Diverticulitis is a condition where small pockets (diverticula) in the large intestine become infected or inflamed.
Typical symptoms of diverticulitis include lower abdominal pain, fever, change in bowel habits, and nausea.
Diagnosis can be made by a combination of typical symptoms, an exam by a healthcare provider, lab testing, and imaging.
Treatment includes bowel rest, a liquid diet, antibiotics, and anti-spasm or pain medications.
Mild cases may be treated as an outpatient condition. However, more severe cases of diverticulitis require hospital admission and IV antibiotics.
Individuals over 70 are the most common age group to develop diverticulitis, but even people in their 30s and 40s can experience signs of this digestive tract condition. Abdominal pain on the lower left side of the body and fevers or chills, though common for numerous ailments, could indicate diverticulitis.
Nearly 200,000 individuals in the United States are hospitalized with diverticulitis every year. If you have been diagnosed with diverticulitis, understanding your condition and managing your symptoms naturally, with medication, or surgically is necessary to maintain health and wellness.
Diverticulitis is a condition in which small pouches called diverticula develop in the large intestine (most commonly the sigmoid colon) and become inflamed or infected. Diverticula or the pouches alone are not harmful to the individual and are referred to as diverticulosis. Undigested food can get caught in the diverticula and cause irritation and inflammation. Once the pouches become infected and diverticulitis develops, treatment is usually needed.
If left untreated, diverticulitis can lead to an abscess outside the lower part of the bowel, usually in the sigmoid colon region. Sepsis or bowel obstruction, requiring emergency surgery, can also occur if diverticulitis symptoms are ignored.
Abdominal pain in the lower left quadrant is one of the main symptoms associated with diverticulitis. Fever, chills, diarrhea or constipation, bloating, nausea, and vomiting are additional symptoms of diverticulitis. While rectal bleeding can occur as a complication of diverticulosis, bleeding and diverticulitis rarely occur together.
Men are more likely to develop diverticulitis than women. If you are of a certain age and are experiencing these symptoms, your doctor may suspect diverticulitis. Other conditions, such as Irritable Bowel Syndrome (IBS) or colitis, may have symptoms similar to those of an episode of diverticulitis, so your healthcare provider will need to systematically review your health.
Your physician will ask you numerous lifestyle questions and perform a physical examination to determine if you need to undergo testing for diverticulitis. Individuals who do not exercise and are overweight are at increased risk of diverticulitis. Individuals who lack dietary fiber are also at increased risk. In addition, a diet high in fats can increase the potential for pouches to develop in the intestines, which may then become inflamed.
The use of opioids and steroids can also lead to an episode of diverticulitis. In addition, your healthcare provider may ask if you frequently use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. The use or overuse of pain relievers is also linked to episodes of diverticulitis.
A physical exam, including temperature and weight, and checking the abdomen for tenderness is part of the process of diagnosing diverticulitis. Women often undergo a pelvic exam and a pregnancy test to rule out other conditions, including the possibility of pregnancy.
Generally, patients concerned about diverticulitis may need to submit urine or stool samples. Blood tests may also be required to check for an increased white blood cell count that could indicate an infection. Once the blood and urine results are examined (or if there is an urgent need), X-rays or a CT scan can be ordered to confirm a diagnosis of diverticulitis. Urgent colonoscopy is typically avoided if diverticulitis is suspected, given the increased risk for colon perforation in this situation.
CT Scan is short for computed tomography scan. An intravenous (IV) or oral contrast solution such as barium sulfate is often used to enhance the CT scan to identify conditions like diverticulitis in the large intestine. The contrast solutions used for CT scans allow better visibility of the body’s internal workings. The severity of the condition can also be determined through this process.
Similar to CT scans, X-ray technology can be used to examine the intestines, although X-rays are much less sensitive to abnormal findings than CT scans. Again, a contrast solution can be used with certain X-rays to create a better image for the radiologist to review. X-rays of the lower GI tract can be assessed for complications associated with diverticular disease. An X-ray will show if there has been a perforation or if the colon is blocked with stool.
A colonoscopy is an internal examination of the colon and lower bowels. A lit tube with an image transmitter (camera) is inserted in the rectum to gain visual access to the problem area. The doctor will be able to see the diverticula and determine what treatment options are needed. In addition, a colonoscopy can help eliminate other conditions, such as colon cancer. Doctors usually wait four weeks after a bout of diverticulitis before performing a colonoscopy, given an increased risk for bowel perforation with acute diverticulitis.
