Why does diverticulitis keep coming back?
Diverticulitis can keep coming back when the deeper conditions that make those pockets inflamed never fully get addressed. In this script, Dr. Kenny explains that the issue is often not just “infection.” It can involve a stressed gut lining, microbiome imbalance, slower motility, local inflammation, and even chronic stress shaping how the gut behaves.
It is not just about having diverticula
One of the most important points in the script is that diverticulosis and diverticulitis are not the same thing. Many people have diverticula, little pockets in the colon wall, and never develop inflammation. So the better question is not just “Why do I have pockets?” but “Why are these pockets getting irritated and inflamed?”
That shift matters. It moves the conversation away from a one-time infection story and toward a root-cause investigation. As a functional medicine practitioner, I think that is where the detective work really starts.
The gut environment may be setting the stage
The video explains that newer thinking is looking more closely at the environment inside the gut itself. That includes:
- the balance of the microbiome
- the health of the gut lining
- local immune activity
- low-grade inflammation in the wall of the colon
Dr. Kenny also points to butyrate, a short-chain fat made by beneficial bacteria, as an important piece of this conversation. Butyrate helps support the colon lining and calm inflammation. When that system is not working well, the terrain may become more prone to flare.
At Dr. Kenny’s clinic, we often look at recurrent digestive issues this way. Not as random bad luck, but as a sign that the gut environment may be asking for a closer look.
Motility and pressure can matter too
The script also highlights motility, how well the digestive tract moves. If stool is moving slowly, pressure inside the colon can build and the local environment can change. That does not guarantee diverticulitis, but it can become part of the pattern.
This helps explain why the old, simple story about one food or one bad meal does not hold up very well. The issue is often broader than that. It may involve how the bowel is moving, what the microbiome is producing, and how inflamed or resilient the tissue is overall.
Stress and the gut-brain connection are part of the story
The script also brings in something many people overlook, the nervous system. Chronic stress can shift motility, change immune tone, and alter the gut environment over time. So even though stress is not the whole story, it can absolutely help keep the cycle going.
That does not mean every recurrence is your fault or “just stress.” It means the gut is connected to a larger system. If diverticulitis keeps returning, the most helpful next step is often to zoom out and ask what keeps making the colon more vulnerable in the first place. That is a much more useful question than only asking how to suppress the next flare.
Additional Resources:
- If you want to look deeper at what may be happening inside the gut itself, Should I Get a Functional Medicine Stool Test for Gut Health? shows how microbiome balance, inflammation, and gut immune patterns can shape chronic digestive symptoms.
- If your digestive symptoms seem to come with fatigue, anxiety, or brain fog, Can gut problems cause fatigue, anxiety, or brain fog? helps connect the gut-brain and immune pieces that often make recurrent issues feel bigger than digestion alone.
- In New Data on How to Treat Diverticulitis, Dr. Kenny explains why uncomplicated diverticulitis may not always behave like a simple infection, and why looking at the gut environment matters when flares keep returning.
- A 2023 meta-analysis of randomized trials found that many people with acute uncomplicated diverticulitis recovered just as well without antibiotics, which supports the idea that every flare is not driven by infection alone.
If you are tired of treating the flare but never understanding the pattern behind it
Answered by Dr. Kenny Mittelstadt, DACM, DC, IFMCP
Certified functional medicine practitioner specializing in advanced lab testing and personalized healing protocols to uncover root causes of health roadblocks.