Medically reviewed by Onikepe Adegbola, MD, PhD
Diverticulitis is one of the most severe diseases, affecting the digestive tract. It can cause discomfort, but it can cause serious complications. Additionally, if it’s left untreated, it can lead to long-term effects on the health.
What are the Causes of Diverticulitis?
Diverticula are small pouches that develop in the wall of the colon. When these pouches get inflamed or infected, the condition is referred to as diverticulitis. Infection of the diverticula can occur when feces and partially digested food block the opening of the diverticula.
The formation of diverticula depends on several factors, a few of them being:
- Decreased immunity
- Addictive habits like smoking
- Sedentary lifestyle
- Change in the gut microbiome
- Medicines that reduce the immunity like steroids
- Dietary habits
Can Diverticulitis Lead to Complications?
In a study, “Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure,” published in the International Journal of Colorectal Disease, it has been reported that more than 75% of cases of diverticulitis do not lead to any complications. This leaves less than 25% of cases of diverticulitis in which complications can develop.
Some of the complications are:
- Formation of an abscess: The diverticula can become infected and fill with pus.
- Formation of phlegmon: Phlegmon is an infected area that is less confined than an abscess.
- Fistula: Fistula is an abnormal connection between two organs or between an organ and the skin.
- Perforation of the intestines: Diverticulitis can lead to a tear in the intestinal wall leading to leakage of abdominal contents into the abdominal cavity, causing inflammation and infection.
- Obstruction of the intestine
What are the Symptoms of Diverticulitis?
The symptoms of diverticulitis can range from mild to severe and can appear suddenly or develop over a period. Some of the most common symptoms of diverticulitis people experience are:
- Pain in the abdomen (localized on the lower left side of the stomach)
- Diarrhea or constipation.
In case of an infection, people may also experience symptoms like nausea, vomiting, fever, chills, blood in the stool, rectal bleeding, and constant severe abdominal pain.
How is Diverticulitis Diagnosed?
Diverticulitis can be diagnosed through clinical examination. In addition, the doctor may perform a physical exam to check the abdomen for any tenderness.
A digital rectal scan may be performed to check for any bleeding from the rectum, inflammation, and infection.
As the symptoms of diverticulitis are non-specific, several other conditions can cause similar symptoms. Therefore, a few more tests may be advised to rule out other differential diagnoses.
Some of the tests that are advised are:
- Imaging studies like an ultrasound of the abdomen, MRI of the abdomen, and CT scan of the stomach can be done to learn more about the anatomy of the gastrointestinal tract.
- Colonoscopy is a procedure in which a colonoscope is inserted into the rectum to visualize the gastrointestinal tract.
- A stool examination may be done to rule out infections caused by microbes like Clostridium difficile.
- A urine examination may be done to rule out infections.
- A pelvic exam may be done to rule out gynecological causes in female patients.
- Blood tests can rule out anemia and kidney problems.
Of all investigations, colonoscopy is the most common one to be ordered by the doctor to confirm the diagnosis of diverticulitis, particularly after the onset of an acute episode of diverticulitis. Additionally, this procedure can help rule out conditions like ulcerative colitis or Crohn’s disease.
Usually, the patient is sedated before starting colonoscopy. Then, a thin, flexible scope is inserted through the rectum and advanced to the colon. This scope can also be used to collect tissue samples for testing.
Sometimes, asymptomatic diverticula may be found during a routine colonoscopy. However, treatment may not be required if there are no symptoms, infection, or inflammation.
How is Diverticulitis Treated?
The treatment of diverticulitis depends on the severity of the disease. Uncomplicated diverticulitis can be treated with diet modifications and taking prescribed antibiotics.
However, in case of complications due to diverticulitis, one may need to visit a hospital. Fluids and antibiotics may be administered intravenously. Surgery may be recommended depending on the type of complication.
Dietary Regulations in Diverticulitis
There are no particular food items that people with diverticulitis should avoid. However, it is recommended to high fiber food items, especially after symptoms improve. According to the study Diverticular Disease: An Update on Pathogenesis and Management, published in Gut and Liver, it is observed that high fiber food items reduce the risk of diverticulitis. This study has also emphasized the benefits of dietary or supplemental fiber for diverticular disease.
Red meat, high fat-containing dairy products, and refined grain products are usually not encouraged in people who have diverticulitis. A cohort study, “Western dietary pattern increases, and prudent dietary pattern decreases, risk of incident diverticulitis in a prospective cohort study,” published in Gastroenterology, has confirmed the relationship between these food items and increased chances of developing diverticulitis. Therefore, the role of diet in managing diverticulitis and maintaining overall digestive health is inevitable.
A clear liquid diet may be advised to allow the digestive tract to recover. If the symptoms of diverticulitis are mild or have started to improve, one may begin with low fiber food items and then switch to high fiber food items.
Antibiotics and anti-inflammatory medicines may be prescribed to reduce the pain and discomfort from diverticulitis.
Some of the home remedies usually undertaken to treat diverticulitis are:-
- Probiotics: A study “The use of probiotics in different phases of diverticular disease” published under Reviews on Recent Clinical Trials has claimed that adding probiotics to the diet can relieve symptoms of diverticulitis.
- Aromatherapy: Certain essential oils can reduce pain.
- Acupuncture: Acupuncture is a standard procedure that is fine to improve digestion and reduce chronic pain.
- Herbs: Certain herbs like ginger, turmeric, and rosemary have anti-inflammatory properties.
Treatment of diverticulitis using medicine and changes in diet can only be done when the symptoms are mild. However, in multiple episodes of diverticulitis, surgery may be required. The common surgeries undertaken to treat diverticulitis are:
- Bowel resection and anastomosis: During this procedure, an infected segment of the bowel is removed, and the healthy parts are reattached.
- Bowel resection with colostomy: In this procedure, after removing the infected segment, the healthy part is attached to the opening in the abdomen, known as a stoma.
When Should you see a Doctor?
People with diverticulitis should not ignore their symptoms. Anyone complaining of constant, unexplained abdominal pain, fever, diarrhea, or constipation should immediately consult a doctor.
Bolkenstein, H. E., Draaisma, W. A., van de Wall, B. J. M., Consten, E. C. J., & Broeders, I. (2018). Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure. International Journal of Colorectal Disease, 33(7), 863–869. https://doi.org/10.1007/s00384-018-3055-1
Diagnosis of diverticular disease. (2021, October 8). National Institute of Diabetes and Digestive and Kidney Diseases; NIDDK | National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/diagnosis
Ojetti, V., Petruzziello, C., Cardone, S., Saviano, L., Migneco, A., Santarelli, L., Gabrielli, M., Zaccaria, R., Lopetuso, L., Covino, M., Candelli, M., Gasbarrini, A., & Franceschi, F. (2018). The use of probiotics in different phases of diverticular disease. Reviews on Recent Clinical Trials, 13(2), 89–96. https://doi.org/10.2174/1574887113666180402143140
Rezapour, M., Ali, S., & Stollman, N. (2018). Diverticular disease: An update on pathogenesis and management. Gut and Liver, 12(2), 125–132. https://doi.org/10.5009/gnl16552
Strate, L. L., Keeley, B. R., Cao, Y., Wu, K., Giovannucci, E. L., & Chan, A. T. (2017). Western dietary pattern increases, and prudent dietary pattern decreases, the risk of incident diverticulitis in a prospective cohort study. Gastroenterology, 152(5), 1023-1030.e2. https://doi.org/10.1053/j.gastro.2016.12.038