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Dietary advice for diverticular disease

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What is diverticular disease?

Diverticular disease is a condition where pouches called diverticula form in the colon. If these pouches or diverticula become infected or inflamed then it is known as diverticulitis. It is a relatively common condition in the developed world affecting around 30% to 50% of people during their lifetime.

What are the causes?

The exact cause of diverticular disease is not known, however, it is thought that a low fibre diet may be a major factor in developing the condition. Diets low in fibre can cause constipation which in turn can cause straining and an increased risk of diverticula forming. Constipation also increases the risk of diverticula becoming infected.

What are the symptoms?

Your symptoms will depend on the severity of the condition. If you have diverticular disease you may not have any symptoms or you may have some of the following:

  • Lower abdominal pain
  • Bloating
  • Changes in bowel habit, such as constipation followed by diarrhoea
  • Blood in stool

If you have a flare up of diverticulitis, where the diverticula have become inflamed or infected, the symptoms are similar to above, but you may also experience:

  • Fever
  • Constant cramping/pain
  • Nausea and vomiting

How is diverticular disease diagnosed?

A general assessment is initially carried out including taking a medical history, blood tests and a stool sample. Tests for diagnosing diverticular disease include a colonoscopy, where a tube with a camera at the end is inserted in to the colon via the rectum; or performing a CT scan of your colon.

How is diverticular disease treated?

If you have been diagnosed with diverticular disease then a high fibre diet is recommended. Further treatment depends on the severity of the disease. If your symptoms become worse or if you have diverticulitis, medical treatment may include antibiotics or pain killers. If you have more severe diverticulitis you may need to be admitted to hospital for medical treatment and to be kept hydrated. If serious complications arise from severe or recurring diverticulitis then surgery may be required. If you have a flare up of diverticulitis and continue to have symptoms, then during this time a low fibre diet may be recommended until the diverticulitis is treated and your symptoms improve.

Dietary treatment of diverticular disease with a high fibre diet:

The following table gives some examples of high fibre foods to include in your diet when not experiencing a flare up. If your diet is currently low in fibre then it is advisable to increase fibre gradually; aim to introduce 1-2 new high fibre foods per week. It is recommended that adults aim for 30g of fibre a day.

Foods High in Fibre:

  • Weetabix®, Bran flakes, All Bran, Fruit & Fibre, porridge, muesli, Shredded Wheat.
  • Brown, wholemeal, wholegrain, granary, multigrain, seeded breads and rolls.
  • Oatcakes, wholegrain rice cakes, Ryvita®, crisp breads, wholegrain crackers, digestive biscuits, popcorn, Hob Nobs, flapjacks, fruit cake, malt loaf.
  • Jacket potato with skin, new potatoes with skin, whole-wheat pasta, brown rice
  • All fruit with skins including, avocado, apples and pears with skin, oranges, and raspberries. Dried fruit including, dates, apricots, prunes.
  • All vegetables with skins left on including, peas, green beans, sprouts, carrots, sweetcorn. Baked beans, kidney beans, lentils.
  • Nuts including almonds, plain peanuts, mixed nuts, brazil nuts.

Some people feel that certain high fibre foods such as multigrain breads, nuts, seeds and foods containing pips e.g. tomatoes, increase the risk of developing diverticulitis and therefore choose to avoid them. However, there is little evidence to support this.

Tips for adding fibre into your diet:

Swap your bread and cereals for the high fibre versions as detailed in the table above. Aim to have at least 5 portions of fruit & vegetables per day. Choose high fibre snacks e.g. piece of fruit, oatcakes, dried fruit and nuts. Add fresh or dried fruit to your high fibre cereal for breakfast. Always include vegetables or a salad with your lunch and evening meal.

Add extra vegetables such as spinach, mushrooms, peppers, broccoli, leak, carrots to meals like stews, pasta sauces, casseroles and stir fries. Add grated carrot, red kidney beans or red lentils to meals made with mincemeat e.g. bolognaise sauce, chilli con carne or shepherd’s pie. Add extra salad or coleslaw to sandwiches. Add lentils or chickpeas to meat or vegetable curries. Use sliced raw vegetables such as carrots or peppers with dips like hummus or guacamole. Add nuts or chia seeds to breakfast cereals.

What else can help?

Fluids:

It is important to drink adequate fluids during the day to remain hydrated and to help prevent constipation. This is particularly important if you are increasing your fibre intake. It is recommended to have at least 6-8 glasses or cups of fluid per day, but you may need to increase this to 8-10 glasses or cups if you are suffering with constipation. Suitable drinks include water, sugar free squash, tea, fruit tea, coffee, and milk. Fruit juice or smoothies should be kept to 1 small glass per day.

Exercise:

Being as active as possible with regular light exercise can help prevent constipation.

Laxative Medication:

If you are unable to take enough fibre in your diet you may be advised to take laxative medication. This is usually a bulk forming laxative such as Fybogel®, Ispagel Orange®, Celevac®, Normacol®. These can cause symptoms of flatulence and bloating. It is recommended to take plenty of fluids with your laxative medication. Further information: www.corecharity.org.uk