Acute Diverticulitis – Causes, Symptoms, Treatment

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Acute Diverticulitis/Diverticulosis is a clinical condition of inflammation due to micro-perforation and herniations of the colonic mucosa and submucosa through the muscle layers, in which multiple sac-like protrusions, abscesses, fistulas, peritonitis, and colonic stenosis, small pouches, or sacs, form and push outward through weak spots in the wall of your colon(diverticula) that develop along the gastrointestinal tract. Though diverticula may form at weak points in the walls of either the small or large intestines, the majority occur in the large intestine (most commonly the sigmoid colon).

These pouches are most common in the lower part of your colon, called the sigmoid colon. One pouch is called a diverticulum. Multiple pouches are called diverticula. Most people with diverticulosis do not have symptoms or problems.

When diverticulosis does cause symptoms or problems, doctors call this diverticular disease. For some people, diverticulosis causes symptoms such as changes in bowel movement patterns or pain in the abdomen. Diverticulosis may also cause problems such as diverticular bleeding and diverticulitis.

Types of Diverticulitis

There are two types of diverticulitis:

  • Uncomplicated diverticulitis – Diverticula and the surrounding intestinal lining are inflamed but there are no signs of pus building up (abscesses) or the inflammation spreading.
  • Complicated diverticulitis – Abscesses have formed. Sometimes the inflammation has even already spread or the wall of the intestine has torn (intestinal perforation). The intestine may also become blocked or the inner lining of the tummy may become inflamed (peritonitis).

or

  • Acute diverticulitis – Surgery usually isn’t necessary for people who have acute diverticulitis. But there are exceptions: If abscesses (collections of pus) have formed, and treatment with antibiotics isn’t successful, surgery is unavoidable. The aim is then to prevent serious complications such as the wall of the intestine tearing (perforation) or the inner lining of the tummy becoming inflamed (peritonitis), which can lead to blood poisoning (septicemia).
  • Chronic diverticular disease – People who have recurrent diverticulitis or chronic symptoms generally don’t develop serious complications. Although such complications are possible, they tend to be rare if the inflammation is “uncomplicated” – in other words, as long as no abscesses have formed.

Causes of Diverticulitis

Experts are not sure what causes diverticulosis and diverticulitis. Researchers are studying several factors that may play a role in causing these conditions.

  • No one knows for certain why diverticulosis develops – however, a few theories have been suggested. Some experts believe that abnormal intermittent high pressure in the colon due to muscle spasm or straining with stool may cause diverticula to form at weak spots in the colon wall. Historically, low-fiber diets were felt to play a role in the development of diverticulosis.
  • Fiber – For more than 50 years, experts thought that following a low-fiber diet led to diverticulosis. However, recent research has found that a low-fiber diet may not play a role. This study also found that a high-fiber diet with more frequent bowel movements may be linked with a greater chance of having diverticulosis.4 Talk with your doctor about how much fiber you should include in your diet.
  • Genes – Some studies suggest that genes may make some people more likely to develop diverticulosis and diverticulitis. Experts are still studying the role genes play in causing these conditions.
  • Other factors – Studies have found links between diverticular disease—diverticulosis that causes symptoms or problems such as diverticular bleeding or diverticulitis—and the following factors:
  • Certain medicines – including nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and steroids
  • Intestinal motility – Another theory suggests the degeneration of glial neurons in the myenteric plexus and the interstitial cells of Cajal lead to slowed intestinal movement and consequently fecal content exerts increased pressure on the colon wall resulting in the formation of diverticula.[rx]
  • Lack of exercise
  • Obesity
  • Smoking
  • constipation
  • A diet that is low in dietary fiber (although this claim is controversial)
  • Connective tissue disorders (such as Marfan syndrome and Ehlers Danlos Syndrome) that may cause weakness in the colon wall
  • Hereditary or genetic predisposition,[rx]
  • Extreme weight loss
  • Heavy meat consumption

Diverticulitis may begin when bacteria or stool get caught in a pouch in your colon. A decrease in healthy bacteria and an increase in disease-causing bacteria in your colon may also lead to diverticulitis.

