Diverticulitis Symptoms, Causes, Complications, Diagnosis, Diet, Risk factors, Treatments, FAQs

Diverticulitis

Diverticulitis is the infection or inflammation of pouches that can form in your intestines. These pouches are called diverticula. The pouches generally aren’t harmful. They can show up anywhere in your intestines. If you have them, it’s called diverticulosis.

Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate many problems, your doctor will need to rule out other causes for your symptoms. Diverticulitis is the infection or inflammation of pouches that can form in your intestines.

These pouches are called diverticula. The pouches generally aren’t harmful. They can show up anywhere in your intestines. If you have them, it’s called diverticulosis. If they become infected or inflamed, you have diverticulitis. Sometimes, diverticulitis is minor. But it can also be severe, with a massive infection or perforation (your doctor will call it a rupture) of the bowel.

Diverticulitis Symptoms

Diverticulitis can cause symptoms ranging from mild to severe. These symptoms can appear suddenly or they can develop gradually over several days.

Potential symptoms of diverticular disease include:

Pain in your abdomen
Bloating
Diarrhea
Constipation

If you develop diverticulitis, you might experience:

Constant or severe pain in your abdomen
Nausea and vomiting
Fever and chills
Blood in your stool
Bleeding from your rectum

Abdominal pain is the most common symptom of diverticulitis. It will most likely occur on the lower left side of your abdomen. But it can also develop on the right side of your abdomen.

If you develop any of the above symptoms, such as vomiting or blood in your stool, it may be a sign of a serious complication from diverticulitis or another condition. Call your doctor right away.

Diverticulitis Causes

It is unknown why pouches start to protrude outward from the colon. However, a lack of dietary fiber is often thought to be the main cause.

Fiber helps to soften stools, and not consuming enough dietary fiber leads to hard stools. This may cause more pressure or strain on the colon as muscles push the stool down. This pressure is thought to cause the development of diverticula.

Diverticula occur when weak spots in the outside layer of colon muscle give way and the inner layer squeezes through.

Although there is no clear clinical evidence proving a link between dietary fiber and diverticulosis, researchers claim that the circumstantial evidence is convincing. However, the topic is hotly debatedTrusted Source.

In parts of the world where dietary fiber intake is large, such as in Africa or South Asia, diverticular disease is fairly uncommon. On the other hand, it is quite common in Western countries where dietary fiber intake is much lower.

However, other reports have debunked the link between increased dietary fiber and diverticulitis prevention, advising that it may increaseTrusted Source the likelihood of the disease.

Previously, the consumption of nuts, seeds, and corn was thought to be a cause of diverticula development, but a study in 2008 found no linkTrusted Source.

Diverticulitis Complications

Peritonitis: Infection may spread into the lining of the abdomen if one of the infected diverticula bursts. Peritonitis is serious and can sometimes be fatal. It requires immediate antibiotic treatment. Some cases of peritonitis require surgery.

Abscess: This is a pus-filled cavity that requires antibiotics. Sometimes, surgery is required to get the pus out.

Fistula: These are abnormal tunnels, or tubes, that connect two parts of the body, such as the intestine to the abdominal wall or the bladder. A fistula can be formed after infected tissues touch each other and stick together; when the infection is over, a fistula forms. Often, surgery is needed to get rid of a fistula.

Intestinal obstruction: The colon may become partly or blocked if the infection has caused scarring. If the colon is blocked completely, emergency medical intervention is needed. A total blockage will lead to peritonitis. If the colon is partially blocked, they will need treatment. However, it is not as urgent as a total blockage.

Depending on the degree of scarring and the extent of blockage, a colon resection may be needed. Sometimes, a colostomy may be required. A hole is made on the side of the abdomen, and the colon is redirected through the hole and connected to an external colostomy bag.

Once the colon heals, it is rejoined. In rare cases, the doctors may have to create an internal ileoanal pouch.

Diverticulitis Diagnosis

To diagnose diverticulitis, your doctor will likely ask you about your symptoms, health history, and any medications that you take. They’ll likely perform a physical exam to check your abdomen for tenderness or if they need more information, a digital rectal exam to check for rectal bleeding, pain, masses, or other problems.

Several other conditions can cause symptoms that are similar to diverticulitis. To rule out other conditions and check for signs of diverticulitis, your doctor might order one or more tests.

