Diverticulitis

During acute diverticulitis: clear liquid diet initially (broth, juice, Jello, tea—allows colon to rest), advance to low-fiber diet as symptoms improve (white rice, white bread, cooked vegetables without skins, chicken, fish), avoid high-fiber until inflammation resolves (paradoxically worsens acute inflammation), After resolution and for prevention (most important): HIGH-FIBER DIET 25-35g/day (prevents diverticulosis progression, reduces diverticulitis risk—contrary to old advice avoiding seeds/nuts, recent studies show high-fiber including seeds/nuts is protective), increase fiber gradually (sudden increase causes bloating, gas), soluble and insoluble fiber (oats, beans, lentils, vegetables, fruits, whole grains), nuts and seeds OK (old advice to avoid was myth—no evidence they cause diverticulitis, actually protective due to fiber and nutrients), adequate hydration (8-10 cups/day—fiber needs water to work), probiotic foods (yogurt, kefir, sauerkraut, kimchi—restore microbiome), omega-3 foods (fatty fish—anti-inflammatory), Avoid: red meat (increases diverticulitis risk—eat sparingly, <4 servings/week), processed foods (low fiber, inflammatory), excessive alcohol (irritates colon, increases risk), Prevent constipation: adequate fiber, hydration, magnesium, exercise, avoid straining.

Fiber intake MOST IMPORTANT for prevention: 25-35g/day (reduces diverticulitis risk 40-50%—most Americans get only 10-15g/day), increase gradually (sudden increase causes bloating), combine soluble and insoluble fiber, fiber supplements if diet inadequate (psyllium, acacia fiber), Adequate hydration: 8-10 cups/day (fiber needs water—dehydration worsens constipation, increases colon pressure), Exercise regularly: 30-60 min most days (stimulates colon motility, reduces constipation, reduces diverticulitis risk 25-50%), maintain healthy weight (obesity increases diverticulitis risk), Avoid smoking (increases diverticulitis risk and complications), Limit NSAIDs and aspirin (increase perforation risk—use acetaminophen for pain if possible, discuss with doctor), Avoid straining with bowel movements (increases colon pressure—causes more diverticula, use squatting position—Squatty Potty), Probiotics: daily supplementation or probiotic foods (restore microbiome—reduces inflammation, diverticulitis risk), Manage IBS symptoms (common with diverticular disease—low-FODMAP diet temporarily if bloating, gas), Acute diverticulitis treatment: Uncomplicated (no abscess/perforation): antibiotics (ciprofloxacin + metronidazole or amoxicillin-clavulanate 7-10 days—outpatient), liquid diet 2-3 days then low-fiber until symptoms resolve, pain management (acetaminophen preferred—avoid NSAIDs), rest, Complicated (abscess, perforation, fistula): hospitalization, IV antibiotics, bowel rest (NPO or clear liquids), CT-guided abscess drainage if >3-4cm, surgery if perforation, fistula, or recurrent attacks, Surgery indications: recurrent attacks (previously 2 attacks, now individualized—depends on severity, age, complications), abscess not amenable to drainage, perforation, fistula, obstruction, inability to rule out cancer, elective surgery (sigmoid colectomy—removes diseased segment, reconnects colon, laparoscopic preferred, 5-10% complication rate, most live well post-surgery), Prevent recurrence after acute attack: high-fiber diet (most important—25-35g/day), probiotics, weight loss, exercise, avoid NSAIDs, rifaximin antibiotic cycles (off-label use—reduces recurrence in some studies, 2 weeks on/month for 12 months), mesalamine (5-ASA anti-inflammatory—some evidence reduces recurrence, off-label use).