Diverticulitis Symptoms, Diet, Foods To Avoid, Treatment, Surgery

What Are Diverticula?

Diverticula (singular ~ diverticulum) are abnormal marble-sized pouches protruding out from the intestinal wall – most often from the sigmoid colon (Picture 1). It is more commonly seen with advancing age. Most of the time diverticula do not pose any significant health problem and may not even present with any symptoms. However, when these diverticula become infected then it can cause significant discomfort and other symptoms.

Diverticulosis as seen in colonoscopy

Picture 1. Diverticula in the colonic wall as seen during colonoscopy.

Most people who develop diverticula are over the age of 50 years. In fact as may as 2 in 3 people aged 85 years and older have diverticula. The majority of people do not experience any symptoms. However, it does affect about 1 in 5 people younger than 50 years. Overall only about 15% of people with diverticula develop diverticulitis. It can lead to serious complications like intestinal blockage and perforation, peritonitis and even sepsis in untreated cases.

Causes of Diverticulitis

Diverticula form when the bowel wall weaken and eventually small pouches form in the colon wall. This is a result of age-related changes which may cause weakening of the intestinal wall. Due to increased pressure within the colon, like when straining to pass stool in constipation, pouches can form slowly over time. The colon is laden with bacteria and these bacteria can enter and infect the pouches thereby leading to diverticulitis.

Signs and Symptoms

It is important to understand the differences between diverticulosis, where diverticula form in the colon, and diverticulitis, where the diverticula become infected. If diverticulitis symptoms or worsen despite treatment then it is imperative that immediate medical attention is sough. Some of the complications of diverticulitis can be serious and even life-threatening without prompt medical attention.

Symptoms of Diverticulosis

Diverticulosis refers to multiple intestinal (mostly colonic) diverticles, which commonly occur in old, but also in young constipated persons who constantly strain at defecation. Diverticula may cause no symptoms at all, or it may cause constipation, bloating, lower left side abdominal cramps or pain.

Symptoms of Diverticulitis

Diverticulitis refers to inflamed (mostly infected) diverticula. Symptoms may last from few hours to several days and include:

  • Lower left side abdominal pain and/or tenderness, or (in Asian populations) right side abdominal pain
  • Nausea
  • Diarrhea or constipation
  • Bloating and flatulence
  • Fever, chills
  • Vomiting (not common)


In both diverticulosis and diverticulitis the following complications may occur:

  • Inflammation of nearby organs such as the prostate, bladder and uterus may occur if the infection spreads from the sigmoid colon.
  • Obstruction of the colon due to scarring after several episodes of  inflammation. This may require immediate surgery.
  • Collections of pus (abscesses) in or around the colonic wall. Abscesses may be treated with antibiotics or surgery.
  • Perforation of the colon, which can lead to life threatening inflammation of the lining of the abdominal cavity (peritonitis). Symptoms of perforation are severe pain, fever and (if shock develops) weak and fast heart pulse, rapid breathing, restlessness. Colon perforation often requires urgent surgery.
  • A fistula (a tunnel through the tissues) may connect colon with adjacent organs (small intestine, bladder, uterus, vagina, skin of abdominal wall) and cause inflammation in the area and of these organs.
  • Intestinal bleeding (not common) may occur and sometimes it is not due to diverticula. Therefore the source of bleeding should be identified and treated.
  • Sepsis is more likely to develop if there is a severe infection that is untreated, especially if perforation is undiagnosed and treatment is delayed.

Diagnosis of Diverticulitis

Diverticulosis or diverticulitis may be suspected from symptoms, mostly from lower left abdominal pain. The presence of diverticles can be confirmed by ultrasound or CT of the abdomen. Blood test may show increased leukocytes. X-ray with barium enema or colonoscopy to evaluate the extent of diverticulosis may be performed after the inflammation has subsided.

Treatment of Diverticulosis and Diverticulitis

Diverticula are usually permanent and do not resolve with time, diet or medication. Surgery may be necessary in some instances. When diverticulitis does occur then the following treatment options may be considered.

  • Rest.
  • Clear liquid diet (water, clear juices, pop-sickles without fruit particles, gelatin, broths) or low-fiber diet (white bread, white rice, pasta, eggs, poultry, fish without bones, fruits without peels, membranes, or seeds).  Avoid vegetables with hard skins, like beans or peas.
  • Oral antibiotics in mild diverticulitis cases and intravenous antibiotics in severe infections.
  • Mild painkillers like paracetamol may be taken in pain. Strong painkillers (morphine) aggravate constipation so they should be avoided, if possible.

Diverticulosis and Surgery

If diverticles cause constant problems over the years, and diet does not help, a surgical removal of the affected part of the colon may help. Surgery can be performed through a classical open-abdomen surgery, or laparoscopic surgery with only few short incisions in the abdominal wall. In most cases, the remaining parts of the colon can be connected end-to-end but sometimes a temporary or permanent colostomy (a free end of the colon connected to abdominal wall) is needed.

Diet to Prevent Diverticulosis and Diverticulitis

After attack of diverticulitis is over, you can adjust your diet to avoid further developing of diverticles:

  • If you are constipated, eat enough fiber to soften the stool. Fruits, vegetables, cereals, nuts, whole-grain or half-white bread and fiber supplements, like psyllium husk, may all be appropriate. Introduce fibers slowly to prevent bloating (also do not exaggerate with an amount – you need enough, not a lot of fiber). Drink enough fluid together with the fiber.
  • If you are bloated, avoid fruits like apples, pears, plums, prunes and dried fruits in general, sugary foods and drinks. Citruses and berries may be fine.
  • Do not delay bowel movements when it is time to go, and avoid straining.
  • Be active. Exercise helps to prevent diverticula formation.

Foods To Avoid For Colon Diverticulitis

In the past it was recommended to avoid foods with hardly digestible peels like popcorn or beans or those with small seeds like strawberries, blueberries, cucumbers or tomatoes because they could lodge in diverticula and cause its inflammation. There no scientific evidence for these claims but these small food particles should be avoided in the event that a person with diverticula is uneasy about this occurring.


  1. Diverticulitis  (merck.com)
  2. Diet in diverticulitis  (mayoclinic.com)
  3. Foods to avoid in diverticulitis (mayoclinic.com)
About Jan Modric (249 Articles)
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  • tracey bryan

    My husband has suffered over the last four years with constant bouts of severe stomache cramps, diarrhea, gas, bloating, then also with constipation, up to one week without a BM. He believes that everytime he tries to eat anything, he becomes violently ill, thus he has been trying not to even eat. Two years ago he had a fistula, which was repaired, but his symptoms this time are worse. We are at our wit’s end, could someone please help us?

  • Jan Modric

    To tracey bryan?

    Has your husband got any official diagnosis so far? Fistules are common in Crohn’s disaese – this can be usually diagnosed by colonoscopy.

    Did he have stool tests for parasites? Is there any food that he thinks it triggers his symptoms? Are symptoms related to meals and, if yes, in what time after the meal he gets symptoms (minutes, hours?) Any blood in the stool?

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  • brenda

    I went on the internet this morning frantically looking for some info. about what has been happening to me. My biggest fear is that my stool is covered in this whitish substance that almost looks like skin. After reading the article about Diverticulitis I was able to kind of piece some things together. I have had lower left abdominal pain for several years. It started after some complications when I had a partial hysterectomy. I had internal bleeding, and my stomach distended. I had a lower G.I., and was told that I have a 4 inch section of my intestine that spasms. Currently, I am just getting off of Hydrocodone that I took for over 2 years because of a work injury. I sometimes go 2 weeks with no bowel movement. Now that I’m off the pain killer I am still having trouble going to the bathroom and the mucus is still there. I’m really worried about this. Should I be? I have no health insurance to even go see a doctor, so any advice is very helpful. Thank you.

