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Diverticular Disease


ID: 050404123

Science Topic

Diverticular Disease

Diverticulosis, Diverticulitis, and Diverticular Bleeding

Education Center | Course ID: 050404123

Publication Details

Author: Finn Vortex

Published: 20 April 2023

Updated: 20 April 2023

Duration: 10 Minutes

Executive Summary

Detailed examination of diverticulosis, diverticulitis, and diverticular bleeding, including the disease process, risk factors, and treatment. Interventions in fisting and lifestyle that diminish flare-ups of diverticulitis. Mental health considerations and communication strategies for play partners and interactions with healthcare providers.

Seek medical advice from licensedprofessionals only.

Do not base your healthcare decisions solely on the information contained in this topic. Only your healthcare provider has a full understanding of your condition, its severity, and other comorbidities that may affect healthcare outcomes.

All ailment related topics at Fist Theory™ are designed to help improve communication with your healthcare provider. See Healthcare Providers for further information.

If you have firsthand experience with diverticular disease and would like to provide insight or correct any misinformation in this topic, please use the Help Wanted link at the bottom of this course.

Disease Overview


Diverticular disease is an umbrella term for three conditions that affect the lining of the fist chute: diverticulosis, diverticulitis, and diverticular bleeding. The defining characteristic of each diverticular disease is the development of diverticula which are small, protruding pouches (sacs) that present along the intestinal walls of the upper fist chute. The status of the diverticula determines the diagnosis:

  • Diverticulosis | Manifestation of the pouches along the intestinal wall, usually in the sigmoid colon.
  • Diverticulitis | Inflammation of the pouches, which is often very painful.
  • Diverticular Bleeding | Rupture of blood vessels within the pouches that results in moderate to heavy bleeding (typically beyond pink).
Image Description in Title Case
Figure 1-1: Upper Fist Chute Diverticula

Inflamed or non-inflamed diverticula typically present in the sigmoid colon but may also appear in the descending and transvers colons.

The precise cause of diverticular disease is not well understood, but it is thought to be related to changes in the strength and elasticity of the colon wall, as well as changes in the diet and lifestyle of the individual.


Diverticulosis is usually asymptomatic. As such, it is often undiagnosed or only diagnosed during examinations for other issues.

The symptoms of diverticulitis include severe, left-sided, abdominal pain, nausea, fever, constipation or diarrhea. The pain may start slowly or appear suddenly. If rupture occurs, a hospitalization is typically necessary to prevent serious illness or death.

Bloody stool or passing blood are signs of diverticular bleeding and require immediate medical attention to avoid severe, life-threatening shock.

Risk Factors

While it is true that fisting can thicken the intestinal walls, this thickening is usually limited to the rectum. Since diverticula appear in the upper fist chute, this thickening has little effect on development of diverticula. No studies exist regarding the long-term effects of fisting on the colon; however, regular agitation of tissues often speeds up disease processes with age.

The following are non-modifiable risk factors for developing diverticular disease:

  • Genetics | In men below age 40, the appearance of diverticula is likely related to genetic factors.
  • Age | Diverticula typically develop mid-life (40-50). By age 80, most individuals have some diverticula present in the colon.

There are several modifiable risk factors for developing diverticular diseases:

  • Diminished Physical Fitness | Lack of exercise and obesity create additional strain on the colon.
  • Drugs and Chems | Smoking, steroids, anti-inflammatories(ibuprofen, aspirin, etc.), lubrications, and booty bumps weaken or erode tissue lining.
  • Diet | Low fiber high fat diets affect passage of stool and increase pressure on the colon walls.
  • Excessive Douching | Repeated flushing and disruption of healthy gut flora allow unhealthy bacteria to agitate the intestines, disrupting normal immune responses.
  • Pressure | Heavy ass play triggers mucosal sloughing, exposing the colon to irritants such as chems, drugs, and intrusive gut flora.


