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Diverticulitis & Diverticulosis

Small pouches in the wall of the colon are very common with age and usually cause no trouble. When one becomes inflamed (diverticulitis) it can cause sudden belly pain and fever. Many mild attacks are treated at home — some without antibiotics — and a high-fiber, active lifestyle may lower the chance of another. Nuts, seeds and popcorn are fine.

Call 911 or go to the nearest emergency room if you have:

Contact your clinician promptly if you have, or may have, diverticulitis and you have:

If you can’t reach your clinician quickly, go to urgent care or the emergency room.

Diverticulosis, diverticulitis and diverticular disease

  • Diverticulosis means having small pouches, or sacs, that push outward through weak spots in the wall of the colon (large intestine), mostly in its lower part, the sigmoid colon. One pouch is a diverticulum; several are diverticula. Most people who have them have no symptoms or problems (NIDDK).
  • Diverticulitis is when one or more pouches become inflamed. It can come on suddenly and may lead to serious complications (NIDDK, MedlinePlus).
  • Diverticular disease is the name used when the pouches cause long-lasting symptoms, bleeding, or diverticulitis and its complications (NIDDK).

Once pouches have formed, you have them for life (MedlinePlus).

How common is it?

Very common, especially with age: more than 30% of U.S. adults aged 50 to 59, and more than 70% of those over 80, have diverticulosis. Most will never have symptoms or problems, and fewer than 5% of people with diverticulosis develop diverticulitis (NIDDK). Even so, about 200,000 people in the U.S. are hospitalized for diverticulitis each year, and about 71,000 for diverticular bleeding (NIDDK). Diverticulitis is most common in older adults, but the biggest recent rise has been in younger adults (AGA, 2021). Under age 50 it is more common in men; from 50 on, in women (NIDDK).

What causes it, and who is at risk?

Doctors aren’t sure what causes diverticular disease (NIDDK). Factors that may raise the risk of diverticulitis or its complications include (NIDDK, AGA, 2021):

  • a diet low in fiber and high in red meat;
  • not being physically active;
  • obesity, especially around the waist, and weight gain;
  • smoking;
  • regular use of NSAID pain relievers (such as ibuprofen and naproxen), steroids and opioid pain medicines;
  • genes — twin and sibling studies suggest about 40% to 50% of the risk is inherited (AGA, 2021). In other words, diverticulitis is not simply the result of something you did wrong.

Symptoms

  • Diverticulosis usually causes no symptoms. Some people have long-lasting bloating, constipation or diarrhea, or cramping or pain in the lower belly — but irritable bowel syndrome and other conditions cause similar symptoms, so see your doctor rather than assume (NIDDK). See our Bowel Problems guide for constipation and other changes in bowel habits.
  • Diverticulitis typically causes belly pain, most often in the lower left side, which is usually severe and sudden but can be mild and worsen over several days; along with fever and chills, nausea or vomiting, and constipation or diarrhea (NIDDK). Bloating and loss of appetite are common too (MedlinePlus).
  • Many people first find out they have diverticula when a complication, such as bleeding or diverticulitis, happens (NIDDK).

Complications

Most diverticulitis is “uncomplicated”: only about 12% of people have complicated disease when they are first seen (AGA, 2021). Complications include (NIDDK, MedlinePlus):

  • Abscess — a painful, swollen pocket of pus.
  • Perforation — a hole in the colon — and peritonitis, an infection of the lining of the belly.
  • Fistula — an abnormal tunnel between the colon and another part of the body, such as the bladder or vagina.
  • Blockage of the intestine, or a narrowed area (stricture).
  • Diverticular bleeding, when a small blood vessel in the wall of a pouch bursts. It is a common cause of bleeding from the lower digestive tract and can be severe (NIDDK).

Encouragingly, complications are most likely with a first attack; the risk of a complicated episode goes down, not up, with later attacks (fistula is the exception) (AGA, 2021).

How is it diagnosed?

Your doctor will ask about your symptoms, bowel habits, diet and medicines, examine your belly, and may order blood and stool tests (NIDDK). Symptoms alone can be misleading — in studies, a doctor’s suspicion of diverticulitis without imaging was right in only 40% to 65% of patients — so the American Gastroenterological Association (AGA) advises considering a CT scan of the belly and pelvis to confirm a first diagnosis and to check for complications in severe cases (AGA, 2021). Ultrasound or MRI are sometimes used instead (NIDDK, AGA, 2021). Diverticulosis is sometimes found by chance during a colonoscopy or x-ray done for another reason (NIDDK).

