Am I having a diverticulitis flare-up? Strategies for feeling better and living well

Experiencing abdominal pain with fevers? Maybe loss of appetite, nausea or vomiting? It is possible you could be having a diverticulitis flare-up. Fortunately, there are ways to manage it effectively, relieve symptoms and get back to enjoying your life.

Understanding what a diverticulitis flare-up is, what causes it and what to do when it happens can significantly improve your overall well-being.

Let’s get the facts.

What is diverticulitis?

Diverticulitis is a complication of diverticulosis.

Diverticulosis is a condition where small, bulging pouches (called “diverticulum” or “diverticula” if there are more than one) develop in the lining of your colon, most commonly in the lower part of the colon.

A diverticulum is essentially a sac-like protrusion of the colonic wall. Think of them like small pockets that form in weak spots of your intestinal wall, like how a bicycle tire might bulge in spots where the wall is weak.

Diverticulitis occurs when the area around or within these pouches becomes inflamed or infected.

While diverticula are usually harmless, an inflammation or infection leading to a diverticulitis flare-up doesn’t feel so harmless due to uncomfortable symptoms and potential complications.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diverticulosis is quite common, and people who have it are often asymptomatic. As of 2021, more than 30% of US adults between the ages of 50 and 59 and more than 70% of those older than 80 have diverticulosis.

And even though less than 5% of people with diverticulosis develop diverticulitis, it is more prevalent in adults over 40, and the risk increases with age. Other risk factors include:

• A low-fiber diet
• Obesity
• Lack of physical activity
• Smoking
• Certain medications

Symptoms of a diverticulitis flare-up

The most reliable way to know if you’re having a diverticulitis flare-up is to be diagnosed by a healthcare provider, as symptoms can be similar to other digestive or non-digestive conditions. However, here are the key signs and symptoms to watch for:

• Abdominal pain or tenderness: The most common symptom is sudden onset of abdominal pain, typically on the lower left side but can be elsewhere. The discomfort can be constant or intermittent (but usually constant) and may worsen with movement or pressure.
• Fever: A diverticulitis flare-up can cause a low-grade fever. If you experience a persistent or high fever, seek medical attention.
• Changes in bowel habits: You may experience diarrhea (up to 25% of people) or constipation (up to half of all people) during a diverticulitis flare-up.
• Nausea and vomiting: Inflammation and infection in the colon can lead to queasiness and an inability to keep solids or liquids down.
• Loss of appetite: The discomfort and pain associated with a diverticulitis flare-up can result in a decreased appetite.
• Urinary issues: Approximately 10 to 15 percent of people with acute diverticulitis have urinary urgency, frequency or discomfort (known as dysuria) due to irritation of the bladder from an inflamed left lower part of the colon.

What causes a diverticulitis flare-up?

When diverticula become persistently blocked with stool, bacteria can accumulate and trigger an immune response, leading to inflammation. This may occur in people who are on a low-fiber diet. The severity can vary, and it’s important to seek medical attention for proper diagnosis and treatment.

“Dietary factors that increase the risk of diverticulitis include high intake of red meat and a Western dietary pattern, which is high in fat and refined grains,” said Ali Akbar, MD, a gastroenterologist on the medical staff at Baylor Scott & White – Waxahachie. In the past, people were advised to avoid foods like nuts, corn and popcorn, but these are not associated with an increase in the risk of diverticulitis.

Can stress cause a diverticulitis flare-up?

While stress itself doesn't directly cause diverticulitis flare-ups, it can contribute to inflammation in your body which may affect your digestive system, and if you have underlying diverticulosis and other risk factors, then it can potentially trigger a flare-up.

How long does a diverticulitis flare-up last?

The duration of a diverticulitis flare-up can vary. A mild flare-up can last from a few days to a week, while more severe cases may take longer to subside. The duration can also depend on your overall health, any underlying conditions and timing of treatment.

Some people may experience recurrent acute (short-term) flare-ups, while others may have longer periods of symptoms resulting in chronic diverticulitis, known as smoldering diverticulitis.

It’s important to get enough rest and follow your provider's instructions to speed up recovery. While flare-ups can be uncomfortable and disruptive, they are typically manageable with the right treatment and lifestyle adjustments.

What to do when diverticulitis flares up

When diverticulitis flares up, medications and lifestyle adjustments can relieve symptoms and help your flare-up resolve. If you think you’re experiencing a diverticulitis flare-up, reach out to your doctor.

Unsure if it’s time to see a doctor? Take our brief digestive quiz to find out.

After a flare-up, you will need to closely monitor and follow up with your provider to ensure proper healing and prevent future episodes. During regular check-ups, your doctor can evaluate your progress, discuss ongoing symptoms, perform diagnostic tests and provide ongoing treatment recommendations to keep you feeling well.

What to eat with diverticulitis flare-up

Follow a low-fiber or liquid diet for a few days to ease the strain on your digestive system and allow your colon to heal. Opt for easily digestible foods such as:

• Broth
• Cooked vegetables
• Smoothies
• Yogurt

As discomfort and other associated symptoms improve, gradually reintroduce high-fiber foods, such as whole grains, fruits and vegetables.

“To reduce recurrent episodes, try to avoid constipation, eat foods with high dietary fiber and avoid dietary and lifestyle patterns that are associated with diverticulitis. For example, limiting red meat, quitting smoking and maintaining an active lifestyle,” said Dr. Akbar.

Self-care during a diverticulitis flare-up

While rest is important during a flare-up, light exercise can also be beneficial. Gentle activities like walking or stretching can stimulate bowel movements and relieve constipation. Avoid strenuous or high-impact exercises that may worsen symptoms. You may use a heating pad or use nonsteroidal anti-inflammatory drugs (NSAIDs) for a few days if you are experiencing any discomfort. And don’t forget to stay hydrated.

Medications for diverticulitis

If the above measures don’t do the trick, your healthcare provider may prescribe antibiotics to fight the infection and reduce inflammation—keeping in mind the symptoms, any health conditions or your other medications.

6 tips to help prevent a diverticulitis flare-up

Often, some specific lifestyle changes, dietary recommendations and other preventive measures can help prevent future flare-ups:

1. Stay hydrated, as drinking plenty of water helps keep your digestive system functioning properly and prevents constipation, which can contribute to diverticulitis.

2. Exercise regularly to promote regular bowel movements, which reduces pressure on the colon.

3. Consume a high-fiber diet, as fruit, vegetables, whole grains and legumes to add bulk to your stool, making it easier to pass through the colon.

4. Avoid smoking and excessive alcohol consumption, as both can increase the risk of diverticulitis.

5. Practice stress management techniques, as stress can worsen digestive symptoms.

6. Follow a regular bowel routine and avoid delaying or straining during bowel movements.

Most people recover easily from a diverticulitis flare-up. By implementing these preventive measures and adopting healthy routines, you can reduce the risk of diverticulitis flare-ups and improve your gut health overall.

When in doubt about your digestive health, make an appointment with a gastroenterologist to discuss your symptoms.