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Diverticulitis: Symptoms, Causes, Treatments, Prevention

Diverticulitis (also called colonic diverticulitis) occurs when small bulging pouches called diverticula in the wall of your large intestine become inflamed or infected.

An image of a woman on a toile holding her stomach in pain.

What's the Difference Between Diverticulosis and Diverticulitis?

According to the National Institutes of Health, diverticulosis is a type of diverticular disease that occurs when small pouches (diverticula) form in the intestinal wall. It is widespread, affecting an estimated 1 out of 10 people over 40 in the United States (1, 1a), and usually does not cause any symptoms.

Diverticulitis is an infection of those small pouches that can lead to severe complications if left untreated. It is the most serious type of diverticular disease.

According to the International Foundation for Gastrointestinal Disorders, "Diverticulosis leads to diverticulitis in about 1 out of 5 to 1 out of 7 cases." (2)

Symptoms of Diverticulosis

Most people with diverticulosis don't experience symptoms. This is called asymptomatic diverticulosis. Consequently, they are often unaware they have this condition. However, when several diverticula are present, it can disrupt normal bowel function. This can cause a variety of symptoms, including:

  • Constipation
  • Diarrhea
  • Changing bowel habits, possibly alternating between constipation and diarrhea
  • Gas (flatulence)
  • Bloating
  • Blood in the stool
  • Anemia from blood loss, if it occurs often
  • Occasional pain in the lower left side of the abdomen, usually after eating or passing stools.
A graphical image of a transparent human body with digestive system highlighted.

Symptoms of Diverticulitis

Symptoms of diverticulitis may include:

  • Abdominal pain, especially in the lower left half of the abdomen. This pain may be constant and last for several days
  • Constipation
  • Abdominal tenderness
  • Nausea
  • Vomiting
  • Fever
  • Chills
  • Cramps in the lower abdomen
  • Abdominal bloating
  • Painful and/or more frequent urination
  • Blood in the stool
  • Rectal bleeding

Diverticulosis and Diverticulitis Risk Factors

Low-Fiber Diet

A low-fiber diet and constipation have been considered the most significant risk factor for diverticulitis since the 1960s. Without adequate fiber intake, you must push harder to expel waste, which increases the risk of fecal matter getting stuck in the diverticula and causing infection.

But recent studies do not show an association between low-fiber diets/constipation and increased diverticulitis risk (3,4). However, fiber may undoubtedly play a role. For example, one study found that at least half of the cases of diverticulitis could be prevented by following a healthy lifestyle that includes consuming more than 23 grams of fiber per day.

An infographic with cartoon images of a young female standing beside a human stomach and intestines with text that details the changes of structural properties of dietary fiber during digestion. Infographic text is described below.

Infographic Text:

Changes of structural properties of dietary fiber during digestion.
Mouth: no significant changes
Stomach: products of acid hydrolysis
Small intestine: ileum microbiota fermentation
Large intestine: microflora fermentation metabolites
Nonfermentable dietary fiber scraps (with an image of a downward pointing arrow signifying excretion.)

End Infographic Text


The diverticulosis and diverticulitis risk increase with age.

The International Foundation for Gastrointestinal Disorders states that "about 1 out of 10 people over age 40, half of those older than 60, and 2 out of 3 over 80 have [diverticulosis]. (5)

The prevalence of diverticular disease is 65% in those 65 years and older. (6)


Being significantly overweight (obese) is thought to increase the risk of developing this disease. However, research suggests that the location of body fat is more important than overall weight for increasing the risk.

In a population-based study published in Mayo Clinic Proceedings, researchers noted: "Rather than BMI per se, increased abdominal visceral and subcutaneous fat are independently associated with diverticulitis. " (8)

Lack of Exercise

We've long known that regular exercise has many health benefits. Now researchers have discovered that it may even reduce diverticulitis risk.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, exercise decreases the risk of diverticula formation. It also stimulates intestinal activity, thus improving digestive function. (9)

And research suggests that exercise combined with weight control can be a protective factor against diverticulitis. In a February 2012 study published in the ​American Journal of Gastroenterology, researchers found that adult females who were overweight and exercised less than 30 minutes a day had a significantly higher risk of developing diverticular disease than those who were of "normal" weight and exercised more frequently. (10)


There is a link between cigarette smoking and diverticulitis.

