What are the discharge instructions for a patient with diverticulitis?

Discharge Instructions for Diverticulitis

Medication Management

Complete the full antibiotic course if prescribed, even when symptoms improve—stopping early increases risk of treatment failure and recurrence. 1, 2

• If antibiotics were prescribed (typically for 4-7 days), take them exactly as directed 2, 3
• If taking metronidazole, avoid all alcohol consumption until at least 48 hours after completing the medication to prevent severe disulfiram-like reactions 2
• Use acetaminophen (Tylenol) for pain control—avoid NSAIDs (ibuprofen, naproxen) as they increase risk of complications and future flares 2, 4
• Avoid opioid pain medications when possible, as they are associated with increased diverticulitis risk 2, 4

Diet Progression

Advance your diet gradually from clear liquids to regular food as tolerated over 2-3 days. 2, 4

• Start with clear liquids (broth, juice, gelatin) for the first 24-48 hours 2, 5
• Progress to low-residue foods (white bread, cooked vegetables without skin, lean proteins) as pain improves 5, 6
• Return to a regular diet within 3-5 days if symptoms continue to resolve 2, 6
• Contrary to outdated advice, you do NOT need to avoid nuts, seeds, popcorn, or small-seeded fruits—these foods are not associated with increased diverticulitis risk 2, 7, 6

Warning Signs Requiring Immediate Medical Attention

Return to the emergency department immediately if you develop any of the following: 2, 4

• Fever above 101°F (38.3°C) 2
• Severe or worsening abdominal pain that is not controlled with acetaminophen 2, 4
• Persistent nausea or vomiting preventing you from keeping down fluids or medications 2, 4
• Inability to eat or drink for more than 24 hours 2
• Signs of dehydration (decreased urination, dizziness, extreme thirst, dry mouth) 2
• Blood in stool or black, tarry stools 4
• Abdominal distention or rigidity 5, 6

Follow-Up Care

Schedule a follow-up appointment with your primary care provider within 2 weeks of discharge. 2, 4

• You will need a colonoscopy 6-8 weeks after symptom resolution to exclude colon cancer (risk is 1.16% with uncomplicated diverticulitis, 7.9% with complicated diverticulitis) 2, 7, 5
• Earlier follow-up (within 7 days) is required if you have any concerning symptoms 1, 2
• If you are immunocompromised, have diabetes, or are over age 80, you may need closer monitoring 2, 3

Long-Term Prevention of Recurrence

Adopt these lifestyle modifications to reduce your risk of future episodes by up to 50%: 2, 7, 6

Dietary Changes

• Consume a high-quality diet with more than 22 grams of fiber daily from fruits, vegetables, whole grains, and legumes 2, 7, 6
• Limit red meat and sweets 2, 6
• Fiber from fruits shows the strongest protective effect 7
• Fiber supplements can help but should not replace a high-quality diet 2, 7

Lifestyle Modifications

• Engage in regular vigorous physical activity 2, 7, 6
• Achieve or maintain a body mass index (BMI) between 18-25 kg/m² 2, 7, 6
• Stop smoking—this is a significant risk factor for diverticulitis 2, 7, 6
• Avoid chronic NSAID use when possible 2, 7, 6

Activity Restrictions

• Resume normal activities as tolerated, but avoid heavy lifting (>10-15 pounds) for the first week 4
• Gradually increase physical activity over 1-2 weeks 6
• No specific restrictions on sexual activity once pain resolves 4

Constipation Management

If constipation develops during recovery, use polyethylene glycol (MiraLAX) as directed. 7

• Start with one capful (17 grams) daily in 8 ounces of liquid 7
• Maintain adequate hydration (8-10 glasses of water daily) 7
• Do not use stimulant laxatives during the acute recovery phase 7
• If constipation persists beyond 3-5 days despite treatment, contact your physician to exclude complications 7

Common Pitfalls to Avoid

• Do not stop antibiotics early even if you feel better—incomplete treatment may lead to recurrence 1, 2
• Do not assume all abdominal pain is recurrent diverticulitis—approximately 45% of patients have ongoing pain at 1 year due to visceral hypersensitivity rather than inflammation 2
• Do not unnecessarily restrict your diet long-term—avoiding nuts, seeds, and popcorn is not evidence-based and may reduce beneficial fiber intake 2, 7, 6
• Do not delay seeking care if symptoms worsen—approximately 5% of uncomplicated cases progress to complicated diverticulitis requiring more aggressive intervention 2