Symptoms of Diverticulitis

Most people with diverticulosis do not have symptoms. If your diverticulosis causes symptoms, they may include

  • bloating
  • constipation or diarrhea
  • cramping or pain in your lower abdomen
  • abdominal pain and bloating
  • constipation and diarrhea
  • flatulence
  • blood in the feces is usually minor, but bleeding can sometimes be heavy if a diverticulum gets inflamed or is near a blood vessel
  • anemia from repeated bleeding may occur.
  • Other conditions, such as irritable bowel syndrome and peptic ulcers, cause similar symptoms, so these symptoms may not mean you have diverticulosis. If you have these symptoms, see your doctor.
  • If you have diverticulosis and develop diverticular bleeding or diverticulitis, these conditions also cause symptoms.
  • In most cases, when you have diverticular bleeding, you will suddenly have a large amount of red or maroon-colored blood in your stool.

When you have diverticulitis, the inflamed pouches most often cause pain in the lower-left side of your abdomen. The pain is usually severe and comes on suddenly, though it can also be mild and get worse over several days. The intensity of the pain can change over time.

Diverticulitis may also cause

  • Diverticular bleeding may also cause dizziness or light-headedness, or weakness. See your doctor right away if you have any of these symptoms.
  • If you have symptoms such as bloating, constipation or diarrhea, or pain in your lower abdomen, see your doctor.
  • Constipation or diarrhea
  • Fevers and chills
  • Nausea or vomiting
  • Get constant, more severe tummy pain
  • Have a high temperature
  • Have diarrhea or constipation
  • Get mucus or blood in your poo, or bleeding from your bottom
  • Intermittent abdominal pain in the left lower quadrant with constipation, diarrhea or occasional large rectal bleeds (the pain may be triggered by eating and relieved by the passage of stool or flatus)
  • Tenderness in the left lower quadrant on abdominal examination.
  • In a minority of people and in people of Asian origin, pain and tenderness may be localized in the right lower quadrant
  • Symptoms may overlap with conditions such as irritable bowel syndrome, colitis, and malignancy.

Diagnosis of Diverticulitis

If your doctor suspects you may have diverticulosis or diverticulitis, your doctor may use your medical history, a physical exam, and tests to diagnose these conditions. Doctors may also diagnose diverticulosis if they notice pouches in the colon wall while performing tests, such as routine x-rays or colonoscopy, for other reasons.

Medical history

Your doctor will ask about your medical history, including your

  • bowel movement patterns
  • diet
  • health
  • medicines
  • symptoms

Physical exam

  • Your doctor will perform a physical exam, which may include a digital rectal exam. During a digital rectal exam, your doctor will have you bend over a table or lie on your side while holding your knees close to your chest. After putting on a glove, the doctor will slide a lubricated finger into your anus to check for pain, bleeding, hemorrhoids, or other problems.
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Lab Test

Your doctor may use the following tests to help diagnose diverticulosis and diverticulitis:

  • Blood test – A health care professional may take a blood sample from you and send the sample to a lab to test for inflammation or anemia.
  • Stool sample – Your stool sample is checked for the presence of abnormal bacteria or parasites as possible causes of your infection, abdominal pain, blood in stool, diarrhea, or your other symptoms.
  • Stool tests – to check for the presence of blood in the feces or the presence of infections, which may mimic the symptoms of diverticulosis and diverticulitis.
  • Digital rectal exam – In this physical exam, your healthcare provider gently inserts a gloved, lubricated finger into your rectum to feel for any problems in your anus or rectum.
  • Barium enema (also called lower gastrointestinal tract radiography) – In this test, a liquid containing barium is injected into your anus. The liquid coats the inside of your colon, which helps make any problems in your colon more visible on X-rays.
  • Esophageal manometry – This technique measures the timing and strength of the contractions of your esophagus.
  • Sigmoidoscopy – In this exam, a thin flexible tube with a light on the end is inserted into your rectum and moved into your sigmoid colon. The tube is connected to a video camera. The camera allows a visual inspection of your sigmoid colon (where most diverticula form) and rectum.
  • Angiography – If you have rapid, heavy rectal bleeding, this procedure helps find where the bleeding is coming from. During this test, the arteries that supply the colon are injected with a harmless dye that allows the source of the bleeding to be seen.