After conducting a comprehensive meta-analysis of 3 studies involving 130,520 participants comparing the risk of colonic diverticulosis among current and former smokers versus nonsmokers, researchers concluded: "A significantly increased risk of colonic diverticulosis among current smokers is demonstrated in this study." (11)

It is not clear why cigarette smoking increases the risk of diverticular disease.

A graphical image of human intestines with intestinal bacteria.

Alterations in the Gut Microbiome

Alterations in the gut microbiome have been observed in those developing acute diverticulitis. Specifically, there was a decrease in anti-inflammatory bacterial species, leading to intestinal inflammation. (12)

Researchers have also observed bacterial colonization of diverticula involved in the development of acute diverticulitis. (13)

Certain Medications

Specific medications are associated with an increased risk of diverticulitis, including:

  • Steroids
  • Opioids
  • Nonsteroidal anti-inflammatory drugs, such as Advil, Aleve, and Motrin IB

Complications of Diverticulitis

Around 25% of diverticulitis cases develop serious complications (complicated diverticulitis) and must be aggressively treated. (14)

The most common diverticulitis complications include:

  • Diverticular Abscess. A diverticular abscess is an infected diverticulum filled with pus. It is confined to a specific area of infection.
  • Phlegmon. A phlegmon is similar to an abscess, except it's not confined to a specific area and can spread.
  • Gastrointestinal Fistula. A gastrointestinal fistula is an abnormal passage that develops between the bowel and a nearby organ.
  • Intestinal perforation. Intestinal perforation is a tear in the intestinal wall causing the colon's contents to leak into the abdominal cavity. This can cause inflammation and infection that can be life-threatening if not treated promptly.
  • Intestinal obstruction. Intestinal obstruction is a blockage in your intestine that prevents stool from passing and can be deadly.

How is Diverticulitis Diagnosed?

If you have asymptomatic diverticulitis, meaning that you are not exhibiting any symptoms, your healthcare provider will probably discover diverticulitis, diverticulosis, or diverticular disease while examining you for other digestive system conditions, such as colorectal cancer. Diverticulitis is often specifically diagnosed when you're having severe symptoms called an acute attack.

To diagnose diverticulitis and diverticular disease, your doctor may perform or order some of the following tests:

  • Medical history. Your healthcare provider will ask you about your medical history, including all your medications. They will also ask about your dietary habits.
  • Symptom Inventory. Your doctor will also take an inventory of your symptoms to see if they are consistent with diverticular disease.
  • Physical exam. Your healthcare provider will manually and visually inspect your body for signs of diverticulitis, such as abdominal tenderness and distension. This inspection will usually include a digital rectal exam.
  • Colonoscopy. This test looks for abnormalities in the colon wall and rectum, such as polyps, colorectal cancer, and irritated or inflamed tissue.
  • CT scan. This scan uses x-rays to create cross-sectional images. It can spot abscesses that are outside of the bowel lining. A CT scan is considered the best imaging method to confirm a diverticulitis diagnosis. (15)
  • Blood tests. Testing the blood is crucial to detect infection.
  • Urinalysis. This test checks for signs of infection and can often indicate the location of diverticulitis.
  • Barium enema. This enema uses a contrasting dye to take clear images of the bowel and anus.
  • Stool tests. A thorough exam of your stool is conducted to see if there is any blood in the feces or the presence of infection.

Conditions that Mimic Diverticulitis

Because you can develop diverticulitis anywhere along the gastrointestinal tract, symptoms may mimic several other conditions, including:

  • Urinary tract infection
  • Small bowel obstruction
  • Acute appendicitis, if the pain is on the lower right side of the abdomen
  • Peptic ulcer disease
  • Pancreatitis, inflammation of the pancreas
  • Cholecystitis, inflammation of the gallbladder
  • Irritable bowel disease
  • Crohn's disease
  • A gynecological issue, such as ovarian cystic disease

Diverticulosis and Diverticulitis Treatment Options

According to the National Institute of Diabetes and Digestive and Kidney Disease, "Your doctor will recommend diverticular disease treatments based on whether you have chronic symptoms, diverticulitis, or complications." (16)

Here are some of the most common treatments your doctor may recommend for diverticulosis and diverticulitis.

Diverticulosis Treatments

High Fiber Diet

Gradually increasing soluble fiber intake will help improve digestive issues and reduce mild diverticulitis symptoms.

An image of a display of a variety of produce in grocery store, including tomatoes, watermelon, cucumber, and lettuce.

