What is diverticulitis?
Inflammation and infection of diverticula are called diverticulitis. Diverticula are pouches which occur along the digestive tract, most often in the colon (large intestine). These pouches are formed when weak spots in the intestine balloon outward. The process of forming pouches is called diverticulosis. Diverticulitis is a more serious condition when these pouches get infected by bacteria and eventually get inflamed causing perforation of the bowel.
The pouches commonly form at the end of the descending and sigmoid colons located on the left side of the abdomen. They also mostly occur in the first section of the small intestine, which rarely causes problems. Diverticula are generally harmless. People having diverticula which are not infected is called diverticulosis.
Diverticulosis typically causes no symptoms and does not need treatment. Only 10-20% of people having diverticulosis progress to a condition called asymptomatic uncomplicated diverticular disease (SUDD) and the symptoms are similar to irritable bowel syndrome, which includes abdominal pain and bloating. Typically it takes about 7 years for symptomatic uncomplicated diverticular disease (SUDD) to progress to diverticulitis.
An episode of diverticulitis can usually recur as an acute, or short-term, problem. However, there is no definite timeframe. Studies have shown that when a person has an episode of diverticulitis, he or she is more likely to have another episode of an acute attack within five years.
Usually, the first attack is the worst one because scar tissue builds up in the diverticula and helps prevent future perforations. If the first episode is mild, there is a higher chance of avoiding serious complications. There are also cases when diverticulitis can progress into a chronic or long-term problem. These cases can be much more serious and surgery may be required to remove the diseased tissue.
There are several risk factors associated with diverticulitis. The foremost risk factor can be associated with age. There is a higher risk of developing diverticulitis at an older age. Diverticulosis, which is the predecessor to diverticulitis, is quite common in adults, especially people above the age of 60. Studies have estimated that diverticulitis can affect 60% of people over age 70 and can affect 75% of people who are 80 years and older. People who are diagnosed very early with diverticulosis have a higher chance of progression to diverticulitis later in their life.
What are the causes of diverticulitis?
One of the main causes of diverticulitis is by fecal matter blocking the opening of diverticula. This can cause inflammation and infection. It can vary from person to person. Multiple factors can lead to diverticulitis, which is discussed below:
- Low-fiber diet: People consuming a low fiber diet are at higher risk of developing diverticulitis. Studies have shown that a lack of dietary fiber has long been suspected for the onset of diverticulitis.
- Heredity: Heredity seems to play an important part for people to have diverticulitis. Research has shown that more than 50% of the potential risk of diverticular disease comes from genetics.
- Obesity: Obesity is another factor related to diverticulitis. People who are obese have a clear risk factor for diverticulitis. Obesity raises the risk of diverticulitis and bleeding, but there is no clear reason behind this.
- Lack of Physical Exercise: People having a sedentary lifestyle are more prone to diverticulitis. Exercise helps a person be flexible and helps in muscle contraction and extension, which is required for a healthy intestine. A sedentary lifestyle can hamper this process, which can lead to the onset of disease.
- Smoking: Research has shown that smoking can increase the risk of symptomatic and complicated diverticular disease.
- Medications: People who consume prescribed medications such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) have a higher risk of diverticulitis. The use of opiates and steroids raises the risk of perforation, which is a serious complication of diverticulitis.
- Vitamin D deficiency: Studies have also noted that people with complicated diverticulitis tend to have lower levels of vitamin D. Studies suggest that vitamin D levels seem to be related to complications of the disease.
- Age and Sex: Diverticulitis seems to be more common among people with the age group of 50 and younger. Diverticulitis also appears to be slightly more common in men than women in this age group. Diverticulitis seems more common in women who are older than 50 years.
Symptoms of Diverticulosis and Diverticulitis
People having diverticulosis usually have minimal to no symptoms. Diverticula are generally painless and hardly cause any symptoms. Some of the symptoms of diverticulosis are:
- Cramping on the left side of the abdomen. This disappears after passing gas or moving the bowels.
- Bright red blood in the stool.
Diverticulitis symptoms are much noticeable. Pain in the abdomen is the most common symptom, which typically occurs in the lower left side of the abdomen. Diverticulitis most often affects the part of the colon in that area. The most common symptoms of diverticulitis include fever, nausea, abdominal pain, vomiting, burning sensation while urinating, increased urge to urinate, constipation, and diarrhea.
Blood in the stool, as well as bleeding from the rectum, occurs in both diverticulosis and diverticulitis. Diverticulitis may be acute or chronic. The acute form of diverticulitis can display itself with one or more severe attacks of infection and inflammation. The infection may never clear up completely in the case of chronic diverticulitis but may subside.
The inflammation that is caused can eventually result in a bowel obstruction, which may cause abdominal swelling or bloating, constipation, thin stools, diarrhea, and abdominal pain. When obstruction persists, abdominal pain and tenderness will increase and people may experience nausea and vomiting.
Complications of Diverticulitis
Diverticulitis can lead to serious complications if untreated and may even require surgery. Some of the complications associated with diverticulitis include:
- Abscesses may form around the infected diverticula. These abscesses go through the intestinal wall and people may develop peritonitis, which is potentially a fatal infection, which requires immediate treatment.
