Looking out for diverticulitis

Diverticulitis arises from a condition called diverticulosis, which occurs when weak areas in the inner wall of the colon bulge outward and form tiny pouches. Many people get diverticulosis as they age. In fact, diverticulosis occurs in about 58% of US adults over age 60. Getting enough fiber in your diet and staying well hydrated can help protect against diverticulosis.

Most people are unaware they even have this condition. Often the diagnosis of diverticulosis is first mentioned in a report when a person has a colonoscopy or had an abdominal CT scan for another reason. Diverticulosis doesn’t cause symptoms, but people who have irritable bowel syndrome or who are prone to constipation, bloating, and abdominal discomfort after eating are more likely to have it.

While diverticulosis is very common, only a small percentage of people who have it will ever develop diverticulitis caused by inflammation of one of the pouches.

Know the signs of diverticulitis

The most common symptoms of diverticulitis are abdominal pain (usually on the lower left side) and fever. The pain is distinct and sharp, and may strike over a few hours. Other symptoms may include a combination of loss of appetite, nausea, vomiting, abdominal bloating and cramping, and not passing gas or stool.

A mild case of diverticulitis that causes only minimal pain in the lower abdomen can resolve on its own within a day or two. However, you should seek immediate medical attention if your symptoms are not going away or you are feeling worse, such as having increasing pain, fever, bloody stools, or abdominal bloating with vomiting.

Treatment depends on whether you have uncomplicated or complicated diverticulitis. Your doctor can determine this by using a combination of blood tests and imaging studies, such as a CT scan.

How is uncomplicated diverticulitis treated?

As the name implies, uncomplicated diverticulitis is the less serious of the two. It means that the inflammation is confined to one section of the colon, and that there is no evidence of complicating factors.

Uncomplicated diverticulitis is typically treated at home. Your doctor may recommend observation only or starting an oral antibiotic immediately. It’s best to initially eat a low-fiber diet for at least a couple days. This gives your bowel a chance to rest and heal, and may reduce pain.

People usually begin to feel improvement within three days. If you and your doctor decided on observation only, contact your doctor if symptoms are not improving. Don’t even wait three days if the symptoms are worse.

If symptoms haven't responded to antibiotics after three to five days, your doctor will likely order an abdominal CT scan to see if you have complicated diverticulitis.

How is complicated diverticulitis treated?

Complicated diverticulitis usually needs to be treated in the hospital with intravenous (IV) antibiotics. It means you will have a specific complication that requires a longer course of IV antibiotics, and possibly surgery.

Types of complications that may occur during an active diverticulitis infection include:

• Abscess. A diverticular abscess is a collection of pus inside the affected diverticulum or just outside of the intestinal wall. If the abscess doesn't get better with antibiotics, a doctor will need to drain the pus using a needle, under guidance through images on a CT scan.
• Perforation. Diverticulitis can cause a hole in the colon that allows bowel contents to spill into the abdominal cavity. If you have a perforation, your abdomen may feel tender to touch, hard, or enlarged. Surgery repairs the hole. Sometimes part of the colon around the hole must be removed.
• Fistula. A fistula is an abnormal connection between the inflamed and infected segment of the colon and adjacent organs, such as other parts of the intestine or the bladder. Surgery consists of colon resection and removing the fistula.

Can diverticulitis be prevented?

Eating a high-fiber diet and staying well hydrated helps lower the formation pouches in the colon known as diverticula. So it makes sense that these lifestyle interventions might help make diverticulitis less likely to occur. However, once you have diverticulosis, there is no proven way to prevent one of the diverticula from becoming infected or inflamed.