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Diverticulitis and Diverticular Disease

Bristol stool chart

Bristol stool chart

What Is Diverticulitis and Diverticular Disease?

Diverticular disease and diverticulitis are related digestive disorders of the large bowel or colon.

Let's begin with the colon.

The Colon

The colon is the last part of the digestive system, also known as the large intestine. It consists of a layer of flexible tissue on the inside covered by a tougher layer of muscle. It is approximately six feet long.

The colon plays a significant role in the absorption of water and some electrolytes into circulation before elimination. It helps to move waste material from the small intestine into the rectum and out through the anus as feces.

Meaning of "Diverticular"

"Diverticular" is a medical term used to describe pouches or sacs that can form in the colon that protrude and bulge out through the muscle wall. Diverticular disease is rare in parts of the world where the diet is characterized by a large intake of fruits and vegetables and a low intake of red meat.

Diverticular disease is related to aging. It occurs in approximately 70% of people by the age of 80.

The cause of the formation of pouches or sacs is unknown. However, according to experts, eating a low-fiber diet is one of the most likely causes. Diverticular disease is common in the United States and Europe, where a high percentage of the food consumed is processed and low in fiber. The result is the formation of hard stool and constipation that increases the pressure in the colon, leading to the formation of pouches.

In certain conditions such as multiple sclerosis, where constipation is a common complication, bowel function needs to be managed to prevent diverticulitis in cases with diverticular disease.

However, with education, people have become much more aware and are making informed choices about the right diet and lifestyle to reduce the incidence of diverticular disease and diverticulitis.

The majority of people with diverticula will not exhibit symptoms, but 1 in 4 will experience abdominal pain and diarrhea. These are said to have diverticular disease.

The pouches in the colon can become infected and inflamed, forming areas of empyema. When this occurs, the condition is known as diverticulitis.

Risk Factors

  • Low-fiber diet
  • Alcohol. Excessive consumption may increase the possibility of diverticulitis by 2-3 times higher when compared to the general population.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may increase the risk of diverticular disease.
  • Suppressed Immune system
  • Age. Under the age of 30, approximately 1 to 2% of people will have diverticula disease. However, the condition is found in more than 40% of the population over the age of 60. The total number of diverticula increases with age.
  • Gender. Women appear to experience complications from diverticula disease at an older age than men.


The symptoms of diverticulitis are more severe than that of diverticular disease, which usually presents symptoms of lower abdominal pain and a feeling of bloating. With diverticulitis, the stomach pain is severe and is accompanied by a high fever with a temperature of more than 38 degrees Celsius, nausea, vomiting, and loss of appetite.

There is a risk that the infection may cause the colon to rupture and spread fecal matter into the sterile area of the abdomen, resulting in peritonitis. Infection can lead to the formation of a fistula, which is an abnormal channel, connecting to other regions causing a wider spread of the infection and further complications that will require surgical intervention.

Diverticulitis can be simple or complicated:

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Read More From Healthproadvice

Simple diverticulitis occurs in around 75% of cases with no complications and responds to medical treatment without the need for surgery.

Complicated diverticulitis occurs in 25% of cases and often requires surgery. Complications such as abscess, fistula, obstruction, peritonitis, and sepsis can occur.

Recent studies demonstrate a lesser role for aggressive antibiotics or surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary.

— Journal of the American Medical Association, January 15, 2014


The treatment for diverticulitis largely depends on the severity of the symptoms; treatment can be in a hospital or at home.


  • To reduce the pain, the doctor may suggest bed rest and the use of heat pads, applied to the abdomen.
  • Pain medication may be indicated and prescribed by your doctor or health care provider; this may include paracetamol and antispasmodics, avoid aspirin and ibuprofen as they may cause internal bleeding. Your doctor will be aware of your medical history and can give advice appropriate to your individual need. Always read the information leaflet that comes with the medication and if in doubt, discuss it with your pharmacists.
  • Take only fluids for the first twenty-four to forty-eight hours. In a hospital, fluids and energy may be given through an intravenous drip, this allows the bowel to rest and recover, before moving on to thicker liquids and then progressing to solid foods.
  • Your doctor may prescribe antibiotics.

When the condition has sufficiently improved, more fiber may be consumed to prevent further attacks. If bloating and gas persist, the amount of fiber can be reduced for a day or two.

Once formed, diverticula pouches remain for life, but by making a few dietary and lifestyle changes, diverticulitis may be kept at bay and prevented from returning. Some foods, however, can worsen the symptoms and should be avoided.

Food to Avoid

Avoid: Beans and peas, dried fruits, coconut, popcorn, strawberries, and coarse grains. Also, vegetables and fruits with skin on, tomatoes, pickles, and cucumbers.

