Why does diverticulitis happen, and what’s the difference with diverticulosis?

Diverticulosis and diverticulitis

Diverticular disease is a medical condition that occurs when small protrusions, known as diverticula, develop in the wall of the colon. The terminology of diverticular disease can be confusing, so let me explain the most relevant definitions first.

  • Diverticula (singular: diverticulum) – protrusions of the colon, in scientific words: herniations of the colonic mucosal wall
  • Diverticulosis – a presence of diverticula without evidence of inflammation
  • Diverticulitis – diverticulosis with evidence of inflammation
  • Complicated diverticulitis – diverticulitis with associated abscesses, fistula, obstruction, or perforation. A fistula is an abnormal connection between two hollow spaces, such as blood vessels, intestines, or other hollow organs.
  • Diverticular disease – an overarching term for asymptomatic or symptomatic diverticula.

Diverticulosis requires medical procedure when it develops into diverticulitis, and, in its mild forms, is treated with antibiotics and paracetamol. Complicated diverticulitis requires intravenous antibiotics, fluids, and a blood transfusion in case of bleeding. Sometimes, surgery is necessary to remove the infected area, and, in the most extreme cases, this can cause stoma formation. The latter is an artificial opening that allows feces or urine either from the intestine or from the urinary tract to pass.

Complications in diverticulitis include the development of abscesses, fistulae, obstruction, diverticular bleeding and perforation of the bowel. Diverticular disease is dominant in older adults and puts them under a health burden.

If you’re experiencing constant bloating, abdominal cramping, or constipation, you may consider getting yourself checked for diverticulosis. The latter condition is less common in women than in men; only a few people with diverticula develop inflammation (i.e., diverticulitis).

Thanks to the healthy dietary options we have, it’s possible to manage the symptoms of diverticulosis, and improve the quality of our life.

The first section of this post explains what diverticulosis and diverticulitis are, their causes, and symptoms. In the second part, I will discuss the gut-friendly high-fiber food and cooking suggestions that will help you prevent and manage this disease.

Diverticulosis – Causes

diverticulosis and diverticulitis

The causes of diverticulosis are not completely clear. Constipation increases the pressure on the colon’s wall, while increased abdominal thickness due to obesity is another potential risk factor. The Western diet, which uses a lot of high-fat and low-fiber ingredients, is a risk factor for diverticulosis. A low-fiber diet can prompt a person to diverticulosis by slowing fecal transit time.

Up to 4% of patients with diverticulosis develop diverticulitis. The risk of diverticular disease increases with age. Diverticulosis is present in more than 65% of individuals older than 85 years. Symptoms usually arise at about the age of 60. Diverticulitis is more common among men as compared to women, and the women risked with this disease are between the ages of 50 and 70 years. Marked female majority with diverticulosis is older than 70 years.

At the clinical presentation of diverticulitis, diverticula become inflamed or infected. The most common presenting symptom is pain, typically crampy, at the left lower quadrant. Pain on the lower right quadrant is instead more likely to be related to acute appendicitis. Some patients may experience fever and leukocytosis (elevated white blood cell count). Symptoms of mild diverticulitis often get confused with overlapping symptoms of irritable bowel syndrome (IBS).

What’s the difference between diverticulosis and diverticulitis?

diverticulosis and diverticulitis

Untreated diverticulosis often leads to diverticulitis, an inflammation (and swelling) of one or more diverticula. The most severe forms of diverticulitis cause pain, fever, nausea, and other symptoms.

Symptoms of Diverticulosis

While diverticulosis doesn’t include noticeable symptoms. You might be suffering from the condition if you have:

  • Tenderness over the affected area
  • Abdominal cramps/mild pain
  • Constant bloating
  • Swelling
  • Constipation

Having one or all of these symptoms above doesn’t mean that you have diverticulosis. These are also the symptoms of other gastrointestinal diseases, including celiac disease, IBS, gallstones, and ulcers.

Symptoms of Diverticulitis

Usually, individuals experience the following initial symptoms of diverticulitis:

  • Abdominal pain that generally happens at the left lower quadrant
  • Nausea
  • Vomiting
  • Constipation or obstipation
  • Bloating
  • Fever
  • Flatulence

Other types of symptoms can occur, but it also depends the severity of inflammation and other complications. Severe complications include infected abscess with production of pus, full-thickness tearing of the colon, and fistula (which is an abnormal connection between two body parts, as explained above).

Diverticula and diverticulitis can develop anywhere in the gastrointestinal tract, and their symptoms can overlap. Here are some examples:

  • Diverticulitis in the right colon or a redundant sigmoid colon can be mistaken for critical appendicitis.
  • Diverticulitis in the cecum, although rare, can resemble critical appendicitis.
  • Diverticulitis in the transverse colon may seem like peptic ulcer disease, pancreatitis, or cholecystitis.
  • Retroperitoneal diverticulitis could appear as renal disease.
  • In females, lower quadrant pain can be challenging to differentiate from a gynecologic process.