Tests can include:

Abdominal ultrasound, abdominal MRI scan, abdominal CT scan, or abdominal X-ray to create pictures of your gastrointestinal (GI) tract
Colonoscopy to examine the inside of your GI tract
Stool test to check for infections, such as Clostridium difficile
Urine test to check for infections
Blood tests to check for signs of inflammation, anemia, or kidney or liver problems
Pelvic exam to rule out gynecological problems in women
Pregnancy test to rule out pregnancy in women

If you have diverticulitis, these exams and tests can help your doctor learn if it’s uncomplicated or complicated.

More than 75 percentTrusted Source of diverticulitis cases is uncomplicated, leaving about 25 percent to develop complications.

These complications can include:

Abscess, an infected pocket that’s filled with pus
Phlegmon, an infected area that’s less well-confined than an abscess
Fistula, an abnormal connection that can develop between two organs or between an organ and the skin
Intestinal perforation, a tear or hole in the intestinal wall that can allow the contents of your colon to leak into your abdominal cavity, causing inflammation and infection
Intestinal obstruction, a blockage in your intestine that can stop stool from passing

Diverticulitis Diet

Sometimes, a doctor will recommend that someone with diverticulitis goes on a special diet, to allow the digestive system to rest.

Initially, only clear liquids are allowed for a few days. These include:

Ice chips
Fruit juice without pulp
Broth
Ice pops
Water
Gelatin
Tea and coffee without cream

As symptoms ease, a person with diverticulitis can start to include low-fiber foods, including:

Canned or cooked fruits and skinned, seedless vegetables
Low-fiber cereals
Eggs, poultry, and fish
Milk, yogurt, and cheese
Refined white bread
Pasta, white rice, and noodles

Foods to avoid

Gastrointestinal problems often come with a list of foods to avoid. It has been suggested in the past that nuts, popcorn, and seeds can cause symptoms to flare up.

However, as the causes of diverticulitis are not known, the National Institutes of Health advise that there are no particular foods to exclude from the diet that will improve diverticulitis symptoms.

The high-fat, low-fiber diet that characterizes Western eating has been shown to increase the risk of diverticulitis in a recent study. It is best, therefore, not to eat red meat, deep-fried foods, full-fat dairy, and refined grains.

Food should be excluded based on individual experience. If you find that a particular type of food aggravates the effects of diverticulitis, avoid it.

Diverticulitis Risk factors

It is not fully understood how diverticulitis occurs. Bacteria in the stool may rapidly multiply and spread and cause the infection. It is thought that a diverticulum might become blocked, possibly by a piece of stool, which then leads to infection.

Risk factors include:

Age, as older adults have a higher risk than younger individuals.
Being obese
Smoking
Lack of exercise
A diet high in animal fats and low in fiber
Some medications, including steroids, opiates, and non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen

Diverticulitis Treatment

Individuals can often self-treat if the case is not too severe.

Diverticulosis treatment

Most people can self-treat their diverticular disease if it is mild, mainly with the help of painkillers and by consuming more dietary fiber.

Painkillers such as aspirin or ibuprofen should be avoided as they increase the risk of internal bleeding, and may also upset the stomach. Acetaminophen is recommended for pain relief from diverticular disease. Acetaminophen is available for purchase over the counter or online.

Eating more dietary fiber, which includes fruits and vegetables, will help resolve the symptoms by softening stool and helping stool patterns become more regular. This may sometimes take a few weeks.

Bulk-forming laxatives may help those who have constipation. It is important to drink plenty of fluids with these medications. Bulk-forming laxatives are available for purchase over the counter or online.

People who experience heavy or constant rectal bleeding should see their doctor.

Diverticulitis treatment

Mild cases of diverticulitis can generally be treated by the individual. However, a doctor may prescribe antibiotics, as well as acetaminophen for the pain.

It is important to complete the whole course of antibiotics, even if symptoms get better.

Some people may experience drowsiness, nausea, diarrhea, and vomiting while they are taking their antibiotics.

Antibiotics include ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex) and doxycycline (Vibramycin).

For those on the contraceptive pill, it is important to remember that antibiotics can interfere with its effectiveness. This effect on the contraceptive pill continues for about 7 days after stopping the antibiotic, so another form of contraception should overlap with this time.