Doctors can advise individuals about eating nuts and seeds. Medical opinion on eating nuts and seeds are changing; some experts say it can complicate the condition of diverticular disease and increase the incidence of diverticulitis. Others say not.

Too much tea, coffee, and alcohol can cause constipation which can aggravate the condition and worsen the symptoms. Eat five portions of fruits and vegetables per day; this will help to form soft, bulky stool.

A section of the large bowel showing multiple diverticula  in the sigmoid colon

A section of the large bowel showing multiple diverticula in the sigmoid colon


This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.


Roxann on July 08, 2018:

What do you do when high fiber foods cause you diarrhea?.

carolyn sue nevill on March 04, 2018:

I have had diverticulosis(started w/this- then went to collagenous colitis with diverticulitis. They put me on Entocort(generic budesonide from 2012 to 2013. Then I was off of the medication for abt. a year after my blood pressure dropped and I fell and hit my rt.side skull on cement. This almost killed me until I was taken back to a neuro-surgeon who did various things to save my. life. But after surviving from this I continued to have the diverticulitis and was put back on the budesonide(cortisteriod) again. Then in 2017 I had to have another colonopscopy . I was again put on 3 med's/day for 1 month-2 per day for 1 month-then 1 a day since. Things have gotten worse. Also they changed the budesonide capsule I had been on for so long to another drug company to supply it (MYLAN) and it doesn't have anything to do with have no idea what to do for this, but my gastroenterologist says that this drug is the best they can give me. (It is very expensive-but my ChampVA insurance pays a lot of it for me.) I try to eat properly but I do not eat a lot, and I am also on vitamins/acetaminophin w/codeine #30 for shoulder that was hurt when I fell-usually 1 per day or night/B12 shot 1000mcg of 1 per month for very low blood pressure. I need some better help with this but I have no idea of what to look for. Any comment I can get on this could help me ask the Doctor for some changes. Thanks!

Kay Redding on October 24, 2017:

I need info on diverticulitis! It is very severe for me. I have have 2 bad cases in 4 months! Thank you

Jo Alexis-Hagues (author) from Lincolnshire, U.K on December 22, 2015:

Sujaya, always a pleasure to see you. Thank you for stopping by.

sujaya venkatesh on December 22, 2015:

a very useful hub

Jo Alexis-Hagues (author) from Lincolnshire, U.K on May 17, 2015:

Robin, this one was written some time ago, it's probably in need of updating. Thank you again for taking the time, much appreciated.

Robin Grosswirth from New York on May 16, 2015:

I always learn something new when reading your hubs. Thanks!

Jo Alexis-Hagues (author) from Lincolnshire, U.K on March 26, 2015:

Hi Mary, yes, some people do have diverticular disease without realizing it, the symptoms occurs when the pouches become infected and inflamed. We should all remember to add more fibre to our diet as a preventative measure. Thank you so much for the visit and insightful comment. Take care and my best to you.

Mary Norton from Ontario, Canada on March 25, 2015:

What worries me is that symptoms sometimes don't appear. More fiber in the diet. This is what I must remember.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on March 20, 2015:

Catherine, sorry to learn that you have this condition, but it's good to know you're managing it and are symptoms free. Thank you for taking a look at the hub, I hope you found it useful. Take care and my best to you.

Catherine Giordano from Orlando Florida on March 19, 2015:

Very interesting. I have diverticulosis, perhaps and early stage of diverticulitis. My symptom was constipation. Now I take a daily dose of MiraLax and all is well. I try to eat a high fiber diet.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on February 16, 2015:

Hi Patricia, so sorry to learn about you friend's mum, diverticulitis can be difficult at the best of times, but complications such as abscesses can increase with age.I'm so glad you found the hub useful in filling some of the gaps. Appreciate you taking a look and commenting. My best always.

Patricia Scott from North Central Florida on February 16, 2015:

My friend's Mom has diverticulitis and often is rushed to the hospital with complications. She had polio as a child and the effects have become quite problematic as she has aged.

This article certainly filled in many gaps in my knowledge of this disease.

Angels are on the way to you this afternoon ps

Debra Allen from West Virginia on February 07, 2015:

Back in 1994 I had my last DVT and the doctor there seen that I also had Ulcerative Colitis. He gave me something to kill the virus, only I did not have the virus and he nearly killed me instead. Seriously. My bones hurt so bad that I cried so hard and then he did not come to me for 2 hours and told me that he didn't think that it was that bad...until he saw me.

Thank you for the hint. I will definitely try that. I love prunes!

Debra Allen from West Virginia on February 07, 2015:

Thaks for explaining this disease. My Aunt has this and so did my father. I have Ulcerative Colitis though. I think stomach problems plague my father side of the family. I have had UC since I was 21. It is is remission and has stayed that way for years. Thank goodness for that!