Preventative measures for these conditions include high diet, exercise, hydration, and probiotics. Specific details are discussed in Diet, Nutrition and Supplements (below).

Treatment of diverticulitis depends on the severity of symptoms. In mild cases, a low fiber diet may be prescribed to allow the colon to rest, followed by a gradual transition to a high fiber diet once healed. For more severe cases, treatment may involve antibiotics to prevent sepsis, and hospitalization may be required to rule out perforation. During hospitalization, intravenous fluids may be given while oral fluids and food are withheld to allow the colon to rest. Anti-diarrheal medications such as Lomotil and Imodium AD are not advised.

Diverticular bleeding can be—but is not always indicative of perforation. Abdominal x-ray, CT scanning, and lab tests may be required to rule out perforation. Once symptoms subside, a gastroenterological surgeon may conduct a sigmoidoscopy and perform endoscopic proceduresto remove diverticula or seal up problematic vessels. In severe cases of diverticular bleeding and diverticulitis, portions of the colon may need to be removed.

Fisting is permissible when asymptomatic. During flare-ups of diverticulitis or diverticular bleeding, do not fist. Wait six weeks from the last date of symptoms before returninging to bottom. The six-week waiting period is based the logic and rationale followed by gastroenterological surgeons. It is medically prohibited to perform endoscopies and sigmoidoscopies for four-to-six-week period following flare-ups.

Physical and Physiological Considerations

After receiving a diagnosis of diverticular disease, your fisting practices, preparation, and routines will require some modification. The level of behavioralchange is based on your risk tolerance and your knowledge regarding the disease.

Risk Mitigation

Diverticular diseases increase your perforation risk because the intestinal lining is weaker and cannot withstand elevated pressure. When coupled with extreme forms of fisting such as depth play, punch play (which increases air pressure), pistoning, width play/extreme stretching, and aggressive 'hole-wrecking', the chance of perforation increases.

Traditional, Slow, Erotic Fisting (Nates)
Figure 2-1: Serenity in Traditional Fisting

Erotic, sensual fisting is an alternative for riskier fisting practices that can agitate the upper fist chute. Credit: Nate Grimes and Nate Stetson.[1]

Diverticula are typically located in the upper fist chute, so traditional fisting has minimal effect on the disease. As a reminder, traditional fisting:

  1. remains confined to the lower fist chute (no attempts at depth fisting),
  2. minimizes extreme movements in the lower fist chute that can agitate the upper fist chute (no rapid pistoning, extreme back-and-forth motions, or prolapsing attempts), and
  3. avoids pumping air into the sigmoid (no punch fisting or gape development/training).

Because diverticular disease manifests differently in every individual, some fisters may be include depth, punch, girth or piston play in their sessions. Several sessions with a trusted friend can help identify allowable practices.

Tactics that help decrease your chance of injury with diverticular disease include:

  • Learning About Your Condition | Apart from knowing the information here, speak with your primary healthcare provider and gastroenterologist to ascertain the scope and severity of your condition. Minor cases generally require less behavioral modification.
  • Enhancing Topping Skills | Improve your topping skills while your hole is off limits.
  • Eliminating Extreme Fisting Practices | Punching and pistoning put additional stress on diverticula. Eliminate deep punching and pistoning and decrease shallow punching. Avoid extremely firm and extremely textured toys that are longer than 20 cm (8 inches).
  • Monitoring Bleeding | Halt any fisting with the appearance of blood, especially darker blood that indicates more than just capillary damage.
  • Allowing Time for Healing | Fisting causes inflammationof the colon. Increase the number of days between sessions to allow the fist chute to rebound.
  • Making Lifestyle Changes | Begin regular exercise and eat a high fiber diet supplemented with prebiotics and probiotics.
  • Discontinuing Contraindicated Medications | Oral and topical steroids decrease the production of collagen, which is an essential component the lining of the fist chute. Use should be limited for prescribed purposes only. NSAIDs, such as Ibuprofen, can erode the lining of the intestine and should be used sparingly. See Table 2-1 for medications that should be avoided.
Topical Steroids