Outlook

Most often diverticulitis is a mild condition that responds well to treatment, and many cases can be treated at home (MedlinePlus). It can come back: about 8% of people have another attack within a year and about 20% within 10 years, and the chance rises after each attack (AGA, 2021). See After an attack below for colonoscopy, repeat attacks and lingering symptoms.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Rest and a short clear-liquid diet, then low-fiber foods during the flare-up; pain relief with acetaminophen or antispasmodics rather than NSAIDs; antibiotics only when needed (many mild, uncomplicated cases in people with a healthy immune system don’t need them); hospital care, drainage or surgery for complications; colonoscopy afterwards when advised. CT of the belly and pelvis: one published self-pay example is $460, but CT prices range from about $300 to $6,750. Colonoscopy without insurance about $1,250–$4,800. Medicare Part B: 20% of the approved amount for CT after the deductible. Hospital and surgery costs: cost estimate being researched. Most attacks are mild and settle with treatment, often at home. About 1 in 5 people have another attack within 10 years. Surgery reduces, but doesn’t eliminate, repeat attacks.
Chiropractic No role in treating diverticulitis or diverticulosis. Not a treatment for diverticular disease, so no cost is listed. Avoid hands-on treatment of a painful belly, and never let it delay medical care for sudden belly pain or fever.
Acupuncture Being researched — coming soon.
Herbal medicine Fiber supplements such as psyllium may lower the risk of diverticulitis, but don’t replace a high-fiber diet. Probiotics: not recommended to prevent repeat attacks — the evidence is insufficient. No herb treats an attack. Cost estimate being researched. Fiber supplements can cause bloating and interact with some medicines. Probiotics carry more risk for people who are seriously ill or have a weakened immune system.
Massage therapy Not a treatment for diverticulitis. Don’t have your belly massaged during an attack or while it is painful or tender. Not a treatment for diverticular disease, so no cost is listed. Massage won’t clear inflammation or infection, and shouldn’t be used to put off seeing a clinician.
MBHA Wellness Coach Build a high-fiber eating pattern step by step (fruits, vegetables, whole grains, beans), with plenty of liquids and less red meat; enjoy nuts, seeds and popcorn; stay active; work toward a healthy weight; quit smoking; and review regular NSAID use with your clinician. Cost estimate being researched. These habits are linked with a lower risk of diverticulitis and of it coming back, though genes also play a large part. They work alongside medical care, never instead of it during an attack.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on whether you have long-lasting symptoms from diverticula, an attack of diverticulitis, or a complication (NIDDK). If you think you have diverticulitis, contact your clinician (MedlinePlus).

1. Home or hospital?

People with uncomplicated diverticulitis can often be treated at home. A hospital stay is usually needed for severe diverticulitis, diverticulitis with complications, or a high risk of complications (NIDDK, MedlinePlus). In the hospital, people may have a CT scan, fluids and antibiotics through a vein (IV), and a special diet to rest the colon (MedlinePlus). People with a weakened immune system — for example from steroids, chemotherapy or transplant medicines — are more likely to have a severe or complicated attack, sometimes with milder warning signs, so doctors have a lower threshold for scans, antibiotics and a surgeon’s opinion (AGA, 2021).

2. Resting the colon: liquids first, then food

3. Antibiotics: only when they’re needed

  • Not everyone with diverticulitis needs antibiotics (NIDDK, MedlinePlus). The AGA’s 2021 expert review says antibiotics can be used selectively rather than routinely in people with a healthy immune system who have mild, uncomplicated diverticulitis. In a review of 9 studies with 2,505 such patients, those treated without antibiotics did just as well on recovery time, readmission, complications and need for surgery (AGA, 2021).
  • The same review advises antibiotics for people who are immunocompromised, frail or have other serious health problems; who have symptoms that aren’t settling or are vomiting; who have certain markers of severe inflammation on blood tests; or who have complicated diverticulitis, a fluid collection or a long inflamed section on CT (AGA, 2021).
  • Whether you need antibiotics is your clinician’s decision. If they are prescribed, take them as directed and finish the whole prescription (MedlinePlus). We don’t list medicines or doses here.

