What Triggers Diverticulitis?

Certain foods may trigger diverticulitis, but these differ from person to person. Trigger foods are generally processed ones like fried foods and cured meats.

Diverticulitis is a form of diverticular disease, which occurs when small pouches in the large intestinal (colonic) wall called diverticula, are present. These diverticula arise in the colon and push through weak spots in the colon’s outer muscle layers. Inflammation of the diverticula is called diverticulitis. Diverticular disease that is not inflamed is called diverticulosis.

Symptoms of diverticulitis may include:

• Abdominal pain (most commonly in the left lower quadrant, may be severe)
• Nausea
• Vomiting
• Constipation (may be severe)
• Diarrhea
• Blood in the stool
• Fever
• Chills
• Gas (flatulence)
• Bloating
• Rectal bleeding (rare)

The cause of diverticulitis in Western countries is believed to be due to a high-fat and low-fiber diet. 

Other possible causes of diverticulitis include: 

• Straining to have a bowel movement from constipation 
• Obesity
• Lack of exercise
• Smoking
• Genetics
• Use of certain medications including nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, and steroids

There are no specific triggers for diverticulitis attacks. In the past, it was believed that foods such as nuts, popcorn, and seeds should be avoided by diverticulitis patients because it was thought these particles could enter or block the diverticula. More recent research indicates these foods are not harmful and since they are high in fiber, they may help some patients. 

Each patient is different and people may find certain foods aggravate or trigger diverticulosis. Common foods such as those low in fiber or high in sugar that may trigger diverticulosis include:

• Processed meats
• Red meats
• Fried foods
• Full fat dairy products

Diverticulitis is diagnosed based on a medical history and physical examination. 

Laboratory tests may also be ordered to aid in diagnosis, such as:

• White blood cell count 
• Hemoglobin level 
• Electrolyte assays 
• Blood cultures 
• Renal function tests
• Liver enzyme and lipase levels 
• Urinalysis 
• Urine culture 
• Stool test for blood
• A pregnancy test for females of childbearing age with abdominal pain

Imaging tests that may be indicated include:

• Computed tomography (CT) scanning of the abdomen 
• Lower GI series (barium contrast enema, using water-soluble medium)
• Abdominal radiographic (X-ray) series
• Colonoscopy

Treatment for diverticulitis depends on the severity, complications that may be present, and other coexisting medical conditions.

Treatment for mild diverticulitis includes:

• Clear liquid diet for 2-3 days; progressing to a soft diet as tolerated
• 7-10 days of oral broad-spectrum antibiotics if needed, such as:
  • Ciprofloxacin (Cipro) plus metronidazole (Flagyl)
  • Trimethoprim-sulfamethoxazole (Bactrim) plus metronidazole (Flagyl)
  • Amoxicillin-clavulanate (Augmentin) 
  • Moxifloxacin (Avelox) (for patients intolerant of both metronidazole and beta-lactam agents)
• Acetaminophen (Tylenol) and antispasmodics for pain

In severe cases hospitalization may be needed. If hospitalized, treatment for severe diverticulitis may include:

• Clear liquid diet; progress to a soft diet as tolerated
• Intravenous (IV) or oral antibiotics
  • Beta-lactamase-inhibiting antibiotics such as piperacillin/tazobactam (Tazocin) and ticarcillin/clavulanic acid (Timentin)
  • Carbapenems such as ertapenem (Invanz) 
• Abscesses less than 3 cm: Typically resolved with antibiotics 
• Abscesses greater than 4 cm: Drain percutaneously
• Pain management 
  • Morphine is preferred, though it may affect bowel tone and sphincters
  • Acetaminophen and antispasmodics such as dicyclomine are first-line medications used to manage pain and cramping in mild to moderate disease
• Elective surgical resection

Complications of diverticulitis may include:

• Abscess (most common complication)
• Intestinal fistula
• Intestinal obstruction
• Intestinal perforation
• Generalized peritonitis (inflammation of the tissue that lines the wall of the abdomen)
• Stricture of colon
• Sepsis (can be life-threatening)

The primary way to prevent diverticulitis is with proper diet and exercise. Diverticular disease can be due to a low fiber diet, so consumption of a high fiber diet with plenty of vegetables and fruits, whole grains, and other high fiber foods is the mainstay of prevention.