  • Jan Modric


    what was said to be a cause of the spasming part of the intestine? Were some diverticles revealed at lower GI?
    What was the reason for histerectomy? Do you have/had raised temperature?

    Is the substance that covers the stool translucent, so mucus?

    Mucus may be from prolonged stay of the stool in the colon, from hemorrhoids, IBS, intestinal parasites or bowel inflammation.

    Have you tried to adjust the diet? Avoiding sugars and eating some high-fiber food and drinking enough water and regular physical activity, like walking, can help.

    Diverticulosis should be seen during lower GI. Diverticulitis is usually present with diarrhea and fever.

    The spasming part of the colon may be due to injury of nerves during histerectomy or later complications.

  • deb308

    Hi, I have been reading through all the posts on here trying to figure out what the heck is going on! I have been having fevers (99.2-100.5) for the past six months but for a year been having major upper tummy pain. I have spams happening, I have major constipation and several trips to the hospital to get the spasms to stop. I was on buscapan for eight months to help get them to stop and got switched to dicetel and it manages it but there is a constant pain in my stomach, above my belly button and off to the right hand side. I get fever aches because of the constant fever and have dropped 60lbs (which I needed to lose anyway) from what ever it is I am suffering with. I have had a scope and all it showed was my IBS (which I have had since the age of 9) and hermoroides which they left even though they told me they would take them out but agreed they are big the guy who did the scope said he does not do that. I have had a catscan and it did show another cyst on my left ovary (no biggie I get them a lot) it also showed three diverculiti on my bowel but from everything I have read up on it they are suppose to be on the left side and my pain is not there. I have the constipation and take doctor perscribed meds for that, I watch my diet, am bed ridden because of weakness, and dizzyness. Have had the fever as a constant for six months and am getting very upset with no answers coming. I have been set up to see a gastro doc but am not sure there is much he can do. I suffer from stomach acid and have even lost my voice because of the acid in the past so if I do not take my medication for it I lose it. I had brain surgery four years ago and have many issues and take meds to help with those problems and now with this new thing I am beyond upset. Life seems useless. Its full of pain, weakness, dizzyness, muscle aches, bleeding from my bowel, constant bathroom issues (bounces from stool so large it rips its way out to so runny and desperate need to go)stress from watching the world around me fall apart because I am unalbe to even care for myself. Does anyone have any suggestions??? I can’t do this much longer!

  • Jan Modric


    how old are you? How did you lose weight – from not eating or from diarrhea?

    First, fever may be a symptom of inflammation or infection (anywhere in the body – tuberculosis, viral pneumonia, etc). It may also appear in hyperthyroidism, lymphoma and some cancers. Most of mentioned conditions would be reflected in the blood – did you have any blood test lately, if so, what were results?

    Diverticula in the sigmoid colon (?) can cause constipation, and resulting straining may cause hemorrhoids. Hemorrhoids can be treated by a simple outpatient procedure…Drugs, especially painkillers may also cause constipation.

  • deb308

    I am 41 an yes my blood work is up to date had then three weeks ago, few things were off but nothing major. Saw a gastro guy and he said yes I have what I thought but its not what is making me ill, he thinks its either in my stomach, gallblader or pancreas so he is sending me in for a scope down my throat and will not stop until he cannot get it down anymore, he is strongly suspecting its more then likey a combo of things hiting all at once making my life so miserable… thanks for the reply though, it was very kind of you to do this for me!!!!!

  • Tyler23456345

    I was 15 when i was diagnosed with diverticulitus. It is extremelly rare at my age to contract this disease but i was lucky enough to.
    It was so bad that my intestines wall continued to stretch until it ripped. It was the worst feeling ever. I could not even walk in my house. I finally got a call saying they had thought my appendix exploded.
    The ER took me for emergency surgery to find out that it was not my appendix at all.. it was diverticulitus. They said it was probably due to a defect . I’m pretty sure oi’m one of the youngest people to have this disease..