4. Pain relief

Doctors may recommend antispasmodic medicines or acetaminophen instead of NSAIDs such as ibuprofen, because NSAIDs may increase the chance of complications (NIDDK). Rest and a heating pad on your belly can help; ask your provider which pain medicines to use (MedlinePlus).

5. Treating complications

  • Abscess: small ones may be treated with antibiotics; large ones, or those that don’t improve, are drained; surgery may be recommended after a large abscess heals, to stop it coming back (NIDDK).
  • Fistula, blockage, perforation or peritonitis: usually treated with surgery (NIDDK).
  • Bleeding: it sometimes stops on its own. Otherwise doctors find and stop it during a colonoscopy, with an angiogram (an x-ray of the blood vessels using dye), or with surgery, and may give a blood transfusion (NIDDK).
  • If diverticulitis doesn’t improve with treatment, surgery to remove part of the colon (colectomy or colon resection) may be needed (NIDDK).

6. Planned surgery to prevent repeat attacks: a personal decision

After diverticulitis, some people are offered a planned (elective) operation to remove the affected part of the colon. Whether it’s recommended depends on your history, health and other factors (NIDDK). The AGA advises that surgery should not be recommended just because of the number of attacks; instead, the decision should weigh how severe your disease has been, your health and immune status, your preferences and values, and the risks and benefits, including quality of life (AGA, 2021).

  • Surgery reduces but does not eliminate repeat attacks: in one study cited by the AGA, 15% of people who had surgery had another attack within 5 years, compared with 61% of those who didn’t (AGA, 2021).
  • Ongoing belly pain doesn’t always improve: in two studies, 22% to 25% still had pain after surgery (AGA, 2021).
  • People on long-term immune-suppressing treatment should talk with a colorectal surgeon after recovering from an attack (AGA, 2021).

7. Medicines that don’t prevent repeat attacks

The AGA advises against mesalamine (5-aminosalicylic acid), probiotics or rifaximin to prevent diverticulitis from coming back: a review of seven trials found no benefit from mesalamine, and the evidence for probiotics and rifaximin is insufficient (AGA, 2021).

Who to see

A primary care provider or urgent care clinic for a suspected attack, and the emergency room for the warning signs at the top of this page. A gastroenterologist can help with colonoscopy, repeat attacks or lingering symptoms, and a colorectal surgeon with complications or decisions about surgery.

What it costs

  • CT scan: prices vary widely. A cost guide reports CT scans without insurance ranging from about $300 to $6,750, depending on the body area, contrast and setting; one provider’s published self-pay schedule lists a CT of the abdomen and pelvis with contrast at $460. Emergency and hospital-based scans can cost much more (The Pricer).
  • Medicare: Part B covers diagnostic tests such as CT scans when your provider orders them; after the Part B deductible you pay 20% of the Medicare-approved amount, and a hospital outpatient copayment may be higher (Medicare.gov).
  • Colonoscopy: without insurance about $1,250–$4,800 (The Pricer). A colonoscopy done to look into symptoms is billed as diagnostic, not preventive screening, so $0 screening rules may not apply (The Pricer). Ask your plan ahead of time how a colonoscopy after diverticulitis will be billed. Medicare’s rules for screening colonoscopy are on the Medicare.gov colonoscopy page (Medicare.gov) and in our screening section.
  • Hospital stays and surgery: cost estimate being researched.

How well it works — what to expect

Most often this is a mild condition that responds well to treatment (MedlinePlus), and pain and other symptoms should ease after a few days of treatment — contact your provider if they don’t, or if they get worse (MedlinePlus).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating diverticulitis or diverticulosis, and we found no research suggesting otherwise. Avoid adjustments or pressure on a painful, tender belly, and never let any treatment delay medical care for the warning signs at the top of this page.

Find a chiropractor in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement treats a diverticulitis attack. An attack can lead to serious complications (NIDDK), so get it checked rather than trying to treat it yourself. Don’t use probiotics or other supplements as a reason to put off seeing your health care provider (NCCIH).

