Fiber and an active lifestyle prevent flare-ups, but act promptly if it hurts or bleeds.
Many men discover they have diverticular disease after a routine colon screening exam to check for hidden colon cancer. Others find out the hard way: intense lower abdominal pain and a fever, and sometimes copious rectal bleeding. What’s going on down there, and what can you do about it?
Diverticula are pouchlike structures that form in the muscular wall of the colon. When you have them, it’s called diverticulosis, and it is usually harmless. But in some people, the pouches may get inflamed and infected (diverticulitis), or they may bleed. Diverticulitis and diverticular bleeding send around 130,000 Americans to the hospital annually.
To simplify matters, doctors refer collectively to diverticulosis and diverticulitis as “diverticular disease.” If you have it, the best thing you can do is adopt a high-fiber diet. While this will not protect everyone, it’s inexpensive and safe. “Fiber can reduce the risk of future complications of diverticular disease, but you get other benefits from it, too,” says Dr. Anne Travis, a gastroenterologist and clinical instructor in medicine at Harvard Medical School.
Can you prevent it?
The likelihood of diverticular disease rises sharply with age. It’s not known for sure why the pouches develop, but several lifestyle factors seem to make a person more vulnerable. The major risk factor is a diet low in fiber, but obesity and lack of exercise have also been tied to diverticular disease.
Logically, then, eating lots of fiber should keep the troublesome colon pouches from forming in the first place. But we really don’t have undisputed proof of that yet. Fortunately, getting adequate fiber also offers relief from constipation, better cholesterol control, and more filling meals that help you maintain a healthy weight. “For most people, getting more fiber in the diet is a good thing,” Dr. Travis emphasizes.
If you already have diverticular disease and want to prevent painful flare-ups or bleeding, increase the amount of fiber in your diet. “For that we do have good data to say fiber decreases your chances of getting complications,” Dr. Travis says.
There’s also some evidence that being physically active may help to keep diverticular disease in check. Like fiber, regular exercise is beneficial for a variety of other reasons.
The anatomy of diverticula
Diverticula develop at weak spots in the colon, such as where arteries penetrate the muscle wall. The colon wall balloons outward, like an inner tube poking through a tire, and forms sacs. Diverticula can become infected and inflamed, or begin to bleed if a nearby artery becomes eroded and ruptures.
How to add fiber
Adults should get 25 to 30 grams per day of dietary fiber every day. “Even with a vegetarian diet, it can be hard to get that much,” Dr. Travis says. “It often requires a supplement to get up to that level of intake.”
As a first step, introduce more fiber-rich foods into your diet. Add them gradually; otherwise you may suffer from gas and bloating. Always be sure to drink plenty of fluids, too.
Here’s a starter tip: Mix high-fiber cereals into your regular breakfast food, or add fruit to your cereal or yogurt. When you take in fiber as part of plant foods, you get the fiber as well as a range of other healthy nutrients.
At one time, people with diverticular disease were told to avoid nuts, popcorn, and seeds—all good sources of fiber—out of concern that these foods might become trapped in the diverticula and cause problems. However, there isn’t much evidence for this. “Nuts and seeds are safe for people with diverticular disease,” Dr. Travis says.
For those who need a fiber supplement, add it to your diet gradually—about 5 grams per week—to avoid gas and bloating. If you do feel discomfort, try a different brand. Most products on the shelf contain either psyllium or methylcellulose; either can be effective.
Don’t delay if your gut hurts or you have bleeding
The most typical symptom of diverticulitis is pain in the lower part of the abdomen. You may also develop a fever or nausea. Constipation or diarrhea may occur as well.
Less often, diverticulosis can lead to bleeding, typically without any pain. You would notice this as maroon or bright red blood with bowel movements.
Act promptly if you experience abdominal pain or bleeding. Diverticulitis can turn into a medical emergency if the infection gets out of control or if colon contents begin to leak into the abdominal cavity through a tear. Diverticular bleeding often stops on its own, but in some cases it can be severe.
For an uncomplicated case of diverticulitis, you may be sent home with antibiotics. If you have bleeding, can’t drink fluids, or have severe pain or have other worrying signs, you may need to be admitted to the hospital.
If you have bleeding, you will likely have a colonoscopy while in the hospital to locate the source of the bleeding. If you have diverticulitis but no bleeding, you should have a colonoscopy once the flare-up has resolved—if you have not had one recently. This is because the symptoms of colon cancer can sometimes mimic diverticulitis. That’s something you would want to catch as early as possible.