Imaging Test

  • CT scan –A CT scan can show infected or inflamed diverticula and also reveal the severity of diverticulitis. A computerized tomography (CT) scan uses a combination of x-rays and computer technology to create images of your gastrointestinal (GI) tract.
  • An x-ray – technician performs the procedure in an outpatient center or a hospital. A radiologist reads and reports on the images. You don’t need anesthesia for this procedure.
  • CT scan – a health care professional may give you a solution to drink and an injection of a special dye called contrast medium. Contrast medium makes the structures inside your body easier to see during the procedure. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. A CT scan of your colon is the most common test doctors use to diagnose diverticulosis and diverticulitis.

Lower GI series

  • A lower GI series, also called a barium enema, is a procedure in which a doctor uses x-rays and a chalky liquid called barium to view your large intestine. The barium will make your large intestine more visible on an x-ray.
  • An x-ray technician and a radiologist perform a lower GI series at a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You don’t need anesthesia for this procedure.
  • For the procedure, you’ll be asked to lie on a table while the radiologist inserts a flexible tube into your anus and fills your large intestine with barium. You will need to hold still in various positions while the radiologist and technician take x-ray images and possibly an x-ray video, called fluoroscopy. If pouches are present in your colon, they will appear on the x-ray.

Colonoscopy

  • Colonoscopy is a procedure in which a doctor uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or endoscope, to look inside your rectum and colon.
  • A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will give you written bowel prep instructions to follow at home before the procedure. You will receive sedatives, anesthesia, or pain medicine during the procedure.
  • During a colonoscopy, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and into your colon. Doctors may use a colonoscopy to confirm a diagnosis of diverticulosis or diverticulitis and rule out other conditions, such as cancer.

Treatment of Diverticulitis

Non-Pharmacological

The goal of treating diverticulosis is to prevent the pouches from causing symptoms or problems. Your doctor may recommend the following treatments.

  • High-fiber diet – Although a high-fiber diet may not prevent diverticulosis, it may help prevent symptoms or problems in people who already have diverticulosis. A doctor may suggest that you increase fiber in your diet slowly to reduce your chances of having gas and pain in your abdomen. Learn more about foods that are high in fiber.
  • Fiber supplements – Your doctor may suggest you take a fiber product such as methylcellulose (Citrucel) or psyllium (Metamucil) one to three times a day. These products are available as powders, pills, or wafers and provide 0.5 to 3.5 grams of fiber per dose. You should take fiber products with at least 8 ounces of water.
  • Diet – Some doctors advise people to try to carry on eating normally – or to eat a low-fiber diet for a while. Others recommend mainly eating soups or other non-solid foods, as well as drinking enough fluids, in the first few days. It’s not clear whether it really is better to avoid solid foods for a while. There aren’t any good studies in this area.
  • Nuts and Seeds – In the past, doctors thought you had to avoid certain foods if you had diverticulosis. These included nuts, seeds like sunflower and sesame, and even little seeds in fruits and vegetables such as cucumbers and strawberries. But recent research shows these foods don’t harm people with diverticulosis.
  • Draining – About 15 out of 100 people who have complicated diverticulitis have a pus-filled abscess. If necessary, the pus can be drained out of the body through a thin tube.
  • Drink plenty of water – Eating more fiber absorbs more water, so you’ll need to increase the amount of water you drink to keep stool soft and on the move. Many healthcare providers suggest drinking half your body’s weight in ounces. For example, if you weigh 160 pounds, you should drink 80 ounces of water each day.
  • Exercise daily – Physical movement helps food pass through your intestinal system. Exercise for 30 minutes on most days if you can.


