From the Guidelines
The primary treatment for colonic diverticulosis without evidence of acute diverticulitis is a high-fiber diet, aiming for 25-30 grams of fiber daily, along with adequate hydration and regular physical activity. This approach is based on the most recent and highest quality study available, which suggests that a fiber-rich diet or fiber supplementation is beneficial for patients with a history of diverticulitis, although the evidence quality is very low 1. The American Gastroenterological Association (AGA) also suggests advising patients with diverticular disease to consider vigorous physical activity, which can help promote normal bowel function 1.
Key Recommendations
- A high-fiber diet is recommended, with a goal of 25-30 grams of fiber daily through foods such as fruits, vegetables, whole grains, and legumes.
- Fiber supplements like psyllium (Metamucil) can be added if dietary fiber is insufficient, at a dose of 1 teaspoon mixed in water 1-3 times daily.
- Patients should maintain adequate hydration by drinking at least 8 glasses of water daily to help prevent constipation.
- Regular physical activity is also beneficial for promoting normal bowel function.
- There is no need for antibiotics or other medications when diverticulosis is asymptomatic.
Considerations
- If mild symptoms like bloating occur when increasing fiber, patients should increase intake gradually over several weeks to allow the digestive system to adjust.
- Should symptoms worsen or if signs of diverticulitis develop (such as abdominal pain, fever, or changes in bowel habits), medical attention should be sought promptly.
- The AGA suggests against routinely advising patients with a history of diverticulitis to avoid consumption of seeds, nuts, and popcorn, or to avoid the use of aspirin 1.
- The decision to perform elective prophylactic colonic resection in patients with a history of diverticulitis should be individualized, taking into account patient-specific factors such as age, access to medical care, and patient preference 1.
From the Research
Treatment for Colonic Diverticulosis without Evidence of Acute Diverticulitis
The treatment for colonic diverticulosis without evidence of acute diverticulitis focuses on managing symptoms and preventing complications. The following are some treatment options:
- Increasing fibre intake with bran or ispaghula husk to help regulate bowel movements and reduce symptoms 2
- Rifaximin, an antibiotic, has been shown to be effective in relieving symptoms and reducing the risk of disease-related complications in patients with symptomatic uncomplicated diverticular disease (SUDD) 3, 4
- A high-fiber diet, with a focus on whole grains, fruits, and vegetables, is recommended to help manage symptoms and prevent recurrence 5, 6
- Probiotics may also be effective in reducing symptoms in patients with SUDD, but more evidence is needed to support their use 6
- Mesalazine, an anti-inflammatory medication, may be used in combination with rifaximin and fiber to control symptoms in patients with SUDD 6
- Surgery may be considered in patients with medical treatment failure and persistently impaired quality of life 5, 6
Lifestyle Modifications
In addition to medical treatment, lifestyle modifications can help manage symptoms and prevent complications:
- Increasing physical activity to help regulate bowel movements and reduce symptoms 5, 6
- Maintaining a healthy weight to reduce the risk of complications 5
- Avoiding smoking and reducing stress to help manage symptoms and prevent recurrence 5, 6
Monitoring and Follow-up
Regular monitoring and follow-up with a healthcare provider are essential to assess the effectiveness of treatment and prevent complications: