Treatment of Diverticulosis
For asymptomatic diverticulosis, no medical treatment is required—focus exclusively on dietary fiber (20-30 grams daily from whole foods), regular vigorous physical activity, maintaining normal BMI, smoking cessation, and minimizing NSAID/opioid use when possible. 1
Core Dietary Management
- Aim for >22.1 grams of fiber daily from fruits, vegetables, whole grains, and legumes, as this threshold demonstrates statistically significant protective effects against progression to diverticulitis 1
- Fiber from fruits appears most protective compared to other sources 1
- Gradually increase fiber intake to minimize abdominal bloating and improve tolerance 1
- Dietary sources of fiber are strongly preferred over supplements alone, though fiber supplementation can be beneficial as an adjunct (not replacement) for a high-quality diet 1
What NOT to Restrict
- Do not restrict nuts, corn, popcorn, or small-seeded fruits—this outdated recommendation lacks evidence and may actually reduce overall fiber intake 1
- These foods are not associated with increased risk of diverticulitis 2
Essential Lifestyle Modifications
- Regular vigorous physical activity significantly decreases the risk of progression to diverticulitis 1
- Achieve or maintain normal BMI (18-25 kg/m²), as obesity increases diverticulitis risk 1
- Avoid smoking, which is an established risk factor for disease progression 1
- Minimize NSAID and opioid use when possible, as these medications are associated with increased risk of diverticulitis 2, 1
Monitoring and Surveillance
- No routine imaging or colonoscopy is needed for asymptomatic diverticulosis 1
- Approximately 50% of diverticulitis risk is genetic, so family history matters in counseling patients 1
- Only 1-4% of patients with diverticulosis will develop acute diverticulitis in their lifetime 3
Critical Pitfalls to Avoid
- Never prescribe chronic antibiotics prophylactically—there is no role for routine antibiotic use in uncomplicated diverticulosis 1
- Do not rely solely on fiber supplements instead of dietary modification 1
- Avoid unnecessarily restrictive diets that eliminate nuts, seeds, and popcorn, as this may paradoxically reduce protective fiber intake 1
When to Escalate Care
- If the patient develops left lower quadrant pain, fever, nausea, vomiting, or changes in bowel habits, this suggests progression to acute diverticulitis and requires immediate evaluation with CT imaging and consideration of antibiotics based on specific risk factors 2, 3
- Abdominal pain, nausea, vomiting, or sudden change in bowel habits persisting for 2 weeks warrants medical evaluation before initiating fiber supplementation 4