Diverticulitis occurs when one or more small outpouchings in the wall of the intestine become inflamed. It is a common condition, especially in those over 50.

The wall of the large intestine or colon is supposed to be smooth. Sometimes, an irregular bulge forms in the wall of the colon and is called a diverticulum. Multiple bulges are called diverticula.

Diverticula usually don’t cause problems, but if they become inflamed, they can cause severe pain, tenderness in the lower left abdomen, fever, chills, nausea, cramps and either constipation or diarrhea. If not treated, it can lead to an abscess, bowel obstruction or fistula, which is a hole in your colon that then connects to other organs such as the bladder or other parts of your intestines. Having several episodes of diverticulitis can cause scarring in the intestines, which can result in an obstruction.

Diverticula develop gradually over years. Scientists aren’t exactly sure what causes them, but research has identified some possible causes including:
• A low fiber diet can lead to hard stools, making it difficult for the colon to move waste, thus putting pressure on the colon walls when you strain, and it does not provide a food source for good gut bacteria.

• Aging can affect all the body’s cells, tissue and organs and lead to changes in how body systems perform as organs become less proficient.

• A family history of diverticulitis increases the likelihood of developing diverticula.

• Obesity may put increased pressure on the colon, change the gut microbiome and contribute to inflammation throughout the body.

• Low vitamin D levels have been associated with more serious cases of diverticulitis.

• Smoking weakens the walls of the colon, making it harder to contract. Nicotine increases inflammation in the colon.

• A lack of regular exercise can lead to constipation.

• Excessive alcohol consumption can irritate the stomach, slow the movement of food and waste through the digestive system, and encourage the growth of harmful bacteria.

• Medications like NSAIDS (aspirin, Motrin and ibuprofen) steroids and opioids increase your risk for perforations and bleeding.

• Women are more likely to have severe diverticulitis than men.

The presence of diverticula is often found during a colonoscopy, CT scan or when you are diagnosed with diverticulitis. Diverticulitis is diagnosed in several ways such as:

• A barium enema or a lower GI series. This is an X-ray of your rectum, the large intestine and the lower part of your small intestine. You are given an enema filled with a fluid called barium which coats the organs so they can be seen on an X-ray. Any blockages, narrowing or other problems will show up.

• A virtual colonoscopy, which is a CT scan that checks the colon using air and contrast.

• A flexible sigmoidoscopy, in which a short flexible lighted tube with a camera on the end is put into your rectum. The tube blows air into your intestine to make it easier to see.

• A colonoscopy, which is similar to the sigmoidoscopy but looks at the full length of the large intestine for abnormal growths, inflammation of tissue, sores and bleeding. A biopsy may be performed during the procedure.

Treatment for diverticulitis varies depending on how severe symptoms are or if the patient has other complications. For mild cases, the doctor will prescribe rest, antibiotics and perhaps a liquid diet. Patients may eat solid food in a few days as symptoms improve. If the symptoms are severe, the doctor may admit the patient to the hospital for IV antibiotics and require the person to fast for a few days before eating regular food again. If there are complications like a bowel perforation, abscess, fistula or intestinal obstruction, some type of surgery will be required.

Those who have a flare up of diverticulitis may need to stop eating for a few days to give their digestive system a rest or may be asked to consume liquids only for a few days. Clear liquids like fat free broth, fruit juice without pulp, plain or carbonated water, sports drinks, tea or coffee without milk products are best.   

After a few days, patients may begin to add back solid foods but should choose low fiber foods like eggs, chicken, turkey, fish, white bread and pasta, rice, canned fruits and vegetables with no seeds or skin, low fiber cereals, milk, yogurt and cheese. Those with diverticulitis may also want to avoid certain foods including fresh fruits, especially apples, pears and raspberries, vegetables other than canned and especially green peas and broccoli, beans and peas, whole grain breads, crackers and cereal, popcorn and nuts until their diverticulitis is controlled and they can resume eating a high fiber diet. Previously, it was thought that people with diverticula shouldn’t eat seeds, nuts and popcorn, but new studies show that it is perfectly okay to eat them as long as there isn’t a flare up.

Individuals can help prevent diverticulitis and other diseases by making the following healthy lifestyle choices.
• A healthy gut microbiome fights off infection so eat a diet high in both prebiotics and probiotics and rich in nutrients like vitamins and minerals.

• Regular exercise increases blood and oxygen flow to all the organs and keeps your body toned and strong.
• Meditation and stress reduction support good gut health.

• A diet high in fiber prevents constipation and promotes good gut bacteria.

• Limit consumption of alcohol and stop smoking or vaping.

• Drink enough fluids like water, tea or nutritious broths to help the digestive system function smoothly and move waste through the colon.

Editor’s note: Lisa Tedder is the wife of Dr. Barry Tedder, who practices at St. Bernards Heart and Vascular and specializes in preventative cardiology and lipidology. They reside in Jonesboro and have two adult children.