Here are some great soluble fiber food sources:

  • Green leafy vegetables
  • Oats/oat bran
  • Beans
  • Avocado
  • Flaxseeds
  • Macadamia nuts
  • Brussels sprouts, cabbage, broccoli, and other cruciferous veggies
  • Carrots

Fiber Supplements

If it's difficult for you to get enough soluble fiber through your diet, you can take fiber supplements in either capsule or powder form.

Metamucil is a famous brand of powdered psyllium husk.

Elimination Diet

Certain foods can make your diverticulosis symptoms worse. If you're unsure what your specific "trigger" foods are, your doctor may recommend an elimination diet.

During an elimination diet, you'll remove one or two foods you suspect may trigger your symptoms for a short time, usually 2-3 weeks. Then you'll reintroduce those foods one at a time, noting any symptoms that may appear.

The foods that may worsen diverticulosis symptoms include nuts, seeds, popcorn, and pips. Foods that may relieve symptoms include peas and beans.


If you're experiencing chronic constipation, your doctor may recommend short-term laxative usage to get your bowels moving again.

There is a variety of laxatives available for this purpose, including:

  • Bulk-producing laxatives (psyllium husk, methylcellulose)
  • Stool softeners (DulcoLax Stool Softener)
  • Osmotic laxatives (Milk of Magnesia)
  • Lubricant laxatives (mineral oil)
  • Saline laxatives (Magnesium citrate)

Diverticulitis Treatments

Diverticulitis treatments vary depending on the severity of symptoms and can include:

  • Antibiotics
  • Medications for pain
  • Liquid diet to rest the digestive tract
  • Regular use of a mild antibiotic to prevent future attacks

Diverticulitis Surgery

Surgery may be necessary to address some of the complications of diverticulitis.

Conditions that may require surgery include:

  • Intestinal perforation
  • Bowel obstruction
  • Rectal bleeding

There are two main types of diverticulitis surgery;

  • Bowel resection, where the surgeon removes the affected part of the bowel and sews the two healthy portions together
  • Bowel resection with a colostomy, where the surgeon connects your bowel with an opening in your abdomen and attaches a temporary or permanent colostomy bag. The surgeon may opt for this procedure if there's excessive inflammation in the colon.

Preventing Diverticulitis

Preventing diverticulitis can be as simple as implementing a few simple lifestyle changes listed below. 

Increase Fiber Intake

Gradually increase your fiber intake. You must consume both soluble and insoluble fiber for digestive health and bowel regularity.

Examples include:

  • Asparagus
  • Broccoli
  • Cauliflower
  • Oats/oat bran
  • Legumes
  • Greenbeans
  • Spinach
  • Kale
  • Cucumber
  • Tomatoes
  • Flaxseeds
  • Chia seeds

Drink Plenty of Water

The water works with the fiber you consume to add bulk to your stool, thus easing digestive issues like constipation. It also helps turn soluble fiber into a gel that the beneficial bacteria in your colon ferment, which helps to support gut health and overall health.

Staying well-hydrated is also essential for bodily function, as up to 60% of the human body is composed of water. (17)

How many fluids should you drink?

The Institute of Medicine recommends that women get 9 cups of fluid daily, and men get 13 cups. (18)

You can get sufficient hydration through the fluids you drink and the foods you eat. Most foods contain water, but certain fruits and vegetables are known as high-water foods. For example, fruits and vegetables like cucumber, iceberg lettuce, watermelon, and celery are over 90% water and contain plenty of fiber to help you stay regular! (19)

Exercise Regularly

As mentioned above, exercise helps keep your bowels moving. It's not only great for the digestive tract, but it's also essential for health. For example, exercise can help you lose or maintain a healthy weight, improve cognitive function, reduce the risk of various cancers, and much more.

You don't have to participate in a structured exercise program either. Here are a few tips for putting more exercise into your day without huffing and puffing on a treadmill:

  • Take the stairs instead of the elevator.
  • Park at the far end of the parking lot for any appointment, shopping trip, or while at work. This enables you to take more steps during the day.
  • Do gentle yoga stretches throughout the day
  • Go bicycling
  • Take leisurely walks around the block.
  • Do some gardening
  • Walk your dog
  • Play softball with your children
  • Join a bowling team

Take Fiber Supplements (if Needed)

Sometimes it's not possible to meet your daily fiber requirement. For example, maybe you have dinner meetings or don't feel like preparing fibrous meals. That's no problem. Several fiber supplements are available on store shelves.

Metamucil is a popular and convenient choice. It contains psyllium husk powder. Simply stir a scoopful of this fiber powder into a glass of water or another liquid, drink it, and go about your day!

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