Mild diverticulitis may heal with diet modifications, stool softener, rest, or oral antibiotics to fight infection. If the diverticulitis disease progresses (worsening symptoms, fevers, increased pain) due to lack of treatment, intravenous antibiotics, hospital admission, and even surgery may be necessary to properly treat the condition.
Your physician may refer you to a general surgeon, colorectal surgeon, or gastroenterologist to determine if surgery is necessary.
Antibiotics, anti-spasm, and pain medications are included in the possible pharmaceutical treatments recommended for managing acute diverticulitis.
Antibiotics are used to treat infections that can occur in acute diverticulitis. Ciprofloxacin, levofloxacin, metronidazole, amoxicillin-clavulanic, and moxifloxacin are typically prescribed to treat diverticulitis-related infections. Intravenous antibiotics are typically used for hospitalized patients. In this case, Zosyn (piperacillin/tazobactam) or Unasyn (ampicillin/sulbactam) may be prescribed.
Muscle relaxants may help reduce spasms in the large intestine due to peritonitis or irritated soft tissue. Levbid or Bentyl (dicyclomine) may be prescribed to aid spastic muscles related to diverticulitis.
When patients require hospitalization with acute diverticulitis, stronger pain medications are often needed to control pain. In this situation, Tramadol or Toradol may be used. If pain is still not controlled, narcotic pain medications may be necessary in the short term. Oral oxycodone or Oxycontin may be used, or IV morphine or Dilaudid can be used temporarily.
Treating diverticulitis with prescription medication can often prevent the need for surgical intervention. Below is a list of some of the top medicines that are used in treating diverticulitis.
| Drug name | Learn more | See SingleCare price |
|---|---|---|
| Levbid | levbid details | Get free coupon |
| Hyoscyamine ER | hyoscyamine-sulfate-er details | Get free coupon |
| Anaspaz | anaspaz details | Get free coupon |
| Hyoscyamine | hyoscyamine-sulfate details | Get free coupon |
| Augmentin | augmentin details | Get free coupon |
| Amoxicillin-Clavulanate | amoxicillin-pot-clavulanate details | Get free coupon |
| Flagyl | flagyl details | Get free coupon |
| Metronidazole | metronidazole details | Get free coupon |
Prescription medicine, such as antibiotics or anti-spasm medications, is often needed to fight infection and reduce pain associated with diverticulitis. Every medication has a list of potential side effects. The most common side effects of diverticulitis medication are nausea, vomiting, headache, dizziness, constipation, and confusion. Additional side effects are also listed in the table above.
See your medication label or talk to your doctor or pharmacist for more information regarding the side effects associated with your prescription. Be sure you are taking your medication as prescribed, and follow up with your doctor if your medication is giving you unwanted side effects.
A variety of home remedies can naturally help relieve symptoms associated with diverticulitis, especially mild cases. Rest is often recommended for individuals with mild or moderate diverticulitis. A liquid diet or a clear liquid diet is another way to allow the intestinal tract to heal naturally.
A liquid diet allows the bowels to empty and inflammation to clear up. Undigested food debris can be flushed out of the bowels during a liquid diet regimen, and bloating pressure can be relieved. Broth, ginger ale, tea (especially green tea), and clear sports drinks can be consumed on a clear liquid diet. Juices like apple or white grape can give you energy while cleansing and resting the intestines. Almost any juice can work as long as the juice does not contain pulp. A less strict liquid diet or soft food diet can also be beneficial if you are suffering from diverticulitis. Gelatin and apple sauce are among many foods that can soothe an infected bowel.
If you are not able to completely go to a liquid diet, a modified diet reducing foods that aggravate the diverticula is suggested. In addition to eliminating diverticulitis triggers, individuals are recommended to increase their intake of foods that support digestive health.
Avoid red meat, fried foods, nuts, corn, and processed foods. Dairy can irritate or soothe some individuals. Take personal notes on what foods trigger or comfort your intestines.
