Treatment of Diverticulosis
For patients with diverticulosis, a high-fiber diet is the primary recommended treatment to prevent progression to diverticulitis, along with regular physical activity, smoking cessation, and avoidance of regular NSAID, opiate, and corticosteroid use. 1
Understanding Diverticulosis vs. Diverticulitis
- Diverticulosis: The presence of multiple outpouchings (diverticula) in the colon without inflammation
- Diverticulitis: Inflammation of these diverticula, which occurs in approximately 1-4% of patients with diverticulosis 2
Management of Asymptomatic Diverticulosis
Dietary Modifications
- High-fiber diet is recommended to prevent complications:
- Fruits, vegetables, whole grains, and legumes
- Psyllium fiber supplements can be used to increase fiber intake 3
- Target: 25-35g of fiber daily
Lifestyle Modifications
- Regular physical activity
- Smoking cessation
- Maintain healthy body weight
- Limit alcohol consumption 4
- Avoid regular use of medications that increase risk:
- NSAIDs
- Opiates
- Corticosteroids 1
Important Clinical Considerations
Outdated Recommendations to Avoid
- Low-residue diets are no longer recommended for diverticulosis
- Historical concerns about nuts, seeds, corn, and popcorn causing diverticulitis have been disproven 5
- No evidence supports restricting these foods 1, 5
Dietary Factors to Consider
- Higher consumption of red meat (especially unprocessed) shows a mild association with increased risk of acute diverticulitis 4
- Poultry consumption has not been associated with diverticulitis risk 4
Monitoring and Follow-up
- Routine colonoscopy screening as per age-appropriate guidelines
- Patient education about symptoms of diverticulitis that require medical attention:
- Left lower quadrant abdominal pain
- Fever
- Change in bowel habits
- Nausea 1
When Diverticulosis Progresses to Diverticulitis
If diverticulitis develops, treatment depends on severity:
Uncomplicated Diverticulitis
- Observation with pain management (typically acetaminophen)
- Clear liquid diet during acute episodes
- Antibiotics only for specific populations:
- Patients with systemic symptoms (persistent fever/chills)
- Increasing leukocytosis
- Age >80 years
- Pregnant patients
- Immunocompromised individuals
- Those with chronic medical conditions 2
Complicated Diverticulitis
- Requires intravenous antibiotics and possible interventional procedures
- May require hospitalization and surgical consultation 1
Common Pitfalls in Diverticulosis Management
- Overuse of antibiotics for asymptomatic diverticulosis or uncomplicated diverticulitis
- Unnecessary dietary restrictions based on outdated recommendations
- Failure to distinguish between diverticulosis (which requires preventive measures) and diverticulitis (which may require active treatment)
- Inadequate fiber intake - gradual increase is recommended to avoid bloating and gas
Remember that while only 1-4% of patients with diverticulosis will develop acute diverticulitis in their lifetime 2, preventive measures are important for reducing this risk.