Diverticular Disease

Also indexed as: Diverticulitis, Diverticulosis

Adhering to a high-fibre diet is one key to keeping diverticular disease at bay. According to research or other evidence, the following self-care steps may help you manage this digestion disorder:

Recognise the warning signs
Seek immediate medical attention if you develop symptoms such as painful abdominal cramping, fever, and nausea

Diet right
Help prevent the disease by eating a high-vegetable, high-fibre, and low-meat diet

Get moving
Start a regular programme of physical activity, such as jogging, to help prevent symptomatic diverticular disease

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full diverticular disease article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

Diverticular disease is a condition of abnormal pouches in portions of the colon.

High pressure inside the intestine may cause these outpouchings (called diverticula) to develop in areas of weakness within the wall of the colon.¹ The development of these pouches is called diverticulosis. Rarely, diverticula may also occur in the stomach or small intestine. When the pouches become inflamed (often as a result of bacterial infection), symptoms such as cramping pains, fever, and nausea can result.² Such an infection (called diverticulitis) is potentially life-threatening and requires immediate medical intervention. Diverticular disease becomes increasingly common as people age and is a malady of 20th-century western society, primarily due to the consumption of a low-fibre diet.³

Product ratings for diverticular disease

Science Ratings	Nutritional Supplements	Herbs
	Fibre	Psyllium
	Glucomannan
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

People with diverticular disease may or may not have abdominal cramps, bloating, constipation, and tenderness or pain, especially along the lower left side of the abdomen. When there is an active infection, there may also be fever, chills, nausea, and vomiting.

Medical options

Over-the-counter fibre supplements such as methylcellulose (Citrucel®), polycarbophil calcium (Fibercon®), and psyllium (Metamucil®) are often recommended.

Serious cases may be treated with prescription drugs, including intravenous antibiotics such as cefazolin (Ancef®), cefamandole (Mandol®), amikacin (Amikin®); pain medication in combination with paracetamol, such as codeine (Tylenol with Codeine®), hydrocodone (Vicodin®, Lortab®), oxycodone (Percocet®); and intestinal antispasmotics such as L-hyoscyamine (Levsin®, Levbid®). Injections of Vasopressin may be used to control bleeding diverticula.

For mild conditions, healthcare practitioners typically recommend adequate fluid intake and a high-fibre diet. Some severe cases might require a liquid diet or surgical removal of the affected portion of the colon. Giant diverticula always require surgery.

Dietary changes that may be helpful

Dietary factors influence the frequency and severity of diverticular disease recurrences. A diet high in fibre has been shown to be protective against diverticular disease.⁴ One study of food intake revealed a 50% increase in incidence of diverticular disease in people eating a diet high in meat and low in vegetables relative to those eating a high-vegetable and low-meat diet.⁵ In addition to helping prevent the disease, a high-fibre diet may also be useful as a treatment for diverticular disease.⁶

Lifestyle changes that may be helpful

Obesity may be associated with increased severity of diverticular disease.⁷ Studies have yet to be conducted to determine if weight loss decreases signs and symptoms of diverticular disease in patients who are overweight.

Physical activity, specifically jogging or running, has been reported to protect against symptomatic diverticular disease.⁸ While the reason for its positive effect is not known, exercise is associated with reduced symptoms of a variety of other diseases of the colon.

Vitamins that may be helpful

In people with diverticular disease, a fibre supplement may improve constipation. The results of double-blind of fibre supplementation for diverticular disease have been mixed. One study⁹ demonstrated a beneficial effect of fibre supplementation in people who suffered from abdominal pain and pain with bowel movements; whereas a second study¹⁰ indicated no improvement in these symptoms following fibre supplementation. Nevertheless, long-term fibre supplementation may protect against the complications of diverticular disease.¹¹

Glucomannan is a water-soluble dietary fibre that is derived from konjac root (Amorphophallus konjac). A preliminary clinical trial found that approximately one-third to one half of people with diverticular disease had reduced symptoms of diverticular disease after taking glucommanan.¹² The amount of glucomannan shown to be effective as a laxative is 3–4 grams per day.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

A preliminary trial of the herb psyllium supports the use of this type of fibre in relieving the symptoms associated with diverticular disease and constipation.¹³

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References
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1. Halphen M, Blain A. Natural history of diverticulosis. Rev Prat 1995;45:952–8 [in French].

2. Thompson WG, Patel DG. Clinical picture of diverticular disease of the colon. Clin Gastroenterol 1986;15:903–16.

3. Ozick LA, Salazar CO, Donelson SS. Pathogenesis, diagnosis, and treatment of diverticular disease of the colon. Gastroenterologist 1995;6:55–63 [review].

4. Handler S. Dietary fiber: Can it prevent certain colonic diseases? Postgrad Med 1983;73:301–7.

5. Manousos O, Day NE, Tzonou A, et al. Diet and other factors in the aetiology of diverticulosis: an epidemiological study in Greece. Gut 1985;26:544–9.

6. Elfrink RJ, Miedema BW. Colonic diverticula. When complications require surgery and when they don’t. Postgrad Med 1992;92:97–8, 101–2, 105, 108.

7. Ozick LA, Salazar CO, Donelson SS. Pathogenesis, diagnosis, and treatment of diverticular disease of the colon. Gastroenterologist 1995;6:55–63 [review].

8. Aldoori WH, Giovannucci EL, Rimm EB, et al. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut 1995;36:276–82.

9. Smits BJ, Whitehead AM, Prescott P. Lactulose in the treatment of symptomatic diverticular disease: a comparative study with high-fibre diet. Br J Clin Pract 1990;44:314–8.

10. Ornstein MH, Littlewood ER, Baird IM, et al. Are fibre supplements really necessary in diverticular disease of the colon? A controlled clinical trial. Br Med J (Clin Res Ed) 1981;25:1353–6.

11. Leahy AL, Ellis RM, Quill DS, Peel AL. High fibre diet in symptomatic diverticular disease of the colon. Ann R Coll Surg Engl 1985;67:173–4.

12. Papi C, Ciaco A, Koch M, Capurso L. Efficacy of rifaximin in the treatment of symptomatic diverticular disease of the colon. A multicentre double-blind placebo-controlled trial. Aliment Pharmacol Ther 1995;9:33–9.

13. Ewerth S, Ahlberg J, Holmstrom B, et al. Influence on symptoms and transit-time of Vi-SiblinR in diverticular disease. Acta Chir Scand Suppl 1980;500:49–50.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.