Management of Acute Diverticulitis Guideline Patient Companion

Clinical practice guidelines are developed under the guidance of the AGA Institute Clinical Guideline Committee and provide evidence-based recommendations for clinical practice in the field of gastroenterology. The clinical practice guidelines and related Clinical Decision Support Tools support evidence-based clinical decision-making by gastroenterologists and other health-care professionals at the point of care. The below information presents important content from those guidelines in a way that will help patients better understand AGA’s recommendations for evaluating, diagnosing or managing a condition.

AGA Clinical Guideline: The Management of Acute Diverticulitis

The information provided by the AGA Institute is not medical advice and should not be considered a replacement for seeing a medical professional.

What is Diverticulitis?

  • Diverticulitis is a painful form of inflammation in the digestive tract. Diverticulosis is a condition in which pockets (or diverticula) occur in the wall of the colon. When these pockets become infected or inflamed, it is called diverticulitis.
  • Acute diverticulitis is a painful, relatively sudden condition that can usually be treated without surgery.
  • Symptoms usually appear within a few days and can include:
    • Abdominal pain and tenderness, often on the lower left side.
    • Fever.
    • Change in bowel habits (such as diarrhea or constipation).
  • Your doctor can usually treat diverticulitis with a special diet, plenty of rest and, in some cases, antibiotic medications.
  • Once treated, most people start feeling better within a few days.
  • Approximately 20 percent of patients will have another flare-up, or recurrence. This usually happens within five years.
  • There may be several steps you can take to lower your risk of future attacks.
  • Diverticulitis is a common disorder.
  • Every year in the U.S., patients spend a total of 1.5 million days in the hospital due to the disease. 
  • If diverticulitis keeps recurring, surgery may be considered.

Preventing Recurrence

REACH FOR FOODS HIGH IN FIBER

  • Fiber is a form of carbohydrate that helps keep the digestive system healthy.
  • Studies suggest that eating enough fiber can help you avoid another flare-up of diverticulitis and reduce the need for surgery in the future.
  • After your diverticulitis has cleared, you will want to slowly start getting more fiber in your diet.
  • Americans should aim to get at least 25 grams of fiber per day, but most get only half of what they need.2
  • The best way to do this is to eat more plant foods throughout the day. Try getting at least 8 grams at breakfast, lunch and dinner to meet your daily requirement.
  • Here are some simple, satisfying ways to add fiber to your daily meals:
    • Berries.
      • Throw some blueberries or raspberries into a smoothie or stir them into a bowl of yogurt. One cup of berries will add 4 to 8 grams of fiber to your meal.
    • Beans.
      • Beans and lentils are packed with fiber: each ½-cup serving contains 5 to 8 grams. Take your taco up a notch by adding some black beans to the mix, or try an online recipe for homemade hummus and dip with carrots and celery for some crunchy, satisfying finger food.
    • Nuts and popcorn.
      • Contrary to what you may have heard, these foods are fine to eat after you recover. Looking for a way to conquer a sweet-and-salty craving between meals? Pair a handful of nuts or a few cups of air-popped popcorn with a piece of fresh fruit. Three cups of popcorn and a pear, for instance, pack more than 8 grams of fiber together.
    • Green veggies.
      • When eating salad, choose spinach or kale over regular lettuce. Oven-roast asparagus or Brussels sprouts in balsamic vinegar for a delicious addition to dinner. One cup of these veggies contains 4 grams of fiber.

BREAK A SWEAT FOR AT LEAST 90 MINUTES A WEEK

  • You probably know that exercise is great for keeping a healthy heart, mind and weight. Some studies even suggest that it can help prevent diverticulitis.
  • Healthy adults should get at least 90 minutes of vigorous activity every week.
  • Vigorous activity is the kind that gets your heart pumping and makes you break a sweat. Great examples are:
    • Jogging.
    • Swimming laps.
    • Taking aerobics classes.
    • Playing competitive sports.

TAKE ASPIRIN OR ACETAMINOPHEN FOR MINOR ACHES AND PAINS

  • Some studies suggest that certain over-the-counter (OTC) pain relievers, such as aspirin and NSAIDs, which include ibuprofen and naproxen, may raise your risk of a future flare-up.
  • For occasional aches and pains, it is best to choose acetaminophen.
  • Always remember to read and follow all of your medicine labels and do not exceed dosing guidelines. For pain that lasts longer than a week, see a doctor. Learn more about medicine labels and guidelines here.

TALK TO YOUR DOCTOR ABOUT GETTING A COLONOSCOPY AFTER YOUR CONDITION IMPROVES

  • In rare cases, diverticulitis can actually be a warning sign for colon cancer. Getting a colonoscopy can rule out this possibility.
  • If you have not had a colonoscopy recently, talk to your doctor about getting one a couple months after you recover.

Questions For Your Doctor

  • How can I tell if I am getting enough fiber in my daily diet?
  • Am I healthy enough to begin/continue vigorous physical activity after I recover?
  • Is there any reason I should not take aspirin or other pain relievers?
  • Should I get a colonoscopy soon to make sure I don’t have colon cancer?

References

Matrana, D.A. and Margolin, D.A. Epidemiology and pathophysiology of diverticular disease. Clin Colon Rectal Surg. 2009; 22: 141–146. link.

King, D.E., Mainous, A.G. III, and Lambourne, C.A. Trends in dietary fiber intake in the United States, 1999-2008. J Acad Nutr Diet. 2012; 112: 642–648. link .

World Health Organization. What is moderate-intensity and vigorous-intensive physical activity? link.

Centers for Disease Control and Prevention. Measuring physical activity intensity. link.