What patient education is recommended for a patient with diverticulitis?

Patient Education for Diverticulitis

Patients with diverticulitis should be educated that lifestyle modifications—including a high-quality, fiber-rich diet, regular vigorous physical activity, maintaining normal body weight, and smoking cessation—can reduce recurrence risk, while outdated dietary restrictions on nuts, seeds, and popcorn should be abandoned. 1

Understanding Your Disease

Genetic Component

• Approximately 50% of your risk for diverticulitis is genetic and cannot be modified. 1
• If you have siblings with diverticulitis, your risk is three times higher than the general population. 1
• This genetic predisposition means that even with perfect lifestyle modifications, some risk remains unavoidable. 1

Dietary Recommendations to Prevent Recurrence

What You SHOULD Eat

• Consume a high-quality diet rich in fiber from whole foods: fruits, vegetables, whole grains, and legumes, while limiting red meat and sweets. 1, 2
• A vegetarian dietary pattern is associated with decreased diverticulitis risk. 1, 2
• Aim for approximately 23 grams of dietary fiber daily from food sources. 3
• Fiber supplements are NOT a replacement for a high-quality diet—the protective effect comes from whole food sources. 1, 2
• After your acute episode resolves, gradually increase fiber intake to prevent recurrence. 1, 4

What You Should NOT Avoid (Debunking Myths)

• You do NOT need to avoid nuts, corn, popcorn, or fruits with small seeds (like strawberries and blueberries). 1, 2
• This outdated recommendation lacks scientific evidence and may actually reduce your overall fiber intake. 1, 2

Lifestyle Modifications

Physical Activity

• Engage in vigorous physical activity regularly—this significantly decreases your risk of recurrence. 1, 2
• Aim for approximately 2 hours of vigorous exercise weekly (activities with metabolic equivalent ≥6). 3

Weight Management

• Achieve or maintain a normal body mass index (BMI 18.5-24.9 kg/m²). 1, 2
• Obesity, particularly central (abdominal) obesity, and weight gain increase your risk of diverticulitis. 1, 2

Smoking Cessation

• Stop smoking immediately—smoking is a modifiable risk factor for diverticulitis. 1, 2

Alcohol Consumption

• Alcoholism (not moderate alcohol consumption) increases diverticulitis risk, so avoid excessive alcohol intake. 1, 2

Medication Considerations

Pain Relievers to AVOID

• Avoid non-aspirin NSAIDs (like ibuprofen, naproxen) whenever possible—they moderately increase your risk of diverticulitis episodes and complications. 1, 5, 2
• Consider acetaminophen as an alternative for pain management. 6

Aspirin Use

• If you take aspirin for cardiovascular disease prevention, do NOT stop it—the cardiovascular benefits outweigh the slight increase in diverticulitis risk. 1, 5

Other Medications to Avoid

• Avoid opiate pain medications when possible—they are associated with diverticulitis and perforation. 1, 2
• If you are on corticosteroids or other immunosuppressive medications, discuss with your doctor, as these increase your risk of severe or complicated disease. 1

Medications That Do NOT Prevent Recurrence

• Do not take mesalamine, rifaximin, or probiotics to prevent recurrence—these are not recommended by current guidelines. 1

Special Considerations for Immunocompromised Patients

• If you are immunocompromised (taking steroids, chemotherapy, or have had an organ transplant), you are at higher risk for severe or complicated diverticulitis. 1
• After recovering from an episode, consult with a colorectal surgeon to discuss whether elective colon resection is appropriate. 1

Expected Outcomes with Lifestyle Adherence

• Adherence to all five low-risk lifestyle factors (low red meat, high fiber, vigorous activity, normal BMI, non-smoking) can prevent approximately 50% of incident diverticulitis cases. 3
• Even adopting 3-4 of these factors reduces your risk by approximately 50%. 3

When to Seek Medical Attention

• Return immediately if you develop fever, persistent vomiting, inability to tolerate oral intake, worsening abdominal pain, or signs of infection. 6
• Follow up with colonoscopy 4-6 weeks after resolution if you had complicated disease or are due for age-appropriate screening. 7