Diverticular health · Evidence-based guide
Diverticulitis, diverticulosis and diverticular disease: what is the difference?
Small pouches called diverticula can develop in the wall of the large bowel, particularly as people get older. The presence of these pouches is called diverticulosis. When diverticula cause ongoing symptoms, doctors may use the term diverticular disease. Diverticulitis means that one or more diverticula have become inflamed and, in some cases, infected.
These conditions are related but not interchangeable. The distinction matters because advice that is appropriate when you are well with diverticulosis may be inappropriate during an acute episode of diverticulitis.
Diverticulosis
Diverticula are present in the colon. Many people have no symptoms and need no specific treatment.
Diverticular disease
Diverticula are associated with symptoms such as intermittent abdominal discomfort, bloating or changes in bowel habit.
Diverticulitis
A diverticulum becomes acutely inflamed, sometimes with infection. Pain is usually more constant and may be severe.
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Symptoms of diverticular disease and diverticulitis
Diverticular disease can cause intermittent pain, often in the lower left abdomen, together with bloating, constipation or diarrhoea. Discomfort may worsen after eating and improve after passing stool or wind.
Acute diverticulitis more typically causes constant abdominal pain, often severe, and may be accompanied by fever, a sudden change in bowel habit, rectal bleeding or mucus. Symptoms can overlap with other bowel conditions, so do not diagnose based on symptoms alone.
In a minority of people, particularly some people of Asian origin, pain may occur on the right side rather than the left.
When to seek urgent medical help
Seek urgent GP or NHS 111 advice if abdominal pain is worsening or does not go away, you have a high temperature, blood or mucus in your stool, or persistent vomiting.
Call 999 or attend A&E for severe abdominal pain with vomiting, marked abdominal swelling, inability to pass stool or wind, heavy rectal bleeding, or symptoms suggesting sepsis such as confusion, very abnormal temperature or rapid breathing.
How is diverticulitis treated?
Treatment depends on whether the episode is uncomplicated or complicated and on the person’s overall health. Current NICE guidance does not recommend routine antibiotics for people with uncomplicated acute diverticulitis who are otherwise systemically well. Simple pain relief such as paracetamol and clinical follow-up may be appropriate.
Antibiotics are more likely to be recommended when a person is systemically unwell, immunosuppressed or has significant comorbidity. Complicated diverticulitis — for example an abscess, obstruction, fistula, perforation or peritonitis — may require hospital treatment, imaging, intravenous antibiotics, drainage or surgery.
Do not self-diagnose an acute attack. New severe or persistent abdominal pain should be medically assessed.
Diet, fibre, nuts and seeds
For people with diverticulosis or stable diverticular disease, NICE recommends a healthy balanced diet containing whole grains, fruit and vegetables. If fibre intake is low, increasing it gradually may reduce bloating and make it easier to tolerate.
You do not routinely need to avoid nuts, seeds, popcorn or fruit skins. Older advice often recommended avoiding these foods, but modern NHS, NICE and international guidance does not support a blanket restriction.
During an acute episode, diet may need to change temporarily, depending on symptoms and medical advice. Some clinicians recommend a short period of clear liquids or lower-fibre foods before gradually returning to normal eating as symptoms improve. The right approach depends on the episode’s severity and the person’s medical circumstances.
Common questions: charcoal, massage, baking soda and colon cleansing
Does activated charcoal help diverticulitis?
Activated charcoal is not part of current guideline-based treatment for diverticulitis. Doctors primarily use it for selected poisonings. It can bind medicines and nutrients and may cause constipation; bowel obstruction has also been reported in higher-risk settings. If you have diverticulitis symptoms, seek medical advice rather than treating the episode with charcoal.
Can abdominal massage help diverticulitis?
Abdominal massage has been studied for constipation in other settings, but it is not a treatment for an acute diverticulitis attack. Do not press or deeply massage a painful, tender abdomen when diverticulitis is suspected. Persistent or severe localised pain, particularly with fever or vomiting, needs medical assessment.
Does baking soda or sodium bicarbonate treat diverticulitis?
No current NHS or NICE diverticulitis guidance recommends baking soda or sodium bicarbonate to treat acute diverticulitis. Do not use oral bicarbonate or a bicarbonate bowel treatment as a substitute for medical assessment of abdominal pain or suspected inflammation.
Should I use an enema or colon cleanse during an acute attack?
No. At Parkland Natural Health, active diverticulitis is a contraindication to colon hydrotherapy. An acute episode can involve inflamed, fragile bowel tissue and may be complicated by abscess, obstruction or perforation. Seek medical care rather than attempting an enema or colon cleanse during an acute attack.
Can colonic irrigation cause diverticulitis?
Diverticulitis is inflammation associated with existing diverticula, and there is not good evidence that a professionally administered colonic is a routine cause of diverticulitis. However, colon hydrotherapy has recognised contraindications and should not be performed during active diverticulitis. New severe pain, fever, bleeding, or persistent symptoms after any bowel procedure should be assessed medically.
What does “microdiverticulitis” mean?
“Microdiverticulitis” is not a standard NHS patient term. People sometimes use it to describe a small or localised area of diverticulitis, or they may be referring to microperforation, which is a radiological finding that can occur in acute diverticulitis. These are medical diagnoses and should be assessed with appropriate clinical evaluation and imaging when indicated.
Colonic irrigation, diverticulitis and diverticulosis at Parkland
We do not provide colon hydrotherapy during active diverticulitis. If you currently have significant abdominal pain, fever, active bleeding, vomiting or another suspected acute episode, seek appropriate medical assessment rather than booking a colonic.
Diverticulosis is different. If diverticula are present without active inflammation, or you have a past history of diverticulitis that has fully settled, we can review suitability individually. Please tell us about your diagnosis, recent symptoms, medication and any previous bowel surgery before booking.
If screening shows that colon hydrotherapy is not appropriate, we will not proceed with treatment. If you have prepaid, Parkland’s current policy is to provide a full refund when a contraindication is identified during suitability screening.
Evidence and further reading
- NHS: Diverticular disease and diverticulitis
- NICE NG147: Diverticular disease — diagnosis and management
- NIDDK: Eating, diet and nutrition for diverticular disease
- American College of Gastroenterology clinical guideline on colonic diverticulitis (2026)
- NCBI Bookshelf: Activated Charcoal — uses and adverse effects
Parkland Natural Health · Holborn
Have a history of diverticulitis but feel well now?
Contact the clinic before booking. We can review your history and explain whether you can have a colon hydrotherapy appointment or need medical advice first.
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