Anorexia, nausea, and vomiting often characterize the most severe cases of diverticulitis. Usually, the pain is localized and remains for several days before its disappearance. Many patients experience a change in their bowel habits, and some have constipation. Some patients complain of urinary symptoms like painful urination, urgency to pee, and frequency of urination. The latter symptoms appear to be cause by inflammation of urinary tract structures.

Diagnosis of diverticular disease

diagnosis of diverticular disease

A CT scan of the abdomen is the ideal method for confirming a diagnosis of diverticulosis. CT scans can help doctors assess the disease stage, its severity, and underlying complications. A CT scan can also identify fistula, peritonitis, and obstructions. Severe diverticulitis is diagnosed based on the patient’s history, physical examination, and laboratory tests, including a hemogram to check for leukocytosis.

Who is Most Likely to Get Diverticulosis and Diverticulitis?

diverticulosis and diverticulitis

You’re in a high-risk bracket if:

  • you’re over 40
  • you’re male
  • you’re obese
  • you consume a low-fiber diet
  • you consume a high-fat diet
  • you don’t workout
  • you consume non-steroidal anti-inflammatory drugs (NSAIDs)

The actual occurrence rate of diverticulosis is unknown, as it is often asymptomatic. Diverticular disease is most common in Western countries

Treatment Recommendations for diverticular disease

treatment for diverticular disease

The American Gastroenterological Association (AGA) issued some recommendations for the treatment of diverticular disease.

  • A fiber-rich diet or fiber supplements, along with daily physical activity, is highly recommended. However, if you have diverticulitis, eating lots of fiber worsen it by increasing colon contractions. Avoiding high-fiber food with diverticulitis may ease symptoms
  • Aspirin use can improve diverticulitis, and it is often continued after resolution as secondary prevention (ask your doctor, don’t take it out of your initiative!)
  • Diverticulosis or diverticulitis patients can eat nuts and popcorn
  • For optimum health recovery and fitness, avoid non-aspirin, non-steroidal anti-inflammatory drugs
  • Mesalamine, rifaximin, and probiotics do not help prevent a recurrence

Dietary risk factors for diverticulosis

A low-fiber diet is a risk factor for diverticular disease since it can slow the gut transit leading to constipation and increased intraluminal pressure in the colon. The latter further causes segmentation and herniation of the mucosa through the muscle. A high‐meat diet can also affect colonic bacterial metabolism that might play a role in the development of diverticula.

Dehydration is potentially responsible for acute diverticulitis along with a low fiber diet. Micronutrient deficiencies, such as vitamin C, B12, and folate can also occur. Physical activity such as exercise can help to reduce the risk of developing diverticulosis.

Nutritional management of diverticulitis and diverticulosis

diet for diverticular disease

Patients with diverticulitis must use a fluid‐only diet, plus dietary supplements, until symptoms start to improve. Later, avoiding foods that can irritate the bowels help reduce inflammation. These foods include fruit and vegetable skins, seeds and nuts, and spicy foods and can be reintroduced into the diet after diverticulitis has healed. Choose overall healthy foods, drinks and let your body heal itself. You may need to make a few lifestyle changes.

A high-fiber diet helps prevent the recurrence of diverticulitis. Cereal fibers tend to be less effective than soluble fibers from fruit and vegetables. Although probiotics cannot prevent diverticulitis, they have a role in maintaining optimum gut health. If you’re wondering what kind of high-fiber foods and meals you should use to prevent diverticulosis, you’ve come to the right place. The following section highlights some of the best high-fiber ingredients that will help you create your dream meal while staying healthy and fit.

High-Fiber Food Ideas

According to Dietary Guidelines for Americans, the ideal intake of fiber should not be less than 33.6g for adult men and 28g for adult women.

But sadly, most of them fail to reach this standard. The average fiber intake in Americans is not more than 17g.

Below you’ll find a list of fiber-rich foods (legumes, fruit, veggies, nuts) that provide benefits for patients with diverticulosis.

Adding a high-fiber diet in food has so many benefits, especially for the gut, heart, and weight loss. A person must have an adequate amount of dietary fiber. A reasonable amount of dietary fiber for men is 33.6 grams per day. Two kinds of dietary fiber exist: soluble and insoluble. As for women, it is 28 grams per day. Fruit, vegetables, legumes, nuts, and whole grains are all sources of fiber.

  • Legumes
diverticulosis and diverticulitis

Legumes are plant-based foods commonly known as beans, lentils, and peas. Legumes are a source of fermentable fiber. The latter helps feed the healthy colonies of bacteria that go to the gut as well.

Beans contain large amount of fiber and protein. Common legumes include pinto beans, black beans, split beans, lentils, mung beans, adzuki beans, lima beans, chickpeas, kidney beans, soybeans, baked beans, and green peas.

