The Link Between Diverticulitis and Constipation

In addition to abdominal pain, some people experience bowel symptoms such as constipation during a flare-up of diverticulitis.

This article will cover how common constipation is with diverticulitis, how the two may or may not be related, and how they might be treated when they occur together.

Diverticulitis and Constipation: One Symptom of Many 

Diverticulitis causes several different symptoms. It affects the digestive tract and the bowels. However, there can be symptoms in other parts of the body as well, such as in the urinary tract. It’s estimated that 50% of people who have diverticulitis also have constipation.

Other Bowel Symptoms

Besides constipation, there could be other symptoms that affect the bowel and the digestive system. These can include:

• Abdominal pain: Could range from mild pain that comes and goes to pain that's severe and constant
  
• Diarrhea 
• Fever
• Nausea
• Tender abdomen
• Urinary symptoms
• Vomiting  

How to Treat Constipation With Diverticulitis

The reason why people develop diverticular disease is not completely understood. However, the theory is that several factors contribute. Some things, such as age and genetics, can't be modified, but others can, including certain lifestyle factors.

Another theory is that constipation may raise the pressure inside the colon. This could lead to the interior of the lining of the colon being under too much pressure and causing the outpouchings of diverticlulosis.

Why the diverticula flare up and cause diverticulitis is also not well understood. Some long-held working theories, such as an infection or constipation causing diverticulitis, are now being challenged. One study published in 2022 showed that having more frequent bowel movements may be more closely associated with developing diverticulitis rather than constipation.

Another newer theory is an imbalance of the colon microbiome. The microbiome is the community of bacteria, viruses, and fungi that live in the digestive system. An imbalance could lead to constipation, which could, in turn, contribute to the formation of diverticula.

Developing diverticulosis and diverticulitis may have more than one cause. Several factors working together can bring on diverticular disease.

Diet

Uncomplicated diverticulitis is often treated at home by going on a liquid diet for a few days. Antibiotics may be prescribed.

After starting to feel better, a healthcare provider may recommend moving to low-fiber. During recovery, there will be follow-ups or touch points to understand when to advance the diet. That first follow-up might be about a week after symptoms first start.

When the acute diverticulitis is resolved, a healthcare provider may give the go-ahead to move back to a diet that includes more fiber. Generally, a high-fiber diet is recommended for most adults. That would include people who live with diverticular disease.

There’s not enough evidence to say that a high-fiber diet will help prevent diverticulitis from coming back again. But because a high-fiber diet can support better health overall, it’s thought that the benefits will outweigh the risks.

Types of Fiber

Increasing fiber in the diet may be recommended for the long-term management of diverticular disease and constipation. The type of fiber used will vary based on what you can tolerate and factors such as your tastes and preferences.

A study of 50,019 nurses showed that those who ate the most fiber had lower rates of diverticulitis. In particular, eating higher amounts of apples, pears, and prunes, as well as more fruit overall, was associated with lower rates of diverticulitis. Eating more vegetables did not have the same effect.

Eating more cereal fiber, though, was associated with a lower risk of diverticulitis. As the name implies, this includes fiber found in cereals and cereal products such as bran, whole wheat bread, whole wheat pasta, brown rice, seeds, barley, and other whole grains.

It should be noted, however, that this study is limited because while it is large and the participants were followed for 24 years, they are also healthcare providers (nurses) who are predominantly White.

Consulting a healthcare provider will help tailor the types of fiber that are tolerable and could be incorporated into a long-term diet plan. 

Laxatives

For some people with acute diverticulitis who are experiencing constipation, a laxative might be recommended by a healthcare provider. However, the healthcare provider should rule out bowel obstruction as a complication of diverticulitis before considering laxatives.

Not all types of laxatives have been studied directly in diverticulitis. Therefore, it’s important to get advice from a healthcare professional before using them.