Medicines

  • NSAIDs and Paracetamol – can be used to relieve pain. Some painkillers, including aspirin and ibuprofen, should not be taken regularly as they can cause stomach upsets. Ask a pharmacist about this.
  • Antispasmodics  – Your doctor may prescribe antispasmodics such as mebeverine, and hyoscine hydrobromide, ondansetron, granisetron if you have persistent abdominal spasms.
  • Mesalazine – Some studies suggest that mesalazine (Asacol) taken every day or in cycles may help reduce symptoms that may occur with diverticulosis, such as pain in your abdomen or bloating. Studies suggest that the antibiotic rifaximin (Xifaxan) may also help with diverticulosis symptoms. The maintenance dose of Mesalazine 1.6g daily was administered to patients with the addition of probiotic VSL3 in patients with more severe disease to maintain remission
  • Antibiotics – The standard of outpatient care includes bowel rest, increase fluid intake, and oral antibiotic therapy (single or multiple drug regimen) that covers gram-negative rods and anaerobic bacteria. The most common regimen used in the United States consists of quinolones (ciprofloxacin) or sulfa drugs (trimethoprim/sulfamethoxazole) in combination with metronidazole  (or clindamycin, if the patient is intolerant to metronidazole) or single-agent amoxicillin-clavulanate for 7 to 10 days.Inpatient management of diverticulitis requires intravenous antibiotics, intravenous fluids, and pain management. Again, antibiotics should cover gram-negative rods and anaerobes and be given for three to 5 days before switching to oral antibiotics for a ten to 14-day course. Bowel rest is preferred in patients requiring inpatient admission. Typically, defervescence and improvement in leukocytosis should be observed for two to four days of hospitalization, if not an alternative diagnosis or complications should be suspected. Prompt surgical evaluation should be considered.
  • Role of vitamin D – The role of vitamin D has recently been explored in diverticular disease. In a retrospective cohort study conducted by Maguire et al., prediagnostic levels of vitamin D (25-OH) were measured and compared between 9,116 patients with uncomplicated diverticulosis and 922 patients who developed diverticulitis requiring hospitalization. The study found a statistically significant higher mean prediagnostic serum vitamin D (25-OH) level in patients with uncomplicated diverticulosis in comparison to patients who required hospitalization for diverticulitis.
  • Citrucel or Metamucil – They might suggest a fiber product like Citrucel or Metamucil. They come in pill, powder, or wafer forms. You’ll take it with lots of water.
  • Probiotics – Some studies show that probiotics may help with diverticulosis symptoms and may help prevent diverticulitis. However, researchers are still studying this subject. Probiotics are live bacteria like those that occur normally in your stomach and intestines. You can find probiotics in dietary supplements—in capsule, tablet, and powder form—and in some foods, such as yogurt. For safety reasons, talk with your doctor before using probiotics or any complementary or alternative medicines or medical practices.
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Antibiotic Regimens for Acute Diverticulitis

Type of Treatment
(References)
Single AgentMultiple AgentsDuration
Outpatient treatment of mild uncomplicated diverticulitis (, , )Moxifloxacin 400 mg PO every 24 h
Amoxicillin-clavulanic acid 875 mg/125 mg PO every 12 h or 1000/62.5 mg tab 2 PO every 12 h
Trimethoprim-sulfamethoxazole 1 DS 160/800 mg PO every 12 h
Ciprofloxacin 750 mg PO every 12 h
Levofloxacin 750 mg PO every 24 hEach in combination with metronidazole 500 mg PO every 6 h
4–7 days if source controlled/abscess drained
Inpatient treatment of mild to moderately complicated diverticulitis (, )Ertepenem 1g IV every 24 h
Moxifloxacin 400 mg IV every 24 h
Ticarcillin-clavulanic acid 200–300 mg/kg/d divided doses every 4–6 h
Cefazolin 1–2 g IV every 8 h
Cefuroxime 1.5 g IV every 8 h
Ceftriaxone 1–2 g IV every12–24 h
Cefotaxime 1–2 g IV every 6–8 h
Ciprofloxacin IV 400 mg every 12 h
Levofloxacin IV 750 mg every 24 hEach in combination with metronidazole 500 mg IV every 8–12 h or 1500 mg IV every 24 h
4–7 days if source controlled/abscess drained
Inpatient treatment of severe complicated diverticulitis, peritonitis (, )Imipenem-cilastatin 500 mg every 6 h or 1g IV every 8 h
Meropenem 1 g IV every 8 h
Doripenem 500 mg IV every 8 h
Piperacillin-tazobactam 3.375g IV every 6 h
Cefepime 2g IV every 8 h
Ceftazidime 2g IV every 8 h
Ciprofloxacin 400 mg IV every 12 h
Levofloxacin 750 mg IV every 24 hEach in combination with metronidazole 500 mg IV every 8–12 h or 1500 mg IV every 24 h
4–7 days if source controlled/abscess drained