  • Lidocaine/Hydrocortisone Cream
  • Hydrocortisone Cream
  • Fluticasone Cream
  • Triamcinolone Foam

Typical Suffix: -sone

Purpose: Alleviates itching and swelling

Anabolic Steroids


  • Testosterone
  • Nandrolone
  • Stanozolol
  • Oxandrolone

Typical Suffix: -olone

Purpose: Build muscle mass

Oral Steroids


  • Prednisone
  • Hydrocortisone
  • Methylprednisolone
  • Dexamethasone

Typical suffix: -sone

Purpose: Alleviate inflammation



  • Ibuprofen
  • Naproxen
  • Voltaren Cream
  • Aspirin

Typical Suffix: None

Purpose: Pain relief, decrease swelling

Table 2-1: Contraindicated Medications

Various medications can weaken the lining of the intestinal tract and increase perforation and bleeding risk. For those with diverticular disease, long term use of these medications can increase risk of perforation.

Diet, Nutrition, and Supplements

Diet for diverticulosis, the benign stage of diverticular disease, corresponds with the fisting clean-out diet. It is high in fiber and potassium rich fruits and vegetables, which help maintain bulk, healthy gut bacteria, and electrolyte balances.



  1. Noun Foods or supplements such as yogurt that contain live microorganisms that will improve or maintain the normal, healthy gut microflora.


  1. Noun High fiber foods that feed existing microflora, such as bananas, greens, and artichokes.

During diverticulitis, fisters should switch to low fiber diets to prevent excess pressure on the colon walls or blockage of individual diverticula. If severe diverticular bleeding is present, a hospitalist may recommend a liquid diet until the colon has rested and recovered. Maintaining full hydration also decreases constipation that can lead to diverticulosis.

Prebiotics and probiotics should be used on a daily basis to maintain a healthy colony of gut bacteria. Once a healthy colony is established, non-digestible fibers, such as raisins, apple with skins, corn, and mushrooms play a restorative role in lower intestinal colonization. Undigested items help transport healthy bacteria to lower areas of the digestive tract.

Green Apple
Yakurt Probiotic Yogurt
Figure 2-2: Foods for Managing Healthy Gut Bacteria

Probiotics (such as Yakurt), preboitics (artichokes), and transport mechanisms (apple skins) help create and nourish a healthy colony of intestinal bacteria. Some fisters with diverticular disease have indicated this diet therapy keeps flare-ups at a minimum.


Douching routines vary based on the severity of diverticular disease. During a flare-up of diverticulitis or diverticular bleeding, anyone should avoid douching to allow the colon to rest. With diverticulosis, douching is allowed, but may require some modification.

Use the scientific process to determine an appropriate clean-out routine after being diagnosed with diverticular disease. First, try your regular clean-out routine without any subsequent play. Avoiding play after your clean-out will allow you to assess your clean-out tolerance. Although it is a "wasted clean-out" because you will not play after, it is an essential step to establishing routines that do not trigger flare-ups of diverticulitis.

If your regular routine causes flare-ups, consider a gentle clean-out routine. This new routine should involve use of gravity enemas instead of shower shots. It may also take several rinses over a couple of hours to achieve the desired level of clean-out.


Some lubricants can irritate the diverticula, clog the diverticula, or feed unwanted bacteria.

Semi-solid lipid lubes, such as Crisco© may clog the diverticula and trigger flare-ups. J-lube contains a sugar substance that feeds harmful bacteria. These lubes may therefore be contraindicated.


Play Modifications

Because each person reacts differently to the disease, restrictions and modifications can vary substantially. Once your diverticular disease is under control, some modifications may be necessary. Minor cases of diverticulosis often require little, if any changes to play.

