Diverticulosis is a disorder of the large intestine characterized by the development of small pouch-like protrusions, known as diverticula. These form when the mucosal and submucosal layers push through the muscular wall of the intestine, usually due to increased pressure in the lumen. Although diverticula can remain asymptomatic for long periods of time, in some cases they become inflamed, leading to a condition known as diverticulitis. If a patient has diverticula, it is very important to pay attention to their diet, as diet plays a crucial role in managing and preventing inflammation, helping to reduce complications and symptoms.
What are diverticula and diverticulitis?
Diverticula are most commonly found in the left side of the colon, particularly in the sigmoid colon, where pressure tends to be higher. Although the exact cause of their formation remains unclear, it appears that chronic constipation, low fiber intake, heredity, and inadequate hydration play a key role. Men over the age of 60 seem to be more vulnerable to developing the condition. The most common symptoms include abdominal pain, especially in the lower left part of the abdomen, bloating, disturbances in bowel movements, nausea, vomiting, fever, and bleeding from the colon.
It is important for every person to remember that many diverticulitis symptoms are similar to those of more serious conditions such as bowel cancer, inflammatory bowel diseases (ulcerative colitis and Crohn’s disease) or celiac disease. If there is a change in symptoms or new ones appear, seeking medical advice should not be neglected, as it is important to rule out other causes of the symptoms.
Diverticula and nutrition
Diverticulitis can remain asymptomatic and cause no symptoms if the patient takes care of their diet. Increasing fiber intake is vital as it improves bowel motility, reduces intraluminal pressure and prevents constipationGood sources of soluble fiber include oats, legumes, and fruits, while insoluble fiber is found in whole grains and vegetables. The recommended daily intake of fiber is 25-35 grams. At the same time, increased fiber intake should be accompanied by adequate hydration, with at least 8 glasses of water per day. It is also important to avoid foods that may worsen symptoms, such as red and processed meat, foods high in fat, and — depending on individual tolerance — nuts and seeds.
The consumption of probiotics also contributes to maintaining gut health, as they help balance the intestinal microbiota. Probiotics can be found in foods such as yogurt, kefir, and fermented vegetables. Limiting the consumption of alcohol and caffeine may also help prevent episodes of intestinal irritation. Finally, maintaining a healthy body weight is important, as obesity increases the risk of developing diverticulitis.
Dietary recommendations during diverticulitis flare-ups
During an acute episode of inflammation, it is initially recommended to consume clear liquids, such as broths, fiber-free juices, and gelatin, to allow the bowel to rest. Afterwards, low-fiber foods are gradually introduced, such as white bread, bananas, and rice. Therefore, when diverticula do not cause symptoms, adequate fiber intake is beneficial, but the opposite applies during acute inflammation. When diverticula become inflamed, the diet should consist of very low-fiber foods that the bowel can easily process. As the inflammation subsides, fiber is gradually reintroduced to prevent the recurrence of symptoms.
When diverticula that have become inflamed does not improve with proper nutrition?
Unfortunately, there are cases where diverticulitis becomes so advanced that it leads to severe complications, such as perforation or even rupture of the intestine. If the rupture is localized, it may be possible to manage the situation with hospitalization, administration of antibiotics, and cessation of all oral intake. However, this is only feasible if there is no peritonitis, bleeding, or sepsis. If the condition does not improve and the clinical picture worsens, surgical intervention is required. The goal of surgery is to remove the affected part of the intestine, allowing for the resolution of inflammation and the prevention of complications. In acute cases, the diseased segment of the sigmoid colon is removed, and a temporary colostomy is created. After a few months, the colostomy is reversed, and the healthy sections of the intestine are reconnected.
In selected cases, the colon can be reconnected directly, along with the creation of a temporary ileostomy, which is easier to close. In some cases, it is even possible to remove the inflamed section and immediately reconnect the remaining segments of the bowel, without the need for a colostomy. The General Surgeons in Athens, who make up the Colon Rectal team, have extensive experience in the surgical management of numerous cases of diverticulitis and select the most appropriate technique for each individual case.
In general, adopting a diet rich in fiber, ensuring adequate hydration, and avoiding foods that burden the bowel are the key measures for managing diverticulosis. Although nuts and seeds are no longer considered strictly prohibited, dietary recommendations should be personalized, taking into account each individual’s tolerance. Ongoing monitoring and guidance from specialists are essential for the optimal management of the condition.