Surgery

Emergency surgery is required to treat peritonitis, the most serious potential complication of diverticulitis. Peritonitis requires surgical repair as well as intravenous antibiotics.

Surgery also may be required during the hospital stay to treat a particularly severe episode of diverticulitis. These include continuous bleeding, perforation of an abscess, attachment of two organs by a fistula, or colon obstruction caused by scarring from previous episodes of diverticulitis.

Surgical procedures to do this include

  • Cricopharyngeal myotomy – This involves making small cuts in the upper sphincter of the esophagus to widen it, so food can pass more easily through your esophagus.
  • Diverticulopexy with cricopharyngeal myotomy – This involves removing a larger diverticulum by turning it upside down and attaching it to the wall of the esophagus.
  • Diverticulectomy and cricopharyngeal myotomy – This involves removing the diverticulum while performing a cricopharyngeal myotomy. It’s a combination that’s often used to treat Zenker’s diverticula.
  • Endoscopic diverticulectomy – This is a minimally invasive procedure that divides the tissue between the diverticulum and esophagus, allowing food to drain from the diverticulum.
  • Colon resection – If your bleeding does not stop, a surgeon may perform abdominal surgery with a colon resection. In a colon resection, the surgeon removes the affected part of your colon and joins the remaining ends of your colon together. You will receive general anesthesia for this procedure.

In some cases, during a colon resection, it may not be safe for the surgeon to rejoin the ends of your colon right away. In this case, the surgeon performs a temporary colostomy. Several months later, in a second surgery, the surgeon rejoins the ends of your colon and closes the opening in your abdomen.

When is surgery for diverticulitis considered?

Surgery for diverticulitis is considered if you have:

  • Abscesses – An abscess is a container or “walled-off” infection in the abdomen. If the fluid in an abscess (a collection of bacteria and white blood cells) is not successfully drained with a needle or catheter, surgery is needed. In surgery, the abscess is cleaned up and the affected part of the colon is removed.
  • Perforation/peritonitis – A tear (perforation) in your colon allows pus or stool to leak into your abdominal cavity, resulting in peritonitis. This is a life-threatening infection that requires emergency surgery to clean the cavity and remove the damaged part of the colon.
  • Blockages or strictures – Previous infections in your colon can cause scars to form, which can result in a partial or complete blockage or strictures (narrowing of sections of the colon). A complete blockage requires surgery (partial blockage does not).
  • Fistulas – A fistula is an abnormal passageway or tunnel that forms and connects with another organ. An abscess that erodes into the surrounding tissue creates these passageways. A fistula in the colon can connect to the skin, bladder, vagina, uterus, or another part of the colon. Most fistulas don’t close on their own so surgery is needed.
  • Continued rectal bleeding (also called diverticular bleeding) – Diverticular bleeding occurs when a small blood vessel near the diverticula bursts. Mild bleeding usually stops on its own, but about 20% of cases require treatment. Surgery may be needed if other attempts to stop the bleeding fail, such as clipping, drug infusion, or cauterizing the bleeding artery. If bleeding is heavy and rapid, emergency surgery is needed.
  • Severe diverticulitis – that has not responded to other treatment methods. Multiple attacks despite following a high-fiber diet. You and your surgeon may decide surgery to remove the diseased part of the colon is the best method to prevent future attacks.

