From the Guidelines
The recommended management for diverticulosis is a high-fiber diet, with or without fiber supplementation, as it is unlikely to pose a substantial risk to patients and may provide benefits in reducing the risk of recurrent diverticulitis. The management of diverticulosis focuses on preventing constipation and reducing intraluminal pressure in the colon, which helps minimize the risk of developing diverticulitis 1. Key components of the management plan include:
- A high-fiber diet, with patients advised to consume 25-30 grams of fiber daily through fruits, vegetables, whole grains, and legumes
- Adequate hydration with 8-10 glasses of water daily to help soften stool and facilitate bowel movements
- Regular physical activity to promote healthy bowel function
- Avoiding medications that increase the risk of complications, particularly non-steroidal anti-inflammatory drugs (NSAIDs)
- Consideration of fiber supplements such as psyllium (Metamucil), methylcellulose (Citrucel), or polycarbophil (FiberCon) at doses of 3-6 grams daily if dietary fiber intake is insufficient, while taking into account patient preferences and potential side effects such as abdominal bloating 1. Most patients with uncomplicated diverticulosis remain asymptomatic and do not require specific treatment beyond these preventive measures, with regular follow-up with healthcare providers recommended, especially if symptoms develop.
From the Research
Recommended Management for Diverticulosis
The management of diverticulosis typically involves dietary changes and other interventions to prevent complications.
- A high-fibre diet is often recommended, although the evidence for its effectiveness is not strong 2, 3.
- Some studies suggest that a high-fibre diet may help improve symptoms and prevent complications of diverticular disease 2.
- However, other studies have found that the evidence for a high-fibre diet is lacking, and most recommendations are based on inconsistent level 2 and mostly level 3 evidence 2.
- Other dietary approaches, such as a low FODMAP diet, have been proposed as a potential way to prevent diverticulitis, but more research is needed to confirm their effectiveness 4.
- Avoiding certain foods, such as nuts and seeds, is not recommended, as there is no evidence to support this approach 3.
- Rifaximin, a rifamycin derivative, has been shown to be effective in achieving symptomatic relief in patients with uncomplicated diverticular disease 5.
Dietary Factors
Dietary factors may play a role in the management of diverticulosis.
- A high-fibre diet may be beneficial, but the evidence is not strong 2, 3.
- A low FODMAP diet may be helpful in preventing diverticulitis, but more research is needed 4.
- Consumption of red meat, especially unprocessed red meat, may be associated with a mild increase in the risk of acute diverticulitis 6.
- Higher consumption of poultry and fish may not be associated with an increased risk of acute diverticulitis, and may even be associated with a reduced risk 6.
- Alcohol intake may be associated with diverticulosis, but alcohol dependence may be related to a lower risk of in-hospital mortality due to acute diverticulitis 6.