Diverticulitis Diet, Symptoms, Treatment, Pictures & Definition

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A woman experiencing abdominal pain.

A woman experiencing abdominal pain.Source: iStock

Diverticulitis Symptoms


Rectal Bleeding

Blood in the stool can be bright red, maroon in color, black and tarry, or not visible to the naked eye.
Rectal bleeding or blood in the stool should be evaluated by a healthcare
professional.

Rectal bleeding also can be a symptom of other diseases or conditions
such as:

  • Anemia
  • Anal fissures
  • Cancer
  • Colon polyps
  • Diverticulitis
  • Hemorrhoids
  • Ulcers (for example, ulcerative or Crohn’s colitis)

Picture of Diverticulitis

Illustration of diverticulosis in the colon.

Illustration of diverticulosis in the colon.Source: Getty Images

What is diverticulosis? What does it look like (pictures)?

The colon (large intestine or large bowel) is a long tube-like structure approximately 6 feet in length that stores and then eliminates waste material left over after digestion of food in the small intestine takes place. It is thought that 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, but are seen in more than 74% of people over the age of 80 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 most people with diverticular disease, the symptoms may be due to the concomitant presence of irritable bowel syndrome (IBS) 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.

Picture of Diverticular Disease

Picture of Diverticular Disease

Artwork based on an endoscopic image of diverticula in the colon.

Artwork based on an endoscopic image of diverticula in the colon.Source: Getty Images

What causes diverticula and how do diverticula form?

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 has been thought to be 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. Nevertheless, studies have not found similar correlations between fiber and diverticula within individual societies. Many people 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 inflammation may be important for the formation of the diverticula and not just the result of them.

An assortment of high fiber foods that helps prevent constipation, which in turn may help prevent diverticulosis.

An assortment of high fiber foods that helps prevent constipation, which in turn may help prevent diverticulosis.Source: iStock

Is there a diverticulitis diet? What food should be avoided to prevent diverticulitis? What foods prevent flares?

Once formed, diverticula do not go away; they are permanent. No treatment has been shown to treat or prevent diverticular disease or diverticulitis. Nevertheless, recommendations have been made in regard to which foods to eat, and which foods to avoid.

Foods to eat that may prevent flares

Since one theory holds that it is reduced fiber in the diet that causes diverticulitis, diets high in fiber are the most recommended treatment for diverticula. Fiber clearly increases stool bulk and prevents constipation, and, if it really reduces pressures in the colon, theoretically it may help prevent further diverticula formation or worsening of the diverticular condition. Foods high in fiber include:

  • Fruits and vegetables
  • Legumes/beans, (for example, lima, kidney, cannellini, and red kidney beans; chickpeas, split peas, and tofu)
  • Whole grains (for example, brown rice, cracked wheat, oatmeal, quinoa, rolled oats, rye bread, wild rice; and whole wheat bread, cereal, crackers, pasta, and tortillas)

Foods to avoid with diverticulitis

Some doctors recommend avoiding nuts, corn, and seeds, which are thought by some to plug diverticular openings and cause diverticulitis, but there is little evidence to support this recommendation. Nevertheless, foods frequently recommended to be avoided include:

  • Popcorn
  • Poppy seeds
  • Sesame seeds

What about probiotics and diverticulitis or diverticular disease?

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 and/or prebiotics; however, there is not enough evidence of a benefit of probiotics yet to recommend treatment with probiotics of patients with diverticular disease.

A doctor and nurse discussing complications of a senior patient in the hospital.

A doctor and nurse discussing complications of a senior patient in the hospital.Source: iStock

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.



SLIDESHOW


Diverticulitis (Diverticulosis) Symptoms, Diet, Treatment
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Colored X-ray of the colon of a patient with diverticulitis showing the small pouch-like structures that protrudes out of weak spots in the intestinal wall.

Colored X-ray of the colon of a patient with diverticulitis showing the small pouch-like structures that protrudes out of weak spots in the intestinal wall.Source: Getty Images

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Ciprofloxacin antibiotic drug is used to treat diverticulitis.

Ciprofloxacin antibiotic drug is used to treat diverticulitis.Source: Getty Images



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Bowel regularity means a bowel movement every day.
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Doctors performing surgical treatment for diverticulitis.

Doctors performing surgical treatment for diverticulitis.Source: Getty Images


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Medically Reviewed on 3/23/2021

References

Anne F. Peery and Robert S. Sandler. Diverticular Disease: Reconsidering Conventional Wisdom. Clin Gastroenterol Hepatol. 2013;11:1532-1537.

Choosemyplate.gov. “Grains Gallery.”

<http://www.choosemyplate.gov/foodgallery-grains>

Eatforhealth.gov. “Vegetables and Legumes/Beans.”

<https://www.eatforhealth.gov.au/food-essentials/five-food-groups/vegetables-and-legumes-beans>



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