The Low-Down on Diverticular Disease

What is Diverticular Disease?

Diverticular disease is a common digestive disorder, which results in the abnormal development of small pouches (diverticula) in the large intestine. It is believed that constipation may cause increased pressure in the large intestine thereby resulting in the development of diverticula in the intestinal wall¹. Constipation may arise due to inadequate fibre and fluid consumption as well as low levels of activity. Diverticulitis, the most common complication of the disease, arises if the diverticula become inflamed or infected (Diverticulitis). Symptoms can include altered bowel habits (diarrhoea and/or constipation), tummy pain, bloating and bleeding¹.

Age and diet are believed to be the most important risk factors for the development of the disease. In fact, more than half of all adults over the age of 70 have the condition. And most of those would be unaware that they have the disease.

What is Diverticulosis?

Diverticulosis refers to having diverticula. Having these pouches does not regularly result in symptoms, other than the occasional bout of constipation or bleeding. It is only once the pouches become inflamed or infected that significant issues arise.

Treatment for Diverticulitis

Diverticulitis is usually a medical emergency, requiring immediate attention and admission to hospital. Mild attacks may be treated at home, but should always be assessed by a medical professional quickly. Immediate treatment may include abstaining from eating or drinking to allow the bowel to rest, antibiotics, painkillers or surgery, if a rupture or obstruction has occurred. In an extreme event, a colostomy bag may need to be fitted, however, this is a rare procedure.

Dietary Management of Diverticular Disease

In the aftermath of a flare-up of diverticulitis, it is important to follow a low-residue diet also know as a low fibre diet. This is to allow the bowel to rest and repair. Low fibre options include white bread, pasta and rice as well as small amounts of fruit and vegetables with the skin peeled. Foods that are contraindicated during a flare-up include whole grains, legumes, brown rice, wholemeal pasta, nuts and seeds, as well as fibrous fruit and vegetables.

Meanwhile, when symptom-free, the management of the disease is relatively straightforward. It simply mimics a healthy eating plan with a particular emphasis on ensuring an adequate fibre and fluid intake. Fibre is found in fruit, vegetables, bread, cereals, nuts and legumes. The role of fibre is to ensure healthy bowel function by assisting the movement of food and waste through the digestive system. Improving bowel habits will also likely reduce the pressure within the large intestine that is believed to be the trigger for the development of diverticula.   

It was long believed that those with diverticular disease needed to avoid high residue foods such as nuts, seeds, corn and popcorn. It was thought that these foods might become wedged in one of the abnormal bowel pouches, causing the area to become infected. However, recent research indicates that avoiding these foods has no impact on preventing a bout of diverticulitis. In fact, nuts and seeds should be included as part of a healthy balanced diet. They are high in protein, good fats, vitamins and minerals and are a good source of fibre. Plus they taste good too. Win-win.

Examples of fibre-rich foods

Porridge/wholegrain cereals

Grain-based bread and crackers

Brown rice, wholemeal pasta

Starchy vegetables including corn, potato, sweet potato and pumpkin

Non-starchy vegetables

Fresh/dried/stewed/tinned fruit

Beans and legumes

Nuts and seeds

Popcorn

Fruit and nut bars

Finally, an Accredited Practising Dietitian/Registered Dietitian can provide you with tailored expert nutrition advice on a range of medical issues including diverticular disease and other gastrointestinal disorders.