Fiber supplements (such as psyllium)

  • MedlinePlus says fiber supplements such as psyllium may decrease your risk of diverticulitis (MedlinePlus), and NIDDK lists high-fiber foods or fiber supplements among the options doctors may suggest for long-lasting symptoms from diverticula (NIDDK).
  • The AGA stresses that a fiber supplement is not a replacement for a high-quality diet (AGA, 2021) — see Wellness coaching below.
  • During an attack, follow your clinician’s advice on liquids and low-fiber foods first (MedlinePlus); ask before starting or restarting a fiber supplement.
  • Safety: psyllium must be taken with a full glass of liquid. Don’t take digoxin, aspirin or nitrofurantoin within 3 hours of it; tell your doctor if you have ever had an intestinal blockage, difficulty swallowing or rectal bleeding; and avoid breathing in the powder, which can cause allergic reactions. Call your doctor right away for difficulty breathing or swallowing, stomach pain, rash, itching, nausea or vomiting (MedlinePlus). Follow the label or your clinician — we don’t list doses here. If you get bloating or gas from fiber, cut back for a few days (MedlinePlus).

Probiotics

  • The AGA says there is insufficient evidence to support any probiotic to prevent diverticulitis, and advises against using them for that purpose (AGA, 2021).
  • A 2016 review of 11 studies (764 participants) of probiotics for diverticular disease could not reach conclusions because the studies were of poor quality (NCCIH).
  • NIDDK notes doctors may sometimes suggest probiotics for long-lasting symptoms, and advises talking with your doctor before using probiotics or any complementary approach (NIDDK).
  • Safety: the risk of harm is greater for people with severe illness or a weakened immune system, and some products have been found to contain microbes not listed on the label (NCCIH).

Tell your clinician and pharmacist about every herb and supplement you take.

Approach 5 of 6

Massage therapy

Don’t have your belly massaged during a diverticulitis attack, or while it is painful, tender or swollen. Sudden or severe belly pain needs medical care, not massage — see the warning signs at the top of this page.

Massage doesn’t treat inflammation or infection in the colon, and we found no research on massage for diverticulitis. Don’t use massage therapy to put off seeing a health care provider about a medical problem (NCCIH). If you enjoy massage for general relaxation when you are well, tell your therapist about your diverticular disease and ask them to avoid deep pressure on your belly.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

There is no guaranteed way to prevent diverticulitis — genes play a large part (AGA, 2021) — but research links several everyday habits with a lower risk of a first attack and of it coming back (NIDDK, AGA, 2021). An MBHA Wellness Coach can help you build them one small step at a time, alongside your medical care. Talk with your doctor first about which changes make sense for you (NIDDK).

A high-fiber, high-quality eating pattern

  • A diet high in fiber and low in red meat may lower the risk of diverticulitis (NIDDK). The AGA describes a “prudent” pattern — high in fiber from fruits, vegetables, whole grains and legumes, and low in red meat and sweets — and a vegetarian diet as linked with lower risk (AGA, 2021).
  • How much fiber? NIDDK cites the Dietary Guidelines for Americans, 2020–2025: 14 grams of fiber for every 1,000 calories, or 28 grams a day on a 2,000-calorie diet (NIDDK). A doctor or dietitian can help you plan the right amount for you.
  • Fiber-rich examples from NIDDK’s list include raspberries, pears, apples with the skin, prunes, cooked peas, lentils, pinto, kidney and garbanzo beans, sweet potatoes, broccoli and collard greens, bulgur and high-fiber cereals (NIDDK).
  • Go slowly. Add fiber a little at a time so your body gets used to it (NIDDK); if you get bloating or gas, cut back for a few days (MedlinePlus). After an attack, wait until your clinician says you’re ready to bring fiber back up (MedlinePlus).

Nuts, seeds and popcorn are fine

Most people with diverticulosis or diverticular disease don’t need to avoid specific foods. Doctors used to advise against nuts, popcorn and seeds, but more recent research suggests they aren’t harmful (NIDDK, MedlinePlus). See Nuts, seeds and popcorn: the old advice below for the research.

Liquids and bowel habits

Drink water and other liquids to help fiber work better and keep stools soft; ask a health care professional how much is right for you (NIDDK). Avoid constipation, and don’t put off having a bowel movement — waiting makes stool firmer and harder to pass (MedlinePlus). See our Bowel Problems guide for more on constipation.