Restricted Activities

The location of diverticula, the quantity of diverticula, and the colon's response to stimulation will restrict your play.

Keep a diet and activity journal so that you can identify activitiesand foods that irritate your colon. Because diverticulitis may not manifest immediately, it is important to have a record of food consumption and activities that occurred in the days prior to the flare-up. This helps you identify activities that should be eliminated.

Suggested guidelines include the following:

  • Restrict bottoming during a flare-up of diverticulitis or diverticular bleeding.
  • Avoid depth play and direct manipulation of diverticula.
  • Eliminate activities that introduce air into the sigmoid colon, such as punch fisting. Pressure from air can inflate diverticula and increase the risk of rupture.
Diverticulosis Proceed with Caution
Diverticulitis Abstain until abdominal pain resolved for two weeks
Diverticular Bleeding Abstain for eight weeks after bleeding ceases
Table 3-1: General Guidelines

Standard wait times for stages of diverticular disease. Your diet and activity journal may indicate shorter or longer abstention periods.

Modified Techniques

Many men with diverticulosis continue fisting without issues after making lifestyle changes.

As mentioned previously, record details about your session for future reference. If you have issues after you play, you can refer to your journal and modify behaviors during your next session.

Consider the following modifications to your fisting sessions:

  • Limit your play to elementary activities in the lower fist chute. Do not attempt to penetrate the second ring. Balling the fist once it has penetrated the anal canal helps prevent unintended probing into the sigmoid colon.
  • Truncate the length of your session. The longer the session, the more likely tissue swelling along the entire course of the fist chute will occur, even if no depth play occurred.
  • Reduce extreme girth play. Choose the least taxing activities for your fist chute. For example, a focus on doubles is likely to result in systemic inflammationof the entire colon.

Toy Considerations

Because diverticulitis almost always occurs in the upper fist chute, you should limit your toys to plugs and realistic sizes. Exclude toys that are longer than 20 cm (8 inches) and always purchase softer toys.

SquarePegToys offers a large variety of toys in this range in Supersoft Bronze™. Increased pressure in the rectum can stimulate the sigmoid. This stimulation may trigger inflammation in the upper fist chute. Consider borrowing large girth toys from friends to determine if use is detrimental to your condition.

Charlie Horse Kidney Butt Plug
Figure X-X: Charlie Horse Kidney

SquarePegToys' Charlie Horse Kidney measures 14 cm (5.5 inches) by 15.5 cm (6 inches). This plug is unlikely to trigger flare-ups.

Psychological and Social Considerations

Mental Health

Any health condition that affects the fist chute can cause anxiety and significant mental distress. Learning that a core element of one's sexual identity may be limited is difficult and often requires the help of mental health professionals. They can help you develop coping mechanisms and explore options that allow you to live your best life, including how to successfully abstain from activities that trigger flare-ups.

If your diverticular disease is severe and requires abandoning bottoming altogether, a counselor is often needed to process grief, develop new identities (as a top, for example), and decrease anxiety.

Session Communication

Some bottoms find it difficult to express their needs due to a fear of being labelled "bossy" or overbearing. A majority of bottoms assume that the top is intuitive enough to ascertain discomfort or assess abnormalities within the fist chute and then alter fisting techniques to accommodate variances or pain. These assumptions and aversions can lead to discomfort, disconnection, and even injury.

With a diverticular disease diagnosis, always start your session with a discussion of your hole. A good top will usually start a session with the request "tell me about your hole." If he does not ask, then volunteer the information. Let him know that you have diverticulosis that can be exacerbated into diverticulitis if he goes "apeshit" on your hole. This will lead into conversations about what makes you feel good, what puts you at ease, and how he can make your hole (and you) happy.

Conversations with Healthcare Providers

Fisters with diverticular disease typically have a primary healthcare provider and a gastroenterologist. Frank conversations about your fisting habits can help them keep you healthy. Do not withhold information from them if you intend to continue fisting after your initial diagnosis.

