Though diverticulosis may sound serious, it seldom is. This disorder of the large bowel occurs when small pouches, usually about the size of a pea, form in the intestinal wall. According to the National Institutes of Health, one in ten people over 40 and half those over 60 have diverticulitis symptoms. The condition occurs most frequently in industrialized societies, where fiber intake tends to be low.

But though the condition is common, most people who have it experience no symptoms and thus never know. Diverticulosis is associated, however, with irritable bowel syndrome, which may cause such symptoms as gas, bloating, and diarrhea. And if your diverticulosis turns into diverticulitis, you will definitely have symptoms. This happens when one or more of the pouches become infected from bacteria in the digestive tract, usually because a particle of undigested food gets trapped in the pouch.

A mild infection can produce bloating, gas, and nausea-symptoms for which most people don’t immediately see a doctor, especially if they improve. (Pain is usually on the left side of the abdomen, unlike appendicitis, which affects the right side.) But sometimes symptoms–abdominal pain and/or rectal bleeding–are severe and shouldn’t be ignored. They can be signs of complications. An abscess may develop and the intestinal wall may become perforated, causing surrounding tissues in the abdominal cavity to become infected. These cases, fortunately rare, can be life-threatening and call for immediate hospitalization and, possibly, surgery.

Perhaps because fiber is sometimes called “roughage,” the idea used to be common that a high-fiber diet–fruits, grains, and vegetables–was somehow rough on the bowels and that a person with symptoms of diverticulitis should immediately go on a low-fiber or even liquid diverticulosis foods. It’s now thought that this is about the worst thing you can do. Indeed such a diet can even cause the large intestine to go into spasm.

Fiber, on the other hand, provides bulk in the intestine, which enables food and waste to pass more easily and efficiently. Waste moves rapidly along–an advantage for the internal economy. Of course, if you have an acute case of diverticulitis requiring hospitalization, you may have to follow a liquid diet and take antibiotics until your colon has begun to heal. Soon after, though, you will be advised to increase your fiber intake for the standard stay at home diverticulitis treatment.

Eat a lot of fruits, whole grains, and vegetables to boost your fiber intake. (If you aren’t used to a high-fiber diet, start gradually.) Choose whole-wheat bread over white, brown rice over white. Add a little bran to baked goods. Eat whole-grain cereals for breakfast. Eat fruits and vegetables unpeeled when you can. Raw produce is good, but cooking does not destroy fiber. Drink plenty of fluids–at least eight 8-ounce glasses of fluids daily, including juices and soups.

Fruits and vegetables also contain a high percentage of water, which is another plus. Get regular exercise. There’s some evidence that active people are less prone to diverticulitis and that exercise may help prevent constipation. If you’re occasionally constipated, try eating a few prunes. These can really help. They not only are a good source of fiber, but also contain a natural laxative. Don’t rely on stimulant laxatives.

The dietary treatment for diverticulitis flare ups has taken an about-face in recent years. In the past, people were advised to adhere to bland and low-residue diets. These are exactly the diets which, it seems, were responsible for causing the diverticulosis in the first place. Nowadays, people are encouraged to consume diets that are higher in fiber and roughage. The fiber increases the quantity of stool and softens its consistency. Commercial preparations, such as Metamucil, also have a similar effect.

Although fiber may not be of benefit to all people, it does seem that a high fiber diet lessens the frequency of the problems that may result from diverticulosis. It is hoped that high fiber diets, when eaten at younger ages, may even help to prevent diverticulosis from occurring at all.

The key to the use of fiber is to use it in moderation. As many people already have discovered, fiber, found in cereals, fibers, and vegetables, can itself cause a sense of bloating and cramps. People should eat a quantity of fiber that does not cause these problems, yet is sufficient for softening the stools. This can only happen with trial and error, and anywhere from three to eight weeks must be allowed to see if fiber has an effect.

It is hoped that as people become much more aware of the importance of dietary fiber, then diverticulosis, a disease of modern society, may become a thing of the past.

Diverticulitis is often incorrectly diagnosed on presentation and computed tomography (CT) scanning is probably the best tool for correcting this situation. That’s the conclusion of a retrospective analysis of 125 acute diverticulitis cases undertaken by researchers at the University of Alberta, Edmonton. The cases were seen between mid – 2005 and early 2007.

The study was undertaken in part to assess compliance with treatment guidelines for complicated and uncomplicated diverticulitis endorsed by the Canadian Society of Colon and Rectal Surgeons. Results were presented here at the annual meeting of the Royal College of Physicians and Surgeons by Dr. David Williams, a general surgery resident at the university.

Guidelines recommend complicated potential diverticulitis surgery cases with free perforation or fistula be treated surgically. Percutaneous drainage is recommended if an abscess is found. Conservative management is advocated for uncomplicated cases with antibiotics and bowel rest recommended.

In their analysis, the researchers assessed how valuable clinical markers such as fever, pain and white blood cell count were in making a correct diagnosis. A similar assessment of ultrasound, CT and contrast enema studies was undertaken.

We wanted to see how we were treating our patients and if it was treatment according to the guidelines,” Dr. Williams said in an interview. Ten patients were excluded from the outcome analysis, he said, because although they were diagnosed with diverticulitis on admission they were later found to have a different problem.

The researchers found only 60% of patients had the correct diagnosis made at presentation. The sensitivity and specificity of CT was better than any of the other tests. Patient – reported pain was a reliable marker of a diverticulitis diet candidate but had no specificity.