What does a diverticulitis attack feel like?

When pouches in the gastrointestinal tract become inflamed, you could have an attack. Here’s what you need to know about symptoms, treatment, and prevention.

By Jennifer Wirth | Jun. 20, 2022 Medically reviewed by Jesse P. Houghton, MD, FACG

Diverticulosis occurs when small sacs or pouches, called diverticula, form in the wall of the gastrointestinal tract. By far, the most common location for these diverticula to occur is the colon. When one or more of these diverticula become inflamed or infected, the condition is known as diverticulitis.

“In order to have an attack of diverticulitis, you must have the predisposing condition called diverticulosis, in which small pouches, or diverticula, form in the wall of the colon,” says Max Pitman, MD, a medical director at Salvo Health and board-certified physician specializing in gastroenterology and internal medicine at Summit Health in Brooklyn, New York.

Although the formation of these diverticula occurs in more than 70% of people over the age of 80, the majority of people don’t experience symptoms or complications. In fact, less than 5% of people with diverticulosis ever develop diverticulitis, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

If you believe you may be experiencing a diverticulitis attack, here is what you need to know about the symptoms, treatment, and prevention.

What does a diverticulitis attack feel like?

Diverticulitis occurs when there is a tiny perforation of a diverticulum (often referred to as a microperforation). The truth is, we don’t know why someone with diverticulosis develops diverticulitis, although one theory is that “a small piece of stool gets stuck within a diverticulum causing the pouch to be blocked off,” Dr. Pitman says. “Once this occurs you can get a local infection within and around the diverticulum. This can also cause a lot of inflammation in the area, which ultimately causes pain.”

As a result, the majority of diverticulitis attacks are accompanied by abdominal pain or discomfort, most commonly in the left lower abdomen.

Other common symptoms of diverticulitis include:

Abdominal tenderness
Stomach cramps
Bloating
Constipation or diarrhea
Nausea or vomiting
Fever or chills
Decreased appetite

The pain most frequently affects the lower left side, but it can occur in the suprapubic (bladder) area and even the right lower abdomen.

There are additional warning signs of diverticulitis: “Sometimes a diverticulitis flare may cause difficulty having a bowel movement or cause thinner stools,” adds Michael Bass, MD, a medical director at Oshi Health and gastroenterology specialist in Delaware. “This is because the inflammation in the colon makes the center of the colon narrower.”

How long does a diverticulitis attack last?

Diverticulitis attacks can vary in frequency and severity. While some people have one flare, others can have several.

Dr. Pitman elaborates on this: “There is no clear pattern to when or how often the attacks occur. A mild attack might last a few days. Longer or more severe attacks may require hospitalization and multiple weeks of antibiotics. Sometimes pain or discomfort lingers for a few more weeks even after the attack has cleared.”

When to see a healthcare provider for diverticulitis symptoms

“If you think you might have diverticulitis, you should always see a healthcare provider,” Dr. Pitman advises. “A physical exam and/or diagnostic tests may be required to make the diagnosis. You should also seek immediate medical attention if you have a sudden change in bowel habits, severe abdominal pain, or abdominal pain associated with persistent fever and chills.”

If left untreated, the symptoms may continue to worsen and complications of diverticulitis can occur. Possible complications include:

Abscess formation, a painful area that may be swollen or pus-filled, as a result of infection
Fistula formation, which occurs when an abscess infection extends into another organ or area
Bowel perforation, which can result in pus or stool leaking into the abdominal cavity, causing a serious infection
Peritonitis, inflammation of the abdominal wall lining caused by bacterial infection, which is often the result of the rupture of an abdominal organ, such as the colon
Rectal bleeding, known as diverticular bleeding, is usually painless but may worsen with bowel movements. This is actually quite rare with diverticulitis, but is another complication of diverticulosis.

The symptoms of diverticulitis can also resemble other medical conditions, so it’s important to consult your healthcare provider for medical advice regarding your symptoms. Your provider will go through the process of making a proper diagnosis and help you get the treatment you need, before your condition worsens.

Diagnosis

In some cases, most commonly when there are no symptoms, your healthcare provider may notice diverticula during an exam for something else (most commonly during a CT scan of the abdomen). In this case, you will most likely not require any treatment.

However, if you are experiencing abdominal pain or other symptoms of diverticulitis, your primary healthcare provider may refer you to a gastroenterologist, a medical doctor who specializes in the health of the digestive tract, including the stomach, colon, and liver.

