Diverticular disease is a condition in which small pouches, or sacs, form in the colon. It is a common but often symptom-free condition. Only 10–20% experience symptoms. This article explores preventive measures against diverticular disease and its possible complications, including diverticulitis.
Symptoms of acute diverticulitis
Most people with diverticulosis have few or no symptoms associated with the condition. However, if acute diverticulitis develops, symptoms may include:
- Persistent pain, either constant or intermittent
- Fever
- Nausea and vomiting
- Reduced general condition (feeling unwell)
- Changes in bowel habits
- Bloating or gas
- Bloody stools
- Frequent or painful urination
Diverticulosis: A condition in which the colonic mucosa herniates through the muscular layer of the intestine.
Diverticular disease: A condition in which diverticulosis causes symptoms, ranging from mild to severe discomfort.
Diverticulitis: Acute inflammation of a diverticulum, which may cause fever, pain, and changes in bowel habits.
Risk Factors
Diverticular Disease
The prevalence of diverticular disease has increased in Western countries and in nations that have adopted a Western lifestyle. The condition is rare in rural areas of Asia and Africa. Known risk factors for developing diverticular disease include:
- Older age
- Being male
- Smoking
- Overweight / obesity
Contrary to previous beliefs, a low fiber intake and constipation do not appear to reduce the risk of developing diverticular disease. Neither physical inactivity, meat consumption, nor alcohol intake are associated with diverticular disease.
Risk Factors for Diverticulitis
For those with diverticular disease, several factors may influence the risk of developing acute diverticulitis (acute inflammation of a diverticulum):
- Dietary factors
- Physical inactivity
- Smoking
- High alcohol intake
- Elevated BMI
Diet
In a large follow-up study, men who ate a diet most similar to a typical Western diet (high in red meat, fat, and refined grains) had a 55% higher risk of developing diverticulitis compared to those who ate least like a typical Western diet. A plant-based (vegetarian) diet, as well as a diet high in fiber, fruits, vegetables, and whole grains, is associated with a reduced risk of diverticulitis. The same applies to anti-inflammatory diets. There is also evidence that the gut microbiota and changes to it may influence the risk of diverticulitis.
Obesity
Obesity is a strong risk factor for diverticulitis. Studies have observed an increased risk ranging from 30% up to over 400% in the most overweight individuals.
Smoking
Smoking increases the risk of both diverticulitis and the complication of perforated diverticulitis.
Alcohol and Diverticulitis
High alcohol consumption is associated with an increased risk of diverticulitis. In a recent follow-up study published in 2024, researchers found that women who consumed 30 grams or more of alcohol per day had a higher risk of diverticulitis. A combined analysis showed that those who both smoked and drank at least 15 grams of alcohol daily had the highest risk of developing the condition.
If you are concerned about problematic alcohol use, the AUDIT test can help you assess it.
Physical Activity
Physical activity appears to reduce the risk of developing diverticulitis. The more physical activity, the greater the preventive effect. Furthermore, more intensive physical activities, such as running, seem to prevent diverticulitis more effectively than lower-intensity activities.
Lifestyle approaches
Asymptomatic Condition
Detection of diverticula without symptoms usually does not require treatment. However, the following measures can be considered:
- For constipation: Bulk-forming laxatives, such as Movicol or Vi-Siblin
- Gradual increase in dietary fiber for those with a low-fiber diet and constipation
- Adequate fluid intake
- Regular physical activity
- Weight reduction in cases of obesity
- Smoking cessation
- It is not necessary to avoid nuts, seeds, or popcorn
Symptomatic Diverticular Disease
For symptomatic diverticular disease (mild pain and tenderness without systemic symptoms such as fever), the same measures as for the asymptomatic condition are recommended (see above).
If tolerated, permanent or lifelong dietary measures are recommended, including increased fiber intake and sufficient fluid consumption. However, it may take several weeks before the effects of increased fiber intake are noticeable.
Acute Diverticulitis
In acute diverticulitis, medications play a larger role in treatment. Sometimes antibiotics and painkillers may be needed, and in some cases, surgery.
Regarding dietary recommendations during acute diverticulitis, it is common to recommend a easily digestible “soft diet,” meaning foods that are low in fiber and leave minimal undigested residue in the colon, including:
- Dairy products
- White rice
- White bread and other refined grains
- Juice from fruits or vegetables, without pulp
The idea behind these dietary recommendations is that a less active bowel reduces irritation and flare-ups of inflammation in the colon.
After a restrictive diet for acute diverticulitis, it is important to gradually return to a healthy, high-fiber diet.
For uncomplicated acute diverticulitis treated at home without antibiotics, improvement is expected within 2–3 days, although some may develop longer-lasting symptoms.
Conclusion
Diverticular disease is common, especially in older adults. While most people with diverticula are asymptomatic, some may experience abdominal pain, changes in bowel habits, and in severe cases, acute diverticulitis with fever and intense pain.
If you already have diverticular disease, self-care measures such as a high-fiber, anti-inflammatory, and plant-rich diet, intensive physical activity, avoiding obesity, and quitting smoking can reduce the risk of developing acute diverticulitis.
During acute diverticulitis, an easily digestible bland diet or light diet may be appropriate until recovery.
The most severe cases of acute diverticulitis are treated in the hospital with antibiotics, pain management, bowel rest, intravenous nutrition, and in some cases, surgery.