Complications

Over time, an esophageal diverticulum can lead to some health complications.

  • Aspiration pneumonia – If an esophageal diverticulum causes regurgitation, it can lead to aspiration pneumonia. This is a lung infection caused by inhaling things, such as food and saliva, that usually travel down your esophagus.
  • Obstruction – An obstruction near the diverticulum can make it hard, if not impossible, to swallow. This can also cause the pouch to rupture and bleed.
  • Squamous cell carcinoma – In very rare cases, ongoing irritation of the pouch can lead to squamous cell carcinoma.
  • Sacs can get infected, and even burst – This is diverticulitis. It’s treated with rest, fluids, and antibiotics.
  • The infection can spread and an abscess can form. A specialist will need to drain the pus.
  • A perforation (a hole along the stomach wall) can occur – It’s rare, but life-threatening and requires immediate surgery.
  • You can get a diverticular hemorrhage – This is rare. It happens when your arteries wear through the intestinal wall. It causes massive bleeding and requires hospitalization and blood transfusions.

Best High-Fiber Foods

You may not think much about fiber — until you find yourself dealing with an, er, irregular situation.

Indeed, dietary fiber is a magic ingredient that keeps you regular. But thwarting constipation is not its only job. “Fiber does lots of cool stuff in the body. Here’s why you need it — and where to get it.

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Benefits of a high-fiber diet

Fiber is an unsung hero. Among its claims to fame, a high-fiber diet can:

  • Soften stool and prevent constipation.
  • Lower cholesterol, reducing the risk of heart disease.
  • Reduce the risk of diseases such as colorectal cancer.
  • Keep blood sugar levels from spiking.
  • Make you feel full longer, which can help you lose weight.

There are two types of fiber, both of which are good for you

  • Soluble fiber –  pulls in water. It slows digestion and lowers cholesterol. Soluble fiber is found in foods such as beans, seeds, peas, barley, oat bran, and some fruits and vegetables.
  • Insoluble fiber – is your classic roughage. It helps stool speed through the intestines. You’ll find it in foods such as whole grains, wheat bran, and the peels and seeds of fruits and veggies.

Aim for 25 to 35 grams of fiber a day, Taylor says — and a mix of soluble and insoluble fiber is ideal.

What foods are high in fiber?

Fiber comes from plants, so don’t bother looking for it in your chicken dinner. But the plant kingdom has a lot to offer, and the best sources of dietary fiber might surprise you. Here are Taylor’s top 11.

1. Whole-wheat pasta

Carbs get a bad rap, but whole grains are a great source of fiber and are also rich in healthy phytonutrients, Taylor says. Skip the white pasta (which has been stripped of all the good stuff), and go for whole-wheat instead.

Nutrition information: 1 cup cooked = 7g fiber, 180 calories, 38g carbs, 8g protein.

2. Barley

“Barley is a delicious grain that’s often overlooked,” Taylor says. Try tossing it in soups or mix up a grain bowl with your favorite meat and veggies.

Nutrition information: 1 cup cooked = 6g fiber, 190 calories, 44g carbs, 4g protein.

3. Chickpeas

“Legumes are star players. They’re some of the best sources of protein and fiber, they help keep you full, and they have amazing nutrient composition. Chickpeas are a fiber-full favorite from the legume list. Add them to soups or salads, snack on chickpea hummus, or roast them whole for a crunchy, shelf-stable snack.

Nutrition information: ½ cup cooked = 6g fiber, 140 calories, 23g carbs, 7g protein.

4. Edamame

Edamame, or immature soybeans, has a mild flavor and pleasing texture. They’re also one of the few plant sources that contain all the amino acids your body needs, so they’re a great choice for vegans and vegetarians. You can find them in the frozen food section, still in the pod, or already shelled. Add edamame to salads and stir-fries, Taylor suggests. (Edamame is often a big hit for kids to snack on, too.)