- Scarring may occur, leading to a stricture or blockage of the intestine.
- Fistulas are formed when an infected diverticulum reaches an adjoining organ. This generally occurs between the large intestine and the bladder.
- May require transfusion if the bleeding is severe.
Treatment for diverticulitis
Diverticulitis is usually a medical emergency depending on the severity of symptoms and may require immediate medical attention and admission to the hospital whereas mild attacks can be treated at home.
- No eating or drinking. Intravenous fluids are given for the bowel to rest.
- Pain-relieving medication.
- Surgery may be needed in severe cases when the weakened sections of the bowel wall have ruptured or become obstructed, or if the attack of infection fails to settle.
- Doctors try to rejoin the healthy section of the bowel during surgery and if it is not possible to rejoin the healthy sections of bowel, a colostomy bag will be fitted. This is generally temporary and the bowel can be rejoined after six to 12 months.
- Long-term use of mild antibiotic becomes necessary to prevent further attacks.
Diverticulitis can cause some serious health conditions and there is no particular diet, which is used to treat them, but there are foods, which needs to be avoided to contain the disease. We may want to consider keeping certain foods to a minimum.
Foods to avoid
High-FODMAP foods: FODMAP foods are called as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols food. Research has shown that a diet, which limits foods that are high in FODMAP, can benefit people with irritable bowel syndrome, which is one of the common symptoms of diverticulitis. Foods high in FODMAPs include:
- Fruits, such as apples, pears, and plums.
- Dairy foods, such as yogurt, ice cream, and milk.
- Fermented foods, such as sauerkraut or kimchi.
- Brussels sprouts.
- Onions and garlic.
High-fiber foods: Foods that are high in fiber usually are very helpful for people with diverticulosis as well as diverticulitis. A systematic review showed a reduction of abdominal symptoms and the prevention of acute diverticulitis with the intake of fiber diet.
However, different people react in different ways depending on the symptoms they have due to the specific fiber needs, which varies based on the condition and symptoms. Doctors generally ask people to avoid these high fiber foods if the person is having pain or other symptoms.
Fiber adds bulk to stool and may increase peristalsis or colon contractions, which may be painful and uncomfortable when having a flare-up. Avoiding high-fiber foods in such cases may ease symptoms and give the system a temporary rest.
Fiber-rich foods which need to be avoided during a flare-up include:
- Beans and legumes such as kidney beans, chickpeas, navy beans, lentils.
- Whole grains such as quinoa, oats, brown rice, etc.
Foods High in Sugar and Fat: Diet containing a high amount of sugar and fat are generally not advisable for any medical condition. A diet containing high in fat and sugar and low in fiber may be linked with an increased incidence of diverticulitis. Some of the foods, which can be avoided to prevent diverticulitis include:
- Red meat.
- Refined grains.
- Full-fat dairy.
- Fried foods.
Other foods to avoid: Doctors generally advise not to consume foods such as nuts, popcorn, and most seeds. Since tiny particles from these foods might get lodged in the pouches and lead to an infection, they are generally avoided. There is no stern evidence that these foods may lead to diverticulitis, but just an assumption. Research has also suggested that people with diverticulitis should avoid alcohol.
Foods to eat
There are some foods, which the doctor recommends to manage diverticulitis. Treatment and disease management for diverticulitis vary from person to person. Change in diet may help people to have lesser symptoms and limit recurrence. During an acute attack of diverticulitis, the doctor may suggest either a low-fiber diet or a clear liquid diet to help relieve the symptoms. Low-fiber foods to consider during the 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
- Cooked animal proteins
- Olive oil or other oils
- Yellow squash, zucchini, or pumpkin: peeled, seeds removed, and cooked
- Cooked spinach, beets, carrots, or asparagus
- Potatoes with no skin.
- Fruit and vegetable juices.
Clear liquid diet: A clear liquid diet is the first choice of diet administered during hospitalization to relieve diverticulitis symptoms. A clear liquid diet is prescribed for a short period of time and may consist:
- 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 excluding any creams, flavors, or sweeteners.
- Clear electrolyte drinks.
Drinking at least eight cups of water daily seems to be the ideal choice when following any diet. Drinking adequate amount of water helps you keep hydrated and supports gastrointestinal health. Usually, after a prescription of clear liquid diet for a few days, doctors may recommend slowly adding low-fiber foods back into the diet. Once the symptoms of diverticulitis have subsided, doctors may suggest resuming a balanced diet.
The bottom line
A diagnosis of diverticulitis needs to be treated appropriately with medications. It is also important to talk to the doctor about food requirements and restrictions. A proper diet may help calm down the symptoms and restrict its recurrence. People having just diverticulosis can consume a diet high in fiber, which will help prevent future flare-ups.
A high fiber diet is not advisable for people suffering from diverticulitis, which can flare-up the symptoms. It is advised to speak to a healthcare professional who has experience working with people affected by diverticulitis. A right diet can make wonders in limiting the symptoms.
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