Move more

Regular physical activity is linked with a lower risk of diverticulitis (NIDDK), and vigorous activity in particular decreases risk (AGA, 2021). A coach can help you find activities you enjoy and build up gradually.

A healthy weight

Obesity — especially around the waist — and weight gain are risk factors (AGA, 2021), and reaching and keeping a healthy weight may lower the risk (NIDDK).

Quit smoking

Smoking is a risk factor for diverticulitis (NIDDK, AGA, 2021). Counseling and medicines together give the best chance of quitting for good, and free coaching is available through the quitline, 1-800-QUIT-NOW (CDC).

Review pain relievers with your clinician

Regular use of NSAIDs raises the risk of diverticulitis, and opioid pain medicines are linked with diverticulitis and perforation. People who have had diverticulitis are advised to avoid regular NSAID use (twice a week or more) — except aspirin prescribed to protect the heart (AGA, 2021). If you take NSAIDs such as ibuprofen or naproxen, ask your provider whether you can stop (MedlinePlus). Never stop a prescribed aspirin or other medicine on your own.

A coach is never a substitute for medical care. If you notice the warning signs at the top of this page, get help right away.

Another approach

After an attack: colonoscopy, repeat attacks and lingering symptoms

Colonoscopy afterwards

Occasionally a colon cancer is mistaken for diverticulitis. In a review of 31 studies cited by the AGA, colon cancer was found in about 1.9% of people with diverticulitis — 7.9% after complicated and 1.3% after uncomplicated diverticulitis (AGA, 2021). The AGA advises:

  • A colonoscopy after complicated diverticulitis and after a first episode of uncomplicated diverticulitis — though it may be put off if you had a high-quality colonoscopy within the past year and nothing was found that needs an earlier follow-up (AGA, 2021).
  • Waiting 6 to 8 weeks, or until symptoms have completely settled, whichever is longer — sooner if there are warning signs such as blood in the stool, a change in stool size, weight loss, iron-deficiency anemia or belly pain (AGA, 2021). MedlinePlus also notes colonoscopy may be recommended 6 to 8 weeks after diverticulitis clears up (MedlinePlus).
  • People with repeat, uncomplicated attacks can follow routine colorectal cancer screening unless warning signs appear (AGA, 2021). See the screening section of our Bowel Problems guide.

Will it come back?

About 8% of people have another attack within a year and about 20% within 10 years. The chance rises after each attack, and is higher after an abscess that was treated without surgery (AGA, 2021). Even so, a complicated attack is most often the first one, and in one study about three-quarters of people with complicated diverticulitis had no earlier attacks (AGA, 2021). The lifestyle steps under Wellness coaching may lower the risk of another attack.

Lingering symptoms

Ongoing belly symptoms are common after an attack: in one trial, about 45% of people reported pain on and off a year later. The AGA advises that ongoing inflammation and other conditions be ruled out with imaging and a colonoscopy; often the cause is a bowel that has become more sensitive to normal sensations, which can be managed (AGA, 2021). NIDDK notes that irritable bowel syndrome can cause similar symptoms (NIDDK).

Another approach

Nuts, seeds and popcorn: the old advice

For years, people with diverticular disease were told to avoid nuts, seeds, corn and popcorn to reduce the risk of complications. There was little evidence behind this (Strate et al., 2008), and the advice has been dropped:

  • NIDDK: most people with diverticulosis or diverticular disease don’t need to avoid specific foods; more recent research suggests nuts, popcorn and seeds are not harmful (NIDDK).
  • MedlinePlus: unlike old recommendations, you don’t need to avoid corn, nuts or seeds if you have diverticulosis or diverticulitis (MedlinePlus).
  • AGA: eating nuts, corn and popcorn is not linked with a higher risk of diverticulitis, and neither are fruits with small seeds, such as strawberries and blueberries (AGA, 2021).
  • The research: a study that followed 47,228 U.S. men for 18 years found that nuts, corn and popcorn did not increase the risk of diverticulosis or its complications. Men who ate popcorn at least twice a week actually had a lower risk of diverticulitis than those who rarely ate it, with a similar trend for nuts (Strate et al., 2008). It was an observational study of men only, so it shows a link rather than proof.

If a particular food seems to bother you, talk it over with your doctor or a dietitian (NIDDK).

Still being researched: Acupuncture. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Diverticulitis & Diverticulosis? Tell us.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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