I have found that too much fiber will block me up and certain pain killers (just noticed this a few weeks ago) with make me constipated. I hate that!!

Jo Alexis-Hagues (author) from Lincolnshire, U.K on December 27, 2014:

Hi Will, so sorry to learn that you suffer from diverticular disease, but you appears to be on top of it, that's good. Diet is important, a good understanding of the condition will help you to better manage it. According to the research, people aged 50 to 70 who eat a high fibre diet have a 40% lower chance of complications, compared to the same age group taking a lower amounts of dietary fibre. Yes, rupture can occur, sorry about your friends, sometimes a colectomy is necessary to treat sever diverticulitis. Keep up the good work and my very best to you.

WillStarr from Phoenix, Arizona on December 27, 2014:

I had bouts of cramping and bloating and thought it was my diet until undergoing a colonoscopy and learning I have diverticula. Now I take lots of fiber, and only occasionally have symptoms.

One of my classmates also has diverticular disease and suffered a rupture. Her recovery took almost half a year. And just this month, another, a much younger female friend underwent a colon resection for the same reason.

It's a serious disease.

Very good Hub, Jo!

Nell Rose from England on December 09, 2014:

Thanks so much Jo, I really appreciate your help, yes my doctor or should I say doctors never tell me anything about it apart from what meds to take, so I will make another appointment, write down a few questions to ask as I always forget when I get in there, and see what help they can give me, once again, thanks so much, nell

Jo Alexis-Hagues (author) from Lincolnshire, U.K on December 09, 2014:

Nell, I'm glad to know you're feeling better, it's not much fun being unwell. I've added some more information to the site and will do a bit more tomorrow. The current approach to treating people who are experiencing recurrent diverticulitis, is to treat each person as an individual. what's best for you may not be appropriate for someone else, although they may have the same condition. Do have a chat with your doctor about the choice of treatment, I know some doctors are not very good at explaining, but the more you know about you treatment, the more proactive you can become. Look after yourself, my best always.

Nell Rose from England on December 09, 2014:

Hi Jo, thanks for answering, yes I had a sigmoidoscopy, and they saw all the little pouches, I understand I just thought that they were supposed to give the antibiotics, but that's fine, I feel a little bit better today, thanks so much for answering my question, have a great evening, nell

Jo Alexis-Hagues (author) from Lincolnshire, U.K on December 09, 2014:

Hi Nell, I'm so sorry to learn that the condition have flared up again. Did the doctors actually diagnosed your condition as diverticulitis, I can't remember if you got a definitive diagnosis? I know they once thought that your symptoms may well have been due to IBS.

Based on recent studies, doctors are prescribing less antibiotics for recurrent attacks of diverticulitis. While antibiotics may relieve the pain, it doesn't particularly reduce incidence of recurrence and with the crisis with antibiotic resistance, we all have to rethink how we use these drugs. Doctors are no longer using antibiotics as aggressively as they once did for recurring diverticulitis. I'll try to add some more recent information to this hub that may help, so do stop by and have a look. I hope you'll feel better soon.

Nell Rose from England on December 08, 2014:

Came back for another read as I have been suffering again, really bad bout this time, saw the doc, he didn't even give me any antibiotics! is that right? I am sure he should have, thanks Jo, nell

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 17, 2014:

SheGetsCreative, thank you for taking a look, much appreciated. About the strawberries; while a high fibre diet is recommended, strawberries, cucumber and tomatoes were once discouraged because the experts believed that the small seeds can become lodged in the small pouches to cause inflammation and flares. However, there is no real evidence to support this. I suppose what works for one person doesn't necessarily work for all. It's a case of knowing your body. Good luck with the diet, you seem to be doing well. Take care and my best to you.

Angela F from Seattle, WA on September 17, 2014:

Very informative - voted up. I knew about many of the foods to avoid, but didn't realize strawberries were on the list!

Jo Alexis-Hagues (author) from Lincolnshire, U.K on September 05, 2014:

Pawpawwrites, watch out for those polyps and keep up the good work.

Thank you for taking a look. My best to you.

Jim from Kansas on September 05, 2014:

Haven't had a problem with mine yet. Except for a couple of polyps.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on June 16, 2014:

DreamerMeg, glad you've found this useful, I appreciate you taking a look, thank you for the kind comment.

DreamerMeg from Northern Ireland on June 16, 2014:

Very useful and interesting, thanks. I always love it when a hub has useful, clear diagrams!