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    Please help me in what foods i should eat, and not eat. I eat lots of Fiberous foods. And i am never Constipated. Thank you very much…Baubsie

    • Jan Modric


      if you have no problems woth bowel movements, you can eat pretty much all you find appropriate. High fiber food can be ok, if it does not result in excessive gas.

  • roja karthik

    dear sir ,
    i was attacked by hepatitis a 5 months before and i took some home made medicines as aresult it shoot up and i became serious ,after that i was admitted in ahospital for treatment and took steroids treatment for a month after medicines are over i started to have left abdominal pain which continues till date. i conducted endoscopy two times first it was recogonised as gasteritis , dueodinistris, easophagitis , and took treatment for 45 days still not cured i went to another gastro dr and done endoscopy this time lax less with a small hiatus hernia has been determined. kindly guide me. i am unable to stand and work for more than two hours pain will come.

    • Jan Modric

      roja karthik,

      treatment you need now depends on what diagnosis you have now, and on the effect of your treatment so far. Hiatal hernia may cause reflux of the stomach acid up into the esophagus and cause its inflammation, so maybe acid reducing medications would be needed. So, the doctor should tell you what to eat and drink, and which medications to take, and if surgical repair of the hiatus hernia would be needed. Maybe you also need a blood test to check for anemia, glucose and vitamin and mineral levels, to find out if there is any deficiency that causes your symptoms.

  • stengo

    How can one who has a regular bowel movement i.e. 3/day and has never suffered from constipation get diverticulitis

    • Jan Modric


      it is an inherited weakness of the intestinal wall that makes one prone to get diverticulosis. If it’s a very weak intestinal wall, diverticles will be created easily without much straining.

  • Sherry Maldonado

    what could be a problem for someone who has constant diarrhea

    • Hi Sherry. Diarrhea is a symptom and there are a number of possible causes of constant diarrhea. There is no single answer for every case. It could be a persistent infection, bacterial overgrowth, disturbances of the normal intestinal flora (aka “good bowel bacteria”), inflammatory bowel disease (IBS), diarrhea-predominant IBS, malabsorption or intolerance syndromes and son on.

      You may find this article to be helpful – https://www.healthhype.com/causes-of-chronic-prolonged-persistent-constant-diarrhea.html . However, at the end of the day the person will need to see a doctor and undergo tests to identify the exact cause. Diarrhea on its own is difficult to diagnosis without considering other symptoms, factoring in the results of different tests and looking at the patient’s medical history.

  • maxime1793

    This might be my problem. I’ve had a big problem with vegetable/tomato peels for a few years now. Often feel bloated with gas and constipation leading to straining. Mucus and/or colourless and odourless stickiness often follows stools. When I am unlucky, stool itself is very sticky and gross, but that is not fully constant. At the same time, no diarrhea and abdominal pain is rare (with the exception of when I tried a granola cereal recently and had huge pains for about 30 mins which appeared to be gastrointestinal).

    In the case I get a response, I suppose this is my issue – I don’t live in the States now and don’t have immediate access to good doctors. The dietary suggestions are a bit problematic since many problems with similar symptoms demand a HIGH-fibre diet while this issue may demand a LOW-fibre diet. Some issues with these symptoms suggest antibiotics, others probiotics. The things I do which might exacerbate issues => diet probably too high in diuretics compared to water intake, a lot of spicy foods, tomatoes/beans/vegetables with peel, due to work and weather (very rainy locale) – not real physically active. Obviously, I am responsible for water intake and exercise levels but I am not able to improve the local health care situation. The symptoms here are familiar except for the talk about pain and sudden “attacks”. Rather, it seems my issue is chronic over the last four years – some days with no symptoms and some days quite bad (though pain is rare).

    What else could I do dietary-wise on my own to test if this is the problem (a low-fibre diet for a couple weeks?) and how can I heal my gut and calm the symptoms considering I am not getting any prescriptions or intricate screenings any time soon?