Topics that should be discussed regarding fisting—specifically related to diverticular disease include:

Include Medical Rationale Down Arrow
  • General proclivities including type of and intensity of play, such as:
    • Depth Play | Including details about how deep, pistoning stroke, and pace of depth movement
    • Punch Play | Including details about style (open/closed fist), extraction (full/partial), pace (fast/slow), and rate (number of consecutive or near-consecutive punches)
    • Width/Girth Play | Including circumference, depth, and punch practices (doubles is the same as jack-in-the-box)
    • Toy Play | Including firmness, width, depth, pace, and rate
  • Lubrication details including type and characteristics, such as:
    • Category | Specifically lipid, PEO, other emulsifiers, petroleum, or silicone (tip: physicians may recognize PEO lubrication as obstetrical lube or veterinary lube)
    • Additives | Specifically analgesics (such as lidocaine, witch hazel), cooling agents, warming agents, or sugars (in the case of J-lube)
    • Quantity | How much and how frequent of application, including any injection practices
    • Communal Lube / Contamination Practices | Such as lube sharing, BYOL, hygienic practices between multiple partners
    • Post Play Lube Douche | Practices to internally rinse and expel excess lube
  • Clean-out routines, including duration, water-flow intensity, laxatives use, and fiber intake
  • Frequency of play
  • Discomfort during or after play (any)
  • Medication and chem usage, such as:
    • Anabolic Steroids | For muscle gain or hormone replacement
    • Corticosteroids | Typically prescribed for other illnesses
    • Topical Steroids | Treatments for inflammation and swelling, especially if used inside the hole
    • Oral Anti-inflammatories and Pain Relief | Specifically NSAIDs (ibuprofen, naproxen) and aspirin including frequency of use
    • Topical Analgesics | Including Voltaren cream or Lidocaine or any substance inside the hole
  • Quantity and location of diverticula
  • Screening tools and frequencies (including colonoscopies)
  • Value and importance of fisting in your life
Doctor Office Communication Doctor Office Communication Doctor Office Communication Doctor Office Communication
Figure 3-1 to 3-4: Doctor-Patient Privilege

Open communication with your healthcare providers allows them to customize care for your specific needs.[2, 3, 4]


Your fisting revelations to your healthcare providers are important. Without covering the information above, they may not diagnose you correctly, they may prescribe unnecessary medications and testing, and they may not offer sound medical advice for you. Their focus may be on abstinence only—especially with providers who aren't familiar with fisting culture.

You can help improve your providers' knowlege by supplying them with the following data sheet:

PDF Icon   050404123-01 Diverticular Disease and Fisting - Data Sheet

Content Development

The following material is under consideration in the development of this topic:


Upon completing this course, the student will be able to:

  • Differentiate between diverticulosis, diverticulitis, and diverticular bleeding.
  • Identify what social and emotional changes may need to be made with a diagnosis diverticulitis
  • List the major risks of bottoming with diverticular diseases.
  • Identify changes to clean-out routines that can decrease risk of exacerbation.

Note: Objectives should follow instructional design standards and be easily measurable with little ambiguity.

Supplemental Content

Blog Articles

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F2 Promotional Materials

  • Thursday Erotica/Nuerotica:
  • Skills:
  • Protocols:
  • FWOTD:
    • Diverticular Disease
    • Diverticulitis
    • Diverticulosis
    • Prebiotics
    • Probiotics
    • Word #6
    • Word #7

Outline (Proposed)

  • Diverticular Disease
  • Overview
  • Symptoms
  • Risk Factors
  • Treatment
  • Physical and Physiological Considerations
  • Risk Mitigation
  • Diet, Nutrition, and Supplements
  • Clean-out
  • Play Modifications
  • Restricted Activiites
  • Modified Techniques
  • Toy Considerations
  • Psychosocial Considerations
  • Mental Health
  • Session Communication
  • Conversations with Healthcare Provider