The types of over-the-counter (OTC) laxatives available include stool softeners (such as Colace), osmotic laxatives (such as Miralax), and stimulant laxatives (such as Ex-Lax). These have not been studied either in short-term or long-term use in diverticulitis. In most cases, these types of laxatives are used in the short term, or at least for the shortest time possible.

Bulk-forming laxatives such as Metamucil or Citrucel may be recommended after the diverticulitis flare-up has resolved. These types of supplements can help add fiber to the diet while treating either constipation or diarrhea.

Fiber supplements can include psyllium, methylcellulose, and polycarbophil. They have not been studied for use in diverticulitis, so they should only be used with the recommendation of a healthcare provider.

However, after diverticulitis resolves, bulk laxatives may be helpful in not only treating constipation and/or diarrhea but also in increasing fiber intake. However, these supplements can cause gas or bloating at first, so it’s important to add them to the diet slowly.

Does Constipation Go Away After Diverticulitis Treatment?

There is little research into how common it is to have constipation after a diverticulitis flare-up. If constipation was a problem before the flare-up of diverticulitis, it might continue after the episode is treated.

Acute Recovery

In the initial part of the recovery from a flare-up of diverticulitis, which is several days to a week or two, a liquid and/or low-fiber diet may be recommended. Using a constipation treatment during the first few days of the flare-up, such as laxatives, should only be tried on the advice of a healthcare provider.

If constipation continues and is causing pain or discomfort, it’s important to discuss that problem with the treating healthcare provider. Several factors can cause constipation, and it may be necessary to review diet, lifestyle, and medications to decide whether short- and long-term changes should be made.

A colonoscopy is advised following the first episode of diverticulitis or in people with complicated diverticulitis. For people with recurrent uncomplicated diverticulitis, the need for repeat colonoscopy needs to be discussed with the healthcare provider who will take into consideration previous episodes of diverticulitis and prior colonoscopies.

Chronic Diverticulitis 

Having abdominal pain even after recovering from a bout of diverticulitis is common. It’s thought that chronic diverticulitis may have some characteristics similar to other digestive system conditions, such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD).

Ongoing abdominal pain may also result from the colon being more sensitive. However, when there are continuing symptoms such as constipation or pain, it is important to find out if there could be another cause. A colonoscopy and/or a computed tomography (CT) scan that’s done with and without contrast might be used to look for other problems in the colon.

If a different reason (aside from diverticular disease) is found for ongoing constipation or pain, that problem will be treated separately.

Daily Habits to Prevent Constipation and Diverticulitis Flares

Diverticulitis may, unfortunately, flare up again in about one-third of people with the condition. Lifestyle changes might be recommended to try to avoid a flare-up.

Recommended prevention habits for diverticulitis might include:

• Eating more dietary fiber or using a fiber supplement
• Getting regular exercise
• Quitting smoking

Surgery to remove part or all of the colon is an established treatment for chronic diverticulitis. In some cases, surgery may improve quality of life. When surgery might be used is a valid question to discuss with a healthcare provider, even after just one flare-up of diverticulitis.

Chronic constipation can be complicated and can occur for a variety of reasons. It can take time to figure out why it might be happening and how to help treat it. Some testing might be done to ensure that there’s no medical condition causing the problem.

However, some daily habits are often recommended to help treat and prevent constipation. Working with a healthcare provider will help narrow down which lifestyle changes might be best.

These daily habits can include:

• Getting more fiber in your diet or taking a fiber supplement
• Learning how to recognize and act on the urge to defecate
• Scheduling time to use the toilet (such as after a meal)

In some cases, there could be a need for more intensive treatments for constipation. These can include using laxatives or other medications developed specifically to treat the cause of hard stools. These medications, even those available over the counter, should be used under the guidance of a healthcare professional.

Summary

Diverticulitis can be a painful and disruptive condition that may be associated with constipation. Treatment for uncomplicated cases of diverticulitis usually involves changing the diet for several days. To treat ongoing problems with constipation, it may be necessary to make some changes to diet and lifestyle.