Diverticulitis

Last reviewed: May 15, 2024

Diverticula are small pouches that can become inflamed and form in the lining of the digestive tract, typically in the colon. They are most commonly detected in individuals over forty and often do not present any symptoms.

The presence of these pouches in the digestive system is referred to as diverticulosis. When one or more pouches become inflamed and infected, it is termed diverticulitis, which manifests with intense abdominal pain, nausea, fever, and notable changes in bowel habits.

Mild cases of diverticulitis can usually be managed with rest, dietary adjustments, and medications. However, recurrent or severe cases may necessitate surgical intervention.

Symptoms

Diverticulitis can cause symptoms ranging from mild to severe, which may appear suddenly or develop gradually over several days.

Common symptoms of diverticulitis include:

  • Constipation
  • Diarrhea
  • Abdominal pain
  • Bloating

In addition, individuals with diverticulitis may experience:

  • Persistent and severe abdominal pain
  • Fever and chills
  • Nausea and vomiting
  • Rectal bleeding
  • Blood in the stool

Abdominal pain, typically located on the lower right or left side, is the most prevalent symptom of diverticulitis.

If any of these symptoms occur, it’s crucial to promptly contact your healthcare provider, as they could indicate severe complications from diverticulitis or another underlying condition.

Causes

Diverticulitis occurs when pouches form along the digestive tract, especially in the colon, and become inflamed and infected due to blockage by feces or partially digested food.

While the exact cause of diverticulitis is not known, several factors can increase the risk, including:

  • Dietary habits
  • Genetic predisposition
  • Weakened immune system
  • Obesity
  • Smoking
  • Lack of physical activity
  • Certain medications, such as steroids
  • Changes in the gut microbiome

Risk factors

The risk of developing diverticulitis is influenced by several factors:

  1. Aging: The likelihood of diverticulitis increases with age.
  2. Obesity: Being overweight or obese raises the risk of diverticular disease.
  3. Smoking: Individuals who smoke cigarettes or cigars are more susceptible to developing diverticular disease compared to nonsmokers.
  4. Sedentary lifestyle: Regular exercise can lower the risk of diverticulitis.
  5. High animal fat, low fiber diet: Diets low in fiber and high in animal fat can raise the risk of diverticulitis.
  6. Certain medications: Several medications, such as opioids, steroids, and nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), can also increase the risk of diverticular diseases.

Complications

Only 25% of diverticulitis cases result in complications, while the remaining 75% do not. These complications may include:

  1. Abscess: An infected pouch filled with pus.
  2. Phlegmon: An infected area that is less severe than an abscess.
  3. Fistula: An abnormal connection that can develop between two organs or between an organ and the skin.
  4. Intestinal perforation: A tear or hole in the intestinal wall, which can cause leakage of colon contents into the abdominal cavity, leading to inflammation and infection.
  5. Intestinal obstruction: A blockage in the intestine that prevents the passage of stool.”

Diagnosis:

To accurately diagnose the condition, healthcare providers typically follow these steps:

  1. Gathering information:
    • Inquiring about symptoms
    • Reviewing health history
    • Noting any medications being taken
    • Conducting a physical examination to assess abdominal tenderness.

If further information is needed, the healthcare provider may conduct a digital rectal exam to evaluate:

  • Pain
  • Presence of masses
  • Rectal bleeding
  • Other potential complications.

Since several other conditions can present similar symptoms to diverticular disease, the doctor may order one or more of the following tests to confirm diverticulitis and exclude other possibilities:

  • Abdominal ultrasound, MRI scan, CT scan, or X-ray to generate images of the gastrointestinal (GI) tract.
  • Colonoscopy to visualize the inside of the GI tract.
  • Stool test to screen for infections like Clostridium difficile (C.diff).
  • Urine test to detect infection.
  • Blood tests such as ESR, CBC, RFT, and LFT to identify signs of inflammation, anemia, or kidney and liver issues, respectively.
  • Pelvic exam to rule out gynecological problems in females.
  • Pregnancy test to exclude pregnancy for females.

Prevention

To significantly reduce the risk of diverticulitis, implement the following preventive measures:

  1. Regular exercise: Engaging in regular physical activity promotes healthy bowel function and reduces pressure within the colon. Aim for at least 30 minutes of exercise each day to lower the risk of developing the condition.

  2. Increase fiber intake: Incorporating more fiber into your diet can decrease the risk of diverticulitis. Opt for a diet rich in fiber from sources like fresh fruits, vegetables, and whole grains, as it helps soften waste material and facilitates its swift passage through the colon.

  3. Stay hydrated: Consuming ample water and other fluids assists in the absorption of fiber and promotes the formation of soft, bulky waste in the colon. Inadequate fluid intake can lead to constipation when consuming fiber-rich foods.

  4. Avoid smoking: Quitting smoking is essential, as it contributes to various health complications, including diverticulitis.

Treatment

Diet A high-fiber diet can help reduce symptoms of diverticular disease and lower the risk of developing diverticulitis. Adults should try to consume at least 30g of fiber daily. Good sources of fiber include fresh and dried fruits, vegetables, nuts, cereals, legumes, and starchy foods.

Fiber supplements, which are usually available as powder sachets that can be mixed with water, are easily found in the market. It’s advisable to gradually increase your fiber intake. This, along with drinking enough fluids, can help reduce potential side effects of a high-fiber diet, such as flatulence and bloating.

Medicine Paracetamol can be taken to relieve pain. Painkillers like aspirin and ibuprofen, should not be used regularly as they can lead to stomach upsets. You may use a bulk-forming laxative to help ease any constipation or diarrhea if paracetamol alone fails to work.

Acetaminophen is a good choice for pain relief. However, it’s best to avoid using painkillers like aspirin and ibuprofen regularly, as they can cause stomach upset. Consult your physician if acetaminophen is not effective for pain due to diverticulitis.

References:

This page was last reviewed and updated by on May 15, 2024.