Hospital treatment may be necessary if any of the following apply:

Normal painkillers do not alleviate the pain, or the pain is severe.
The individual cannot consume enough liquids to keep hydrated.
A person with diverticulitis cannot take oral antibiotics.
They have a poor state of health.
The doctor suspects complications, often if the immune system is weak.
Treatment at home is ineffective after 2 days.

Hospital patients are generally given antibiotics intravenously (IV), as well as fluids if they are dehydrated.

Surgery

People who have at least two diverticulitis episodes may benefit from surgery. Studies indicate that such patients are significantly more likelyTrusted Source to have further episodes and complications if they do not have surgery.

A colon resection removes part of the affected colon and joins the remaining healthy parts together.

Patients who undergo colon resection will have to introduce solid foods into their system gradually. Apart from this, their normal bowel functions will not usually be affected.

Frequently Asked Questions about Diverticulitis

What is diverticulosis?

The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material. Pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colonic walls as a person ages. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to in the plural as diverticula. Diverticula can occur throughout the colon but are most common near the end of the left colon referred to as the sigmoid colon. The condition of having these diverticula in the colon is called diverticulosis.

What causes diverticulosis to turn into diverticulitis?

Diverticulosis is a condition where small pockets occur in the wall of the colon or large intestine. These pockets are believed to be caused by high pressure within the colon pushing out against weak spots in the colon wall. These pockets, called diverticula, become more common as people age, though they can be found in patients as young as 25. Diverticulosis can lead to bleeding or diverticulitis.

Diverticulitis is an infection that occurs when one of the diverticula becomes infected and perforates. Most patients with diverticulitis experience several episodes of abdominal pain requiring antibiotics. Some can be treated at home and others need to be hospitalized for several days, depending on the severity of the condition.

Few patients go on to develop complications such as abscess (a collection of infected fluid in the abdomen), fistula (an abnormal connection between the colon and another organ such as the bladder), stricture (a narrow area in the colon causing blockage), or perforation (a hole in the colon requiring emergency surgery).

Why aren‘t doctors using your method to treat and prevent diverticular disease?

Because it isn‘t based on the kind of interventional therapy doctors traditionally perform, but on basic preventive principles available to anyone. Just as you don‘t need a prescription for a bar of soap to keep your hands germ-free, you don‘t need a doctor to prevent diverticular disease.

The sole objective of my method is to keep a person with a case of preexisting diverticulosis from turning into diverticulitis. Once that happens, it‘s too late for prevention, and you‘ll need a doctor. In an ideal world, after patching you up, doctors would suggest using this method to prevent a relapse. And as doctors learn more about it, some of them certainly will.

Why does fiber seem to help some people with diverticular disease?

It doesn‘t. At best, fiber is a placebo. At worse, it‘s the main cause of diverticular disease. In between, it creates a false sense of security and postpones proper treatment, because fiber may temporarily reduce the symptoms of irregularity by increasing the size and weight of stools, and create the illusion that you‘re no longer constipated. It may also cause diarrhea or semi-soft stools, which, for a while, may clear out the content of an infected diverticulum.

When a person experiences mild diverticulitis, doctors invariably prescribe antibiotics, pain relievers, and anti-inflammatory drugs. The resulting remission results from medication therapy, and not from the fiber.

Furthermore, patients with acute diverticulitis aren‘t placed on high-fiber diets to “relieve” it, but on a zero-fiber liquid diet, because gastric surgeons, who are called in to manage the treatment at this stage, are well aware of fiber‘s danger, and prohibit patients from taking it.

Why does the conventional treatment of diverticulitis may cause more harm than good?

The conventional treatment may certainly save you from lethal infection, but not from inevitable relapse and surgery. As odd as it may sound, the standard treatment protocol recommends a high fiber diet for patients who have just recovered from acute diverticulitis (underline mine):

“For the patient who is not very ill, treatment at home is reasonable, with rest, a liquid diet, and oral antibiotics (cephalexin 250 mg qid [four times daily]). Symptoms usually subside rapidly. The patient gradually advances to a soft low-roughage diet and a daily psyllium seed preparation. A barium enema 2 wk later can confirm the diagnosis. After 1 mo [month], a high-roughage diet is resumed.”