Diverticular Disease / Diverticulitis

Diverticulosis is the condition of having diverticulae in the colon, which are out-pouching’s of the colonic mucosa and submucosa due to weakness of muscle layers in the colon wall. Basically, raised pockets of your bowel wall that are weak and inflamed.

These are more common in the sigmoid colon, which is a common place for increased pressure. Uncommon before the age of 40; incidence increases with age and very common in the elderly.

Diverticulitis is acute inflammation of diverticulae, caused by infection. Occurs in 10-25% of people with diverticulosis. May cause serious complications such as bleeding, perforations, peritonitis and abscess formation.

Risk factors

• Poor gut function / long term bacterial overgrowth / long term gut infections
• Increasing age
• Low-fibre, refined diet
• Constipation
• High intake of inflammatory foods
• Obesity
• Genetic predisposition
• Sedentary lifestyle

Differential diagnosis

• IBS
• IBD
• Colorectal cancer
• Appendicitis

Signs & symptoms of Diverticulitis

• diverticulosis is generally asymptomatic. Symptoms usually arise when the diverticulae become inflamed:
• Painful cramps and tenderness in affected area (often left lower abdomen). Pain may be dull and constant, and/or sharp and intermittent
• Bloating
• Changes in bowel movements: diarrhea or constipation; often have small pellet-like stools which relieve pain

Investigations

• Advanced Stool Testing including markers for calprotectin & Secretory IgA
• Colonoscopy
• Abdominal x-ray / barium enema /CT scan / MRI

TREATMENT STRATEGY FOR DIVERTICULITIS

• Reduce gut inflammation and pain / rebalance gut microflora
• Support bowel function / prevent constipation
• Reduce intracolonic pressure
• Repair intestinal lining
• Support immunity / prevent infection

Diet plan guidelines for Diverticulitis

• Increase fibre intake gradually: to at least 25 g/day for women and 30 g /day for men. High fibre diets facilitate passage of stools and reduce intracolonic pressure
• Increased intake of fruit and vegetables, wholegrains, legumes
• 1 tsp psyllium, ground flaxseed or ground chia added to water daily, gradually building up to 1 tsp twice daily for women and 1 tsp three times daily for men
• NB Dietary fibre supplements may interfere with absorption of medication
• Increase fluid intake to 2L+ water/day: especially as fibre intake is increased
• Decrease intake of commercially raised red meat, refined grains, processed foods
• Decrease intake of gluten and dairy (except natural yoghurt) to prevent inflammation in gut
• Reduce saturated fat intake: appears to reduce smooth muscle contraction in patients with diverticulitis
• Avoid whole seeds, nuts, popcorn: may become trapped in diverticulae
• Coconut oil (2 Tbsp/day): anti-inflammatory, antimicrobial, immune support, repairs gut
• Chamomile tea: 1-3 cups per day to reduce inflammation and microbial activity

Supplements that support Diverticulitis

• Slippery elm: Helps soothe and repair intestinal wall
• Glutamine: repair gut wall
• Magnesium: if associated with cramping/spasm
• Omega-3 EFA’s: to reduce inflammation
• Probiotics

Herbal medicine treatment for Diverticulitis

• Demulcents/vulneraries: slippery elm, licorice, marshmallow, aloe
• Antispasmodics: cramp bark, wild yam, chamomile
• Digestive stimulants: gentian, ginger, agrimony
• Gallbladder stimulants: dandelion, yellow dock, barberry, St Mary’s thistle
• Antimicrobials: chamomile, goldenseal, echinacea, baptisia, barberry, olive leaf

FUNCTIONAL MEDICINE TREATMENT OF DIVERTICULITIS

The above considerations may assist in the relief and management of diverticular disease.  A comprehensive investigation into gut function, digestion markers, underlying bacterial or parasitic infections, food intolerances, gall bladder efficiency, methylation and immune system function are required to effectively manage the condition.

We have extensive experience with diverticular disease at our Perth clinic of Advanced Functional Medicine.  Many patients are unaware of the factors driving the disease prior to becoming a patient at our clinic.

If you or a family member are require assistance with diverticular disease or other digestive disorder we would love to hear from you.  What methods to you use during  flare up?  Have you had functional testing and what were the outcomes?  Please write a comment below.

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