Jo Alexis-Hagues (author) from Lincolnshire, U.K on March 26, 2014:

Hi Jackie, this type of stomach problems can be pretty terrible indeed. thank you for stopping by, I was just on my way over to you. :)

Jackie Lynnley from the beautiful south on March 26, 2014:

Stomach problems are just so horrible to have. Great info and advice, Jo. ^

Nell Rose from England on March 03, 2014:

Thanks Jo, that's great! I will go and try the acidophilus probiotic and if it still plays me up I will go back and see the doc, thanks for all your help! have a great day, nell

Jo Alexis-Hagues (author) from Lincolnshire, U.K on March 03, 2014:

Hi Nell, lovely to see you, sorry about the abdo. pain.....diverticulitis can be difficult to diagnose just by the symptoms which are similar to a lot of other abdominal conditions like pelvic inflammatory disease, IBS and coeliac disease (an intolerance to gluten), and many more. Diverticulitis is usually diagnosed during an acute attack, it's often done by doing a Colonoscopy, where a small tube with a camera on the end is passed into the colon to show what is going on inside. They can also do a CT scan, this will give a 3D picture and can also show if there is a spread of infection to other parts of the abdomen or even other parts of the body. Other tests such as a Barium enema X-ray can also show what's happening in the abdomen.

Have you tried using acidophilus probiotic? Good luck with the doctor, if you've been having pain and spasm for a while they may decide to do one of the test I mentioned, but chances are it may well be IBS or a bowel infection, try the probiotic anyway. Good luck with the doctors, use the one you trust and find it easier to talk to. Take care and my very best to you.

Nell Rose from England on March 02, 2014:

Hi, I came looking for you on this because I wanted to ask a question? I was seen by about 5 docs, all saying it was ibs, one saying I was making it up...long story! I have a lower back pain, they told me it was diverticulitis, but I get bowel spasm too, so darn painful, but they have never done anything else, they gave me antibiotics last time, that was from a good doc! because she gave me a blood test and it said I had an infection. just had this again, total pain, do you think I need more test? thanks!

Jo Alexis-Hagues (author) from Lincolnshire, U.K on November 15, 2013:

Suzette, your doctor was correct, colitis can be very serious. The hospital where I work is closely linked to a national and international referral center for intestinal and colorectal disorders. So of course, we see the worst cases. Take care of yourself and stay on top of it. Keep a close eye on the diet and stress levels, although I'm sure you are already doing just that. Thank you for reading this, I hope it was helpful.

Enjoy the weekend and my best to you.

Suzette Walker from Taos, NM on November 15, 2013:

Very informative article, Jo. My sister suffers from diverticulitis and it is not funny. It is very painful and discomforting. She does watch what she eats, but every once in a while will have an attack. I have had issues with colitis, but I too, watch my diet and haven't had a colitis attack in quite some time. They are scary and serious. Years ago when I was in the ER with a colitis attack, the doctors impressed on me that one can die from these attacks. So, I really watch my diet and try not to have too much stress going in my life. Thanks for sharing your knowledge with us on an important medical issue.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on October 19, 2013:

Your great grandmother knew what she was talking about, a very sensible lady. Much appreciate!

CraftytotheCore on October 19, 2013:

Very interesting. My great-grandmother suffered from this in her late 80s before passing away. I remember her telling me she was afraid to eat tomatoes because of the seeds.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on May 17, 2013:

Suzette, thank you very much, I do appreciated your visit. Hope you're in good health; have a wonderful weekend.

Suzette Walker from Taos, NM on May 17, 2013:

Very interesting and informative article! These health problems run in my family and we have all suffered from this at some point in our lives. The key for me was diet change and making sure I intake enough fiber in my diet. Your suggestions and advice are spot on!

Jo Alexis-Hagues (author) from Lincolnshire, U.K on February 15, 2013:

Thank you again travel_man, always appreciated. Take care now.


Ireno Alcala from Bicol, Philippines on February 14, 2013:

A first-rate information. Yes, a change in diet will hamper the effects of diverticulitis. Thank you for the information. :)

Jo Alexis-Hagues (author) from Lincolnshire, U.K on January 23, 2013:

DDE, you are very kind, thank you for reading this, and for the insightful comment. My best to you.

Devika Primić from Dubrovnik, Croatia on January 23, 2013:

Brilliantly researched hub health information is very important to make note of. Thanks for sharing such valuable points

Jo Alexis-Hagues (author) from Lincolnshire, U.K on January 12, 2013:

Thank you lurana, yes this condition can be very confusing, it can be very unpleasant to live with, it is very important to know how to manage it. Sorry to hear about you family member, I hope the information is of so e help.

Lurana Brown on January 12, 2013:

Thank you for the informative article! I have a family member who has suffered from this disease. It is so important to be aware of positive, simple lifestyle habits that can keep us healthy.

Jo Alexis-Hagues (author) from Lincolnshire, U.K on January 04, 2013:

Phoebe, you should visit more often! :) thank you so very much for this wonderful comment, much appreciated and best wishes to you.

Phoebe Pike