How can diverticular disease be prevented?
The general consensus is that a high-fibre diet helps to reduce the risk of developing diverticular disease and can ease symptoms. Fibre helps to soften the stool and allow for easy passage with less straining. A diet low in fibre leads to a reduction in stool bulk and less water retention in the stool. This causes increased intracolonic pressures and difficulty with bowel evacuation.
Your medication may need to be reviewed. Long-term opiate use such as codeine can be constipating and may aggravate symptoms. Patients are encouraged to ensure an adequate fluid intake to prevent constipation. Increased physical activity is felt to be beneficial but the reasons for this are not fully understood.
High-fibre or no fibre diet?
A high-fibre diet is advised for prevention of diverticular disease. However, during a flare-up of diverticular disease the aim is to rest the bowel, so a liquid or low-fibre diet is normally suggested. A liquid diet is not very nutritious and so should be followed only for a few days. If you have developed a serious complication of diverticular disease then complete bowel rest, that is nothing by mouth, may be advised by your doctor. During this time you will be given fluids via a drip into the vein to ensure that you remain hydrated. Once the bowel has settled down, a high-fibre diet can slowly be introduced.
What is in a high-fibre diet?
The recommended fibre intake is 20 to 35 grams a day. It is important to remember that a sudden increase of fibre in the diet will cause symptoms of bloating, flatulence and abdominal cramps, especially if you are not used to a high-fibre diet. The key is to introduce high fibre-containing foods slowly over a period of several weeks to allow your body to adjust. At the same time drink plenty of water to prevent constipation (two litres a day).
The following is a list of foods that contain plenty of fibre:
- Fresh fruit and vegetables. Examples of fruit that have plenty of fibre include apricots, berries, bananas, pears and apples with skins, dried prunes and dates. Examples of vegetables include spinach, brussels sprouts, broccoli and carrots
- Reduce the amount of refined foods (that is, white flour) and introduce whole-grain products into your diet such as wholemeal pasta, muesli, bran flakes, porridge and brown bread.
- Reduce the amount of saturated fat and red meat in your diet. Instead replace with foods such as lentils, beans and green beans, which are high in protein.
- Fibre supplements including rice bran or psyllium seed husks (ispaghula) can be added to the diet.
- Metamucil (psyllium) and Citrucel (methylcellulose) are bulk-forming laxatives with a fibre supplement that can be added to a high-fibre diet.
- Some patients find that spicy foods upset their bowel and cause diarrhoea; you may therefore wish to avoid spicy foods.
- Some patients will have been asked to avoid foods such as nuts, seeds or popcorn that may get ‘stuck’ in the diverticula and increase the risk of inflammation, but there is no evidence for this.
- There is no strong evidence for a relationship between smoking, alcohol or caffeine intake and diverticular disease risk.
