Diverticular disease involves the formation of small, bulging pouches, known as diverticula, within the wall of the digestive tract, most commonly in the large intestine. When these pouches become inflamed or infected, the condition is termed diverticulitis, representing a “flare-up” of the disease.
Understanding Diverticular Flare-Ups
Diverticulosis, the presence of diverticula in the colon wall, often remains without symptoms. These pouches are common, especially after age 50, and are usually found in the lower part of the colon. Pressure within the colon, from spasms or straining, can cause these pouches to form where the colon wall is weak. While diverticulosis itself is not a disease, it can progress to diverticulitis when one or more of these pouches become inflamed or infected.
Diverticulitis occurs when a diverticulum tears, which can then become infected by bacteria naturally present in the colon. This inflammation can lead to symptoms such as severe abdominal pain, fever, nausea, and changes in bowel habits like constipation or diarrhea. Approximately 5% to 25% of individuals with diverticulosis may develop diverticulitis.
Dietary Contributions to Flare-Ups
Diet plays a significant role in the development and management of diverticular flare-ups. A diet low in fiber is commonly associated with an increased risk of diverticulosis and subsequent diverticulitis. Fiber helps to keep stool soft and bulky, facilitating its movement through the colon and reducing pressure on the colon walls. When fiber intake is insufficient, stools can become hard and difficult to pass, potentially contributing to the formation of diverticula and increasing the risk of inflammation.
High consumption of red meat, particularly processed red meat, has also been linked to an increased risk of diverticulitis. Processed foods, often lacking in essential dietary fiber and high in refined sugars and saturated fats, can contribute to changes in gut microbiota and inflammation, further exacerbating the risk.
Contrary to long-held beliefs, current research does not support avoiding nuts, seeds, or popcorn to prevent diverticulitis flare-ups. While older theories suggested these particles could become lodged and cause inflammation, studies have found no increased risk with their consumption, and some research even suggests a lower risk for those who regularly eat nuts.
Lifestyle and Medication Influences
Beyond dietary factors, several lifestyle choices can influence the risk of diverticular flare-ups. Obesity is a recognized risk factor for diverticulitis, with higher body mass index (BMI) and waist circumference correlating with increased risk. Physical inactivity also contributes; regular exercise is associated with a decreased risk of diverticulitis. Smoking is another factor that raises the risk of diverticulitis, and it may lead to the condition occurring at younger ages in smokers compared to non-smokers.
Certain medications can also increase the likelihood or severity of diverticular flare-ups. Nonsteroidal anti-inflammatory drugs (NSAIDs) are linked to an increased risk of diverticulitis and its complications. Regular use of NSAIDs may also worsen symptoms. Opioid pain medications are associated with an increased risk of diverticulitis and complications, partly due to causing severe constipation. Corticosteroids are also associated with an increased chance of developing diverticulitis and perforations.
Underlying Biological Factors
Internal biological mechanisms also contribute to susceptibility to diverticular flare-ups. The gut microbiome, the community of bacteria residing in the colon, is increasingly understood to influence diverticular disease. Alterations in the balance of gut bacteria, known as dysbiosis, may be associated with the development of diverticulitis. Changes observed in the gut microbiota of patients with acute diverticulitis include an increase in bacteria with inflammatory actions and a decrease in those with anti-inflammatory properties.
This imbalance in the gut microbiome can contribute to a state of chronic low-grade inflammation within the colon. This persistent inflammation can make the colon more vulnerable to diverticulitis. The interplay between an altered microbiome and mucosal inflammation contributes to symptom development and disease progression.