To make a diagnosis, your provider will start by reviewing your medical history and performing a physical exam. You will likely be asked to explain your symptoms, current diet, medications, and your bowel habits, including frequency and appearance. You will also be asked whether you have experienced these symptoms in the past and how often you recall experiencing them.

During the physical exam, your healthcare provider will check your blood pressure, heart rate, and temperature. They will also check for abdominal tenderness and any noticeable bulges in the abdominal region. They might also listen to your abdomen using a stethoscope. In some cases, a rectal exam may be performed during the physical exam.

Following the results of the physical exam, your healthcare provider may order additional tests to rule out other conditions that commonly resemble diverticulitis, such as appendicitis, irritable bowel syndrome (IBS), ovarian cysts, or a small bowel blockage. These tests may include:

Stool and blood tests
Pregnancy test
Pelvic exam
Imaging tests, such as CT, ultrasound, MRI, or X-rays
Colonoscopy

A diverticulitis diagnosis is usually confirmed with a CT scan. “Following a diverticulitis attack,” Dr. Pitman says, “a colonoscopy is generally used to check on the colon six to eight weeks after the attack has passed.”

Treatment

Treatment for diverticulitis will vary with the severity of the case. Mild, uncomplicated diverticulitis can resolve on its own. In cases where diverticulitis does not resolve on its own, your healthcare provider will recommend a treatment plan. It’s important to follow your treatment plan to reduce the risk of complications as a result of your diverticulitis.

Your healthcare provider may recommend one, or multiple, of the following treatment options:

Adjusting fiber intake: Consuming high fiber foods, such as whole grains and vegetables, can help move stool through the digestive system. While a high fiber diet is believed to lower the risk of future attacks of diverticulitis, during and immediately after an attack of diverticulitis, a low fiber or low residue diet is recommended. Fiber supplements like Benefiber or Metamucil may be helpful.
Using stool softeners: This may help reduce constipation and allow stool to move more easily through the digestive system. Common over-the-counter stool softeners include colace and mineral oil.
Consuming a clear liquid diet: This may allow the bowels to rest, allowing time for inflammation to improve as a result.
Taking antibiotics: This is commonly used to fight infection. Common antibiotics prescribed for diverticulitis include ciprofloxacin or moxifloxacin combined with metronidazole.
Taking antispasmodics: This is commonly used to relax the smooth muscle of the intestinal wall and reduce abdominal pain that results from diverticulitis and even symptomatic diverticulosis. A common antispasmodic prescribed for diverticulitis is hyoscyamine sulfate.
Colonics or colon hydrotherapy: This is done to flush the colon and reduce severe constipation. While not considered a medical treatment, some people find benefit in this holistic preventive treatment.
Surgery: This is usually reserved for severe, complicated, or recurrent diverticulitis. A sigmoid resection, known as sigmoidectomy, is the most common type of surgery for diverticulitis, since the sigmoid colon is the most common location of diverticulosis.

“On occasion, mild cases of diverticulitis may require bowel rest and a clear liquid diet for a few days; most cases, however, are treated with antibiotics,” Dr. Pitman says. “Depending on the severity, this could be oral antibiotics in the outpatient setting or IV antibiotics in the hospital. Occasionally, surgery or a drainage procedure is required for more severe cases.”

Talk to your healthcare provider about the pros and cons to each treatment option, as not every option will be right for everyone. For example, surgery will generally not be recommended to someone who has not had recurring instances of diverticulitis symptoms. Your healthcare provider will work with you to determine the best treatment options for you based on the frequency and severity of your symptoms.

RELATED: Benefiber vs. Metamucil

Prevention

In most cases, experts suggest that diverticular disease is not only treatable, but also preventable. There are steps you can take to improve the overall health of your digestive system and prevent future attacks of diverticulitis, including:

Increase fiber intake. A low-fiber diet is associated with the development of diverticulosis and diverticulitis. A high-fiber diet helps soften the stool and reduce constipation.
Drink plenty of fluids. This helps soften the stool and prevent constipation.
Limit consumption of red meat and animal fats. A diet high in animal fats has been linked to diverticulitis.
Maintain a healthy weight. Obesity may also increase your risk of diverticulitis.
Exercise regularly. Regular exercise has been proven to promote normal bowel function and reduce constipation.
Avoid or limit the use of certain medications. Opioids, steroids, and nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may increase your risk of diverticulitis flare ups.
Do not smoke. Smoking is considered a risk factor for diverticulitis.

If you have experienced diverticulitis flare-ups in the past, you should consult with your gastroenterologist or other healthcare provider. They will help you identify any changes to your lifestyle or diet that could help prevent diverticulitis flare-ups in the future.