Nutrition information: ½ cup boiled and shelled = 4g fiber, 100 calories, 7g carbs, 9g protein.

5. Lentils and split peas

These two legumes have similar nutrition profiles and are used in similar ways. “Lentils and split peas are nutritional powerhouses. They cook quickly and are great in soups. Try swapping lentils for some of the meat in your chili to boost the plant-powered goodness, she recommends.

Nutrition information:

Lentils, ½ cup cooked = 8g fiber, 120 calories, 20g carbs, 9g protein.

Split peas, ½ cup boiled = 8g fiber, 120 calories, 20g carbs, 8g protein.

6. Berries

“All berries are good for you, but blackberries and raspberries have the most fiber. They’re also delicious. Fresh berries can be expensive, but frozen is often more economical. If you don’t love the mushy texture of thawed berries, blend them into a smoothie or stir them into your oatmeal, she suggests. “You can also cook them down and put them on waffles in place of syrup.”

Nutrition information: 1 cup = 8g fiber, 70 calories, 15g carbs, 5g sugar.

7. Pears

Another fruit, pears, are a fantastic source of fiber. And compared to many other fruits, they’re particularly high in soluble fiber.

Nutrition information: 1 medium pear = 6g fiber, 100 calories, 28g carbs, 17g sugar.

8. Artichokes hearts

Artichoke hearts are packed with fiber. Add them to salads or pile them on pizza. If dealing with these spiky veggies is too daunting, try the canned kind. (But if you’re eating canned, keep an eye on sodium levels so you don’t go overboard.)

Nutrition information: ½ cup cooked = 7g fiber, 45 calories, 9g carbs, 2g protein, 1g sugar.

9. Brussels sprouts

If you’ve been avoiding Brussels sprouts since you were a kid, they’re worth a second look. “Brussels sprouts are awesome. They’re delicious roasted or sautéed. (Plus, they’re cute.)

Nutrition information: 1 cup cooked = 5g fiber, 60 calories, 12g carbs, 3g sugars, 5g protein.

10. Chia seeds

A spoonful of chia seeds can go a long way. They’re incredibly rich in fiber, contain omega-3 fatty acids, and have a nice protein punch, too. “You can throw them in oatmeal, yogurt, pudding, cereal, salads, and smoothies.

Many people love the jelly-like texture. If you aren’t one of them, try mixing them into a smoothie or yogurt right before you eat it, so they don’t have as much time to absorb water and plump up.

Nutrition information: 2 tablespoons = 10g fiber, 140 calories, 12g carbs, 5g protein.

11. Haas avocados

Haas avocados are a great source of healthy fats. And unlike most fiber-rich foods, you can use them as a condiment. “You can spread avocado on sandwiches instead of mayonnaise, or put it on your toast if you’re a true millennial.” Guacamole (with whole-grain crackers or paired with raw veggies) is another delicious way to get your daily fiber.

Nutrition information: ½ avocado = 5 g fiber, 120 calories, 6g carbs, 1g protein.

Eating more fiber? Read this first!

Before you jump on the fiber bandwagon, a word of caution: “Add fiber to your diet slowly,” Taylor says. If you aren’t used to a lot of fiber, eating too much can cause bloating and cramping. Increase high-fiber foods gradually over a few weeks to avoid that inflated feeling.

Another important tip

When adding fiber to your diet, be sure to drink enough water. Fiber pulls in water. That’s a good thing, but if you aren’t drinking enough, it can make constipation worse. To keep things moving, drink at least 2 liters of fluids each day.

If you increase your fiber slowly and steadily and drink lots of fluid, your body will adjust,” Taylor says. And you’ll be glad it did.

How much fiber should I eat?

The National Institute of Diabetes and Digestive and Kidney Disease recommends eating 14 grams per 1,000 calories consumed per day. For example, if you follow a 2,000 calorie diet every day, you should try to eat 28 grams of fiber each day. Every person, regardless of whether they have diverticula, should try to consume this much fiber every day. Fiber is the part of plant foods that can’t be digested.

References

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