When a Diverticulosis Flare-up Becomes Diverticulitis

March 1, 2025

IM  -  

For musicians whose careers revolve around gigging, touring, eating on the road, and sitting for long periods, diverticulosis requires vigilance. Flare-ups can come on suddenly and may require urgent treatment.

According to the American Society of Gastrointestinal Endoscopy (ASGE) diverticulosis affects half of everyone aged 60 and over in the US. As a person ages, the pouches (diverticula) in the digestive tract become more prominent.

Typically, the wall of the large intestine, the colon, is smooth. An irregular, bulging pouch in the colon wall is called a diverticulum; multiple pouches are diverticula. Diverticulitis occurs when the pouches become inflamed or infected. Mild diverticulitis is usually treated with rest, changes in diet, and possibly antibiotics. An acute attack can cause severe abdominal pain, fever, nausea, and bowel irritability. It can also cause more serious problems, such as peritonitis (caused by perforations), abscess in the abdomen, or blockages of the intestine.

Diverticulosis is usually detected through a routine colonoscopy. If you have been diagnosed with diverticulosis, it’s advisable to enlist a gastroenterologist and see a dietician for food recommendations.

As we age, diverticulosis often develops in the lower left side of the large intestine (the sigmoid colon). Experts say the increased pressure in the colon pushes diverticula out through weak spots in the colon wall. Diverticulosis is generally asymptomatic, and without a colonoscopy or abdominal imaging, many people don’t know they have it.

Managing Diverticulitis

Be concerned about bleeding. In about 5% of people who have diverticulosis, rectal bleeding occurs when a small blood vessel ruptures in a diverticulum. This is known as diverticular bleeding, which can be triggered by medications like nonsteroidal anti-inflammatory drugs (a typical class of pain relievers that includes aspirin) or blood thinners.

Do not strain. If you have diverticula, putting pressure on them (constipation) may cause one to rupture (perforate) and become inflamed or infected (diverticulitis).

Report any pain to your primary physician. Diverticulitis symptoms include pain and cramps in the lower left of the abdomen, diarrhea, constipation, fever, nausea, or vomiting. Call your doctor if the pain doesn’t go away or is especially intense. In mild cases without fever, you may not need to be treated with antibiotics. But if diverticulitis is severe, you would likely be admitted to the hospital and treated with intravenous antibiotics and a liquid diet for a few days. Doctors say about a third of cases are severe.

Maintain a healthy lifestyle. General guidelines include minimal use of alcohol (which dehydrates), getting regular exercise, and maintaining a healthy weight. A sedentary lifestyle is a risk factor. Desk jobs and sitting for too long are generally unhealthy: Stand up every hour—move around, stretch, take a short walk. Try to fit in moderate-to-vigorous exercise during the day, like a brisk walk or a run.

Vigorous physical activity reduces the risk of diverticulitis and diverticular bleeding. Any exercise that gets your heart and lungs pumping (like a brisk walk) is believed to support a diverse population of helpful microbes in the gut, which are thought to play a role in healthy aging and longevity.

Adopt a high-fiber diet. Eating vegetables and whole grains is a starting point for managing diverticulosis. Drinking plenty of water helps the body capitalize on the fiber—aim for 25 to 30 grams of dietary fiber daily. The best sources of fiber are beans, such as black beans and kidney beans; brown and wild rice; fruits, fresh and dried, raw or cooked; all sorts of vegetables, raw or cooked; and whole grain breads, cereals, and pasta.

Low-fiber diet during an episode. During the active stage of the infection, physicians recommend eating a low-fiber diet and drinking more water. Once the infection clears, and on the recommendation of your doctor, fiber should be back on the menu.

Don’t worry about eating nuts! Years ago, doctors recommended avoiding nuts and seeds if you had diverticulosis. The thinking was that bits of food could become lodged in those pouches and cause inflammation or infection. Today, we know the advice was wrong. The evidence does not show a higher risk of diverticulitis in people who eat those foods than those who do not.

Supplements may be helpful. If you have received a diverticulosis diagnosis, your doctor may recommend adding fiber supplements to ensure adequate fiber intake and prevent constipation. Probiotics can also be helpful as a possible measure to prevent diverticulitis. Fiber and protein bars can supplement for days on the road when you cannot work in a proper meal or regular exercise.

Also, if you have been diagnosed with diverticulosis, consider talking with a dietitian about general food guidelines for management to prevent an attack of diverticulitis.

---