How to heal Diverticulitis / Diverticulosis

Female with stomach pain Diverticulitis holding stomach tummy, belly, bowels

What is Diverticulitis & Diverticulosis?

There are 3 primary stages of the disease.

1. Diverticulosis

is a very common condition where small pouches or pockets form in the wall of your large intestine/ bowel

  • This is the physical structural difference from a disease free bowel
  • It is usually asymptomatic (does not cause any symptoms and you can’t tell it is there unless tested for)

2. Diverticular disease

is when Diverticulosis causes symptoms such as:

  • Mild cramps or lower stomach pain that may come and go
  • BloatingInconsistent or irregular bowels

3. Diverticulitis

is when the small pouches of diverticulosis “flares up”, becomes irritated and/or is infected. This may commonly lead to one or multiple of the following:

  • Significant sharp & intense pain and/ or cramping in lower stomach/ abdomen
  • Fever
  • Nausea &/ or vomiting
  • Loss of appetite
  • Constipation or diarrhoea
  • Blood in stool

Piccin, A. et al. (2023)

What causes diverticulosis and diverticulitis?

Diverticulitis is a multifactorial disease, meaning that multiple things appear to contribute to its development. It’s primary influence is low fibre intake (meaning low vegetable, fruit and legume intake) and dehydration in the diet over many years. Additional contributors can be

  • Reduced physical activity & exercise
  • Pushing when going to the toilet and chronic/ long term constipation.
  • Obesity
  • Smoking
  • General “wear and tear” of our bowels as we age

How is it treated?

Once diagnosis has been confirmed via your Doctor, treatment may depend on the severity/ stage of the disease or if there are complications present.

Diverticulosis: For a large portion of cases, dietary intervention of higher fibre intake should be sufficient in preventing progression or flare ups to Diverticulitis

Diverticulitis (flare up): For more severe &/ or frequent cases,

  • A bowel rest diet may be begun including 2-3 days of clear fluids (no solids and no fluids that are not transparent), followed by a easy to chew & soft foods diet until pain improves. Once pain improves, resuming a higher fibre diet is recommended. If you’re looking for further support, a Dietitian is a nutrition expert and can assist with meeting your requirements
  • Your Doctor may recommend medicines or surgery (colectomy) to support your quality of life if severe enough

How common is it?

Diverticular disease is a very common disease in Australia and globally

  • 1 In 3 Australians over the age of 45 have diverticular disease
  • 1 in 2 people over 80 have the disease
  • large portion of cases are asymptomatic and unnoticeable in daily life
Person with diverticulitis / diverticulosis slutching stomach

When should you see a Doctor?

See your doctor if you have:

  • Cramps or lower abdominal (tummy) pain
  • Irregular bowel habits — alternating episodes of constipation and diarrhoea
  • Blood in your stool (poo)

When should you see a Dietitian?

For personal assistance with modifying your diet because of diverticular disease, contact an Accredited Practising Dietitian (APD).

We recommend seeing a dietitian if you:

  • Have been diagnosed with diverticular disease and want some support on dietary management of this condition
  • Would like to optimise healing rate of diverticula
  • Are struggling with any of the symptoms of diverticular disease
  • Need nutritional advice to help ensure you’re meeting your individual nutrient requirements
  • Would like advice on ways to have more high-fibre foods in your diet
  • Would like personalised advice and support from a professional

Accredited Practising Dietitians (APDs) are university-trained nutrition experts. They can help you with personalised, easy-to-follow and evidence-based advice.

Dietitians Max Dennehy and Matthew Rigoni smiling and laughing

Frequently asked questions and common misconceptions

Can I eat seeds, corn and peas with diverticulosis/ diverticulitis?

It was prior thought that small and hard food items such as seeds, corn, nuts and popcorn would get stuck in the small pockets/ pouches in diverticular disease. There is currently no evidence supporting these claims and, in fact, it appears that consuming these foods may actually reduce the risk of diverticulitis/ fare ups.

Will probiotics reduce the risk of a diverticulitis flare up?

No. There is currently no evidence that supports the use of probiotics to prevent flare ups.

My Doctor told me I should go on a low fibre diet until my pain gets better

Currently, there is very poor evidence for either low fibre or high fibre diets while a flare up is active. Usually, this decision should be made on a case by case basis and taking into account the complexity of your condition/ situation.

If a high fibre diet is recommended, can I just get all my fibre from a supplement such as psyllium husk instead of whole foods?

No. While the current evidence for supporting dietary fibre intake is not completely conclusive, we at R.E.A.L conclude that the wide micronutrient intake that accompany high fibre foods may assist with the healing process (and reduce occurrence of additional chronic disease) in combination with the fibre int the food, which you do not achieve with the supplemental form alone.

What foods should be avoided if I have diverticulitis?

Generally, it’s not the foods that you should avoid, it’s the foods that you should be getting. A high fibre diet with plenty of fruit, vegetables and legumes may reduce the occurrence of diverticulitis and by extension, support health in many other areas.

Is exercise necessary?

If your goal is to reduce the risk of a flare up/ diverticulitis as much as possible, then yes. There is strong evidence to support that physical activity decreases the occurrence of diverticulitis.

Does stress cause diverticulitis?

While there is no specific link, chronic muscle tightness and contractions, colonic pressure and systemic inflammation all theoretically have rolls in the development of diverticulosis.

Matthew Rigoni
Dietitian, Sports Nutritionist

References

Dahl, C., Crichton, M., Jenkins, J., Nucera, R., Mahoney, S., Marx, W., & Marshall, S. (2018). Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review. Nutrients, 10(2), 137. https://doi.org/10.3390/nu10020137

Dietitians Australia. Diverticular disease, Dietitians Australia. Available at: https://dietitiansaustralia.org.au/health-advice/diverticular-disease (Accessed: 20 January 2025).

Health Direct Diverticular disease – diverticulitis and diverticulosis, healthdirect. Available at: https://www.healthdirect.gov.au/diverticular-disease-and-diverticulitis (Accessed: 20 January 2025).

MacKee, N. Uncomplicated diverticulitis: Putting antibiotics on hold, InSight+. Available at: https://insightplus.mja.com.au/2019/29/uncomplicated-diverticulitis-putting-antibiotics-on-hold/ (Accessed: 20 January 2025).

NIDDK Diverticular Disease – NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis (Accessed: 20 January 2025

Piccin, A. et al. (2023) Diverticular disease and Rifaximin: An evidence-based review, MDPI. Available at: https://www.mdpi.com/2079-6382/12/3/443 (Accessed: 20 January 2025).

Strate, L.L. et al. (2009) ‘Physical activity decreases diverticular complications’, The American Journal of Gastroenterology, 104(5), pp. 1221–1230. doi:10.1038/ajg.2009.121

Weisberger, L., & Jamieson, B. (2009). Clinical inquiries: How can you help prevent a recurrence of diverticulitis?. The Journal of family practice, 58(7), 381–382. https://pubmed.ncbi.nlm.nih.gov/19607778/

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