these foods cause diverticulitis flares. But if you feel they trigger your symptoms, eat other high-fibre foods instead; if you find raw high-fibre foods irritating, steam or boil them and eat the softer version for a week. Fibre softens and adds bulk to stools, helping them pass more easily through the colon while reducing pressure in the digestive tract.

Think of fibre as nature's “scrub brush” to clean, stimulate and move things along our colon. Thinks of raw vegetables vs steamed vegetables as the “hard bristle brush” or the “soft bristle brush.” Many studies show that eating fibre-rich foods can help control diverticular symptoms. Drinking plenty of water and incorporating daily movement or exercise will also help.

Fortunately, you don't have to look hard to find an abundance of high-fibre foods. Fibre is found in fruits, vegetables, whole grains, and legumes (dried beans, peas, and lentils). Make smart food choices, including brown rice and whole wheat pasta in place of the regular version. And add extra veggies to your favourite dishes -- pizza, stews, and spaghetti sauce. Women younger than 51 should aim for 25 grams of fibre daily. Men younger than 51 should aim for 38 grams of fibre daily. Women 51 and older should get 21 grams daily. Men 51 and older should get 30 grams daily. 

Alternatively, the use of fibre laxatives may be recommended. Make sure that you drink plenty of water or fluids with these. Little water with a fibre laxative can have the opposite effect and increase cramping and constipation.