Diverticulosis And Diverticulitis (Diverticular Disease)

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Last Medical Review: March 27, 2020
Medically Reviewed by Dr. David Costa Navarro
Diverticulosis and diverticulitis (March 27, 2020)

Diverticulosis

It is a problem that affects over half of older people, even if only in a minority (20%) the disease is clinically manifest. Abdominal discomfort such as cramps and swelling, sometimes associated with constipation and diarrhea, can occur in these patients. The presence of symptoms and their greater or lesser extent is not proportional to the severity of the condition. Damage to the vessels at the level of the diverticula can cause bleeding even to a certain extent. Diverticulosis is frequently discovered casually during radiological or endoscopic investigations performed for other reasons. In the presence of suspicious symptoms, the diagnosis can be made thanks to 2 instrumental investigations: opaque enema with double contrast or colonoscopy. In the absence of symptoms, no treatment is required and a high fiber diet is recommended that reduces the risk of symptoms occurring. In the presence of symptoms, a diet rich in fiber leads to a subjective improvement and seems to reduce the risk that diverticulosis evolves into diverticulitis. The recommendation to follow a diet rich in fiber in all cases, even in the presence of non-univocal data, appears reasonable also in view of the potential benefits obtainable in terms of general health. Symptomatic treatment with antispasmodics (eg Colic Antispasmin) to reduce abdominal cramps is not currently supported by adequate data confirming its usefulness. The use of surgery is unjustified except in a few rare cases. There are no adequate clinical studies on the possibility of preventing the appearance of episodes of diverticulitis or its complications with the prophylactic use of non-absorbable antibiotics (e.g. neomycin, neomycin + bacitracin, paromomycin, rifaximin), although this practice is often followed.

Diverticulitis

When the mucous membrane of the diverticula becomes inflamed, due to the permanence of fecal material inside them, it is called diverticulitis, with several possible complications such as the formation of fistulas, abscesses, peritonitis, occlusion and hemorrhages. The less severe forms are treated with rest, liquid diet and antibiotics. As symptoms improve, a low-fiber diet begins with the daily addition of psyllium preparations. The fiber-rich diet can be resumed only after one month as in diverticulosis. Hospitalization is required in case of severe diverticulitis.

Diet for diverticulosis and diverticulitis

People suffering from diverticular disease need to increase fiber consumption. This increase must take place gradually to limit swelling, bloating and flatulence as much as possible which, however, generally resolves in a short time, without interrupting the diet. The action of the fibers is closely linked to water and it is therefore essential to take abundant quantities of liquids (at least 2 liters per day) between meals. In general, it is advisable to avoid a sedentary life, to adopt a diet that keeps weight under control, not to skip meals, to moderate the intake of meat and too refined or “heavy” foods which, compared to the calories provided, have little or no fiber content (avoid cheeses and fatty meats, spicy foods, processed foods, fried foods, carbonated drinks, alcohol). To increase dietary fiber consumption you need:

  • prefer bread, biscuits, etc… based on whole grains
  • eat 2 – 3 servings of raw or cooked vegetables daily. The richest fiber vegetables are agretti, asparagus, cauliflower, artichokes, mushrooms, broccoli, aubergine, chicory. Lettuce, radicchio, celery and carrots have a greater ability to retain water and therefore increase the volume of feces;
  • consume two servings a day of fruit. The fruits with the highest fiber are kiwis, berries, medlars, pomegranate and plums, while those that can hold the most water are apples, oranges and pears;
  • consume legumes (beans, chickpeas, lentils, broad beans, peas) twice a week.

In addition to food, the amount of fiber needed can be taken through psyllium and bran supplements which must be taken with plenty of water and between meals to prevent them from interfering with the absorption of the nutrients in the food.    

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