While a high-fiber diet is recommended for long-term digestive health, a low-fiber or low-residue diet is recommended in an acute bout of diverticulitis and for a couple of weeks afterward. A low-residue diet limits raw vegetables, fruits with skins, and nuts. If at least a couple weeks have passed since your bout of diverticulitis and you are consuming solid foods, whole-grain bread, pasta, and cereals can be gradually incorporated into your daily meal plan. Adding almost any kind of beans, rice, vegetables (potatoes or squash), and fruits (pears, peaches, and apples) can increase your fiber intake. Prune juice is also helpful for bowel health.
Green tea, aloe vera juice, turmeric, spinach, garlic, and ginger have healing properties to support healthy digestion. Superfoods are sometimes considered natural medicines, so ask your doctor what superfoods you can include in your daily diet.
Digestive enzymes and probiotics are available over the counter to promote healthy digestion. Enzyme supplements, similar to the enzymes occurring naturally in your stomach and pancreas, can increase your body’s ability to digest food.
Management of acute uncomplicated diverticulitis may include the use of probiotics. Probiotics support healthy bacteria in the gut, allowing better digestion. Naturally found in fermented foods like sauerkraut and yogurt, probiotics can be purchased in powder or capsule form. Taking a daily probiotic can help aid digestive health and normalize bowel function. If you are taking an antibiotic, your doctor may recommend a probiotic to counterbalance the removal of necessary bacteria. The current literature is inconclusive regarding the impact of probiotics on diverticulitis. However, more research is needed in this area.
Fiber supplements such as Metamucil can help keep the bowels moving regularly. Usually, fiber comes in a powder mix that is added to water and drank once a day, usually in the morning. Fiber substances may initially cause bloating and gas, but over time, they can be extremely helpful in reducing constipation, which puts stress on the colon. While fiber supplements should not be used during a bout of acute diverticulitis, they are helpful in the long-term management of diverticular disease.
Colonics or colon hydrotherapy is a method of irrigating the colon using large volumes of water. While a colonic can be helpful in cleaning out the bowels, especially if you are constipated, risk factors are involved. The colonic process could be irritating to the intestinal tissue and cause damage. Data regarding its beneficial effects for patients with diverticulitis is limited, and safety is a concern. Colon hydrotherapy should be avoided in acute diverticulitis. If you have chronic diverticulosis and are considering colon hydrotherapy, consult your healthcare provider first.
Although certain risk factors can increase the risk of diverticulitis, it is not known which patients will develop it. Age and stress on the colon from constipation over a lifetime can increase the risk. Undigested foods that get trapped in pockets in the intestinal lining can irritate the condition.
Rest and a low-residue diet can potentially alleviate a mild case of diverticulitis. Drinking a clear liquid for 24 hours is a good way to rest your GI tract if you are experiencing diverticulitis symptoms. If conservative management is ineffective, antibiotics may ultimately be needed to treat diverticulitis infections.
Pain in the lower left quadrant of the abdomen, bloating, and stomach cramps are typical of diverticulitis-related pain. The pain may last several hours to a few days and range from a mild “uncomfortable” feeling to severe, unrelenting pain.
Generally, diverticulitis is not a serious condition, but if left untreated, it can lead to complications such as an abscess or even a possible colon resection surgery.
A diet high in fried foods and red meat may irritate the intestinal lining, increasing the risk for diverticulitis flare-ups. Despite popular belief, nuts, seeds, and popcorn are safe for people with diverticulosis. Studies have shown that these foods do not increase the risk of diverticulitis.
While stress can weaken the immune system and the body’s ability to function, there is no direct correlation between stress and diverticulitis.
Jesse P. Houghton, MD, FACG, was born and raised in New Jersey, becoming the first physician in his entire family. He earned his medical degree from New Jersey Medical School (Now Rutgers Medical School) in 2002. He then went on to complete his residency in Internal Medicine and his fellowship in Gastroenterology at the Robert Wood Johnson University Hospital in 2005 and 2008, respectively. He moved to southern Ohio in 2012 and has been practicing at Southern Ohio Medical Center as the Senior Medical Director of Gastroenterology since that time.
Dr. Houghton is the author of What Your Doctor Doesn't (Have the Time to) Tell You: The Gastrointestinal System. He is also an Adjunct Clinical Associate Professor of Medicine at the Ohio University School of Osteopathic Medicine. He has been in practice since 2008 and has remained board-certified in both Internal Medicine and Gastroenterology for his entire career. He has lent his expertise to dozens of online articles in the medical field.
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