You can use legumes to make several sweet and savory recipes. For instance, fresh fava beans taste yum when cooked with caramelized soften leeks. You can cook mung beans and rice together to prepare a wonderful pilaf. Similarly, red kidney beans enhance the taste and texture of curries and soups.

  • Vegetables
diverticulosis and diverticulitis

Vegetables are a source of numerous nutrients and fiber. They don’t only provide many sorts of healthy vitamins, but they offer dietary fiber. Here is a list of vegetables that contain high amounts of fiber.

Fiber-rich vegetables include artichokes, parsnips, winter squash, broccoli, and pumpkin. Some of them come with antioxidant abundance as well, which is very healthy for overall health.

The best way to include vegetables into your diet is to include it in every meal as a side dish. You can also blend or puree them, and add to soups and gravies. Replace unhealthy snacks with vegetable sticks and different types of dips. And the possibilities are endless.

  • Fruit
diverticulosis and diverticulitis

Fruit is the best snack in between meals. It is sweet and sour and it contains lots of fiber. Some types of fruit have less while some offer plenty of fiber, but one thing is for sure, each one comes with fiber. Pears, apples, raspberries, blackberries, prunes, oranges, and guava, all contain fiber that help maintain gut health.

Although avocados are usually not considered fruits, they contain monosaturated healthy fats that can reduce inflammation. 

All fruits are versatile. You can add them to your salads or serve them in a bowl right after every meal. Top your toasts with juicy strawberries or make your boring granola bowl special by adding blueberries or kiwis. There’s plenty of things you can do with fruits to make your meal special.

Also, you can blitz your favorite with some yogurt to make a healthy and delicious smoothie.

  • Nuts and seeds
diverticulosis and diverticulitis

Nuts and seeds contain healthy fats, protein, and omega-3 fatty acids. Some of them contain monounsaturated fibers, and some have polyunsaturated fatty acids. They also contain fibers that are essential for our body. The most fiber-rich seeds include the following.

Buckwheat: although it sounds different, it is a seed and not a grain. These provide gluten-free fibers.

Chia seeds: High-fiber seeds, ideal for breakfast porridges. 

Quinoa: Highly popular pseudo-cereal seed that goes well with various foods.

Lastly, pumpkin seeds, almonds, and popcorn are used as snacks on their own and also in various food dishes. Just make sure to avoid extra salt, sugar, or fried nuts in case of diverticulosis.

I’ve also discussed some of these high-fiber nuts and seeds in my ‘Gluten-Free Grains and Pseudo-Grains‘ article. Make sure you give that blog a go if you’re looking to know more about them. As far as their use is concerned, I would prefer to top my every food with nuts and seeds – be it a smoothie, salads, or desserts. These nuts and seeds aren’t only healthy, but they also add texture and depth to your food.

  • Whole grains
diverticulosis and diverticulitis
Crispbread with a variety of seeds on the board.

Whole grains keep your stomach full for a longer time after meals compared to refined grains. They are an essential part of our diet so, replacing the grain flour with healthy whole grain to increase the fiber intake.

The list starts from freekeh, which is made with green wheat that is not fully grown. It has an abundance of fiber. Then comes bulgur and barley.

Apart from that, unrefined rice and wheat are whole grains that contain lots of fiber and healthy nutrients. The best part? You can cook them in a variety of different ways. Whole grain wheat flatbreads and wraps for preparing a healthy version of shawarma. Similarly, you can use rice to prepare different sweet and savory options, including rice pudding, snacks, salads, etc.

Diverticular disease: conclusions

Diverticulosis and diverticulitis are common conditions. They can impact your quality of life and keep you bloated and uncomfortable.

Dietary changes represent the most effective way to prevent the diverticular disease. Make sure you accompany a nutritious diet with a healthy lifestyle.

I hope this post has served its purpose and helped you learn some of the tried-and-tested options to deals with diverticulosis and diverticulitis.

Feel free to write your comments and feedback below. I’d love to hear back from you!

Picture of Gianluca Tognon

Gianluca Tognon

Gianluca Tognon is an Italian nutrition coach, speaker, entrepreneur and associate professor at the University of Gothenburg. He started his career as a biologist and spent 15 years working both in Italy and then in Sweden. He has been involved in several EU research projects and has extensively worked and published on the association between diet, longevity and cardiovascular risk across the lifespan, also studying potential interactions between diet and genes. His work about the Mediterranean diet in Sweden has been cited by many newspapers worldwide including the Washington Post and The Telegraph among others. As a speaker, he has been invited by Harvard University and the Italian multi-national food company Barilla.

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About Me

I’m an Italian nutrition coach, speaker, entrepreneur and associate professor at the University of Gothenburg. I started MY career as a biologist and spent 15 years working both in Italy and then in Sweden.

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