stomach

Diverticulitis (Diverticulosis) Symptoms, Treatment And Prevention

Understanding diverticulitis and diverticulosis will be easier if you have some idea about intestinal anatomy. Both of these can be serious illnesses if left untreated. First you must understand diverticula, the plural form of diverticulum, which is simply a bulging sac that pushes against the walls of the colon. They can occur anywhere in the digestive system including the esophagus, small intestine or stomach despite the fact they are most commonly found in the large intestine.

Diverticulitis occurs when the diverticula that presses against the colon ruptures. This can lead to an infection in the tissue around the colon. When those diverticula are present in the colon it is referred to as diverticulosis.

Diverticulitis And Diverticulosis

Diagram showing diverticulitis and diverticulosis

Diverticulitis Symptoms

Once you know the symptoms of diverticulitis you will be better prepared to identify them and seek treatment immediately. Although some symptoms may not present right away, many of them will last anywhere from a few hours up to a few days.

Some of the most common diverticulitis symptoms include:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Constipation and diarrhea
  • Gas
  • Bloating
  • Abdominal swelling
  • Fever and chills
  • Cramps or abdominal pain that worsens upon movement
  • Pain mostly on the left side of the abdomen, but occasionally on the right side
  • Bleeding from the rectum
  • Changes in bowel movements (more or less)

If you exhibit any of these symptoms and they last for more than a few days, you should make an appointment to see your doctor right away. Likewise if these symptoms worsen over time you should see a doctor immediately.

What Causes Diverticulitis?

To have a clear understanding of what causes diverticulitis you must understand what causes diverticula to form. Typically this occurs when those areas in the colon that are already weak, give under the pressure. These pouches, although small, begin to press harder against the walls of the colon.

One of the ways in which this can occur is by bowel movements. The job of the colon is to get rid of feces and to do that a certain amount of pressure is required. It is that pressure that can lead to diverticulitis when a lot of pressure is required to eliminate feces. The more pressure required to perform this action, the more those pouches press against the colon walls.

A diet that is lacking in sufficient fiber is perhaps the main cause of this, as fiber aids productive bowel movements. A low fiber diet typically requires more pressure to eliminate feces, which is one cause of diverticulitis.

When To Seek Medical Care

If you have been experiencing any of the symptoms of diverticulitis for more than a few days you need to seek medical care right away. Often these symptoms are ignored or passed off as some other benign digestive problems. But digestive problems associated with diet don’t usually last more than a day or two. So if your symptoms persist or worsen over a few days, you will need to seek medical attention immediately.

Some symptoms that may indicate a serious problem include:

  • Persistent diarrhea and vomiting
  • Recurring urinary tract infections
  • Rectal bleeding
  • Constant fever accompanied by abdominal pain

These symptoms cannot be ignored as some plain digestive problem, so monitor them and seek medical attention as soon as you can. This is particularly important if you experience any type of bleeding.

Diagnosis

If you have been experiencing symptoms of diverticulitis your doctor will want to perform at least one test to get an accurate diagnosis. Your doctor will likely ask you questions in regards to your lifestyle, diet and exercise habits, medical history and symptoms.

Some of the tests used to diagnose diverticulitis are:

  • Barium x-rays that allow the doctor to see the pouches breaking through the walls of the colon.
  • CT scans may also be used to give the doctor a clear picture of the colon, but these scans are costly and more time consuming than some other diagnostic methods.
  • Blood tests may be performed in order to test for blood loss or infections due to a breach in the wall of the colon. Blood tests may also rule out other illnesses that have similar symptoms.
  • A physical exam is almost always performed to check for abdominal tenderness. This may also include a digital exam of the rectum to search for causes of the bleeding or pain in that area.
  • Colonoscopies or flexible sigmoidoscopies are two types of scope methods to diagnose diverticulitis. The scopes are equipped with cameras on the end and inserted into the colon or anus. The cameras provide doctors with a view of the colon and rectum lining so the doctor can search for diverticula.

Either one or a combination of these tests will be used to diagnose diverticulitis.

Treatment

Treatment for diverticulitis will depend on the symptoms you are exhibiting as well as how severe those symptoms are presented. Milder symptoms will have a different treatment plan than more severe symptoms, but due to the risk of complications you may have to undergo a stricter, more advanced treatment plan.

Self-Care at Home may be advised if you have a mild case of diverticulitis. During this time you will be ordered to rest and subsist on a liquid diet. The liquid diet will relieve the pressure of bowel movements, allowing your body time to heal properly. Typically this type of treatment plan for diverticulitis lasts no more than 3 to 5 days. You will likely be given antibiotics to kill or prevent an infection from occurring.

Medical Treatment for diverticulitis often includes anti-spasmodic drugs that will relieve the pressure associated with squeezing during bowel movements. These drugs can relax the muscles and also alleviate the pressure allowing the patient to heal. Traditionally diverticulitis patients undergo a round of antibiotic treatment to prevent or kill any infections they may have. It is important that all antibiotics are taken to reduce the risk of the infection returning.

Surgery

In the event that surgery is needed to treat diverticulitis, your treating physician may recommend surgery. Generally if you have an abscess, fistula or perforation, surgery is necessary. There are two different surgeries your doctor may recommend:

  • Primary bowel resection where only the diseased section of the intestine is removed. Then the healthy sections are reconnected to your colon so you can continue to have normal bowel movements. This surgery can be performed traditionally or laparoscopically.
  • Bowel resection with colostomy is required with the colon is so inflamed that the colon and rectum cannot be reconnected. In this case the surgeon will make an opening (also called a stoma) and connect the healthy part of the colon to it so that your waste may pass through a colostomy bag. Depending on how you heal, you may or may not be able to remove the bag and reconnect the colon and rectum.
bowl resection with colostomy

The photo shows what a bowel resection with colostomy would look like

 

Diet

One of the main indicators for diverticulitis and diverticular disease is diet. A better diet can help you prevent diverticulitis. Since a correlation exists between fiber intake and the prevalence of diverticulitis, a change in diet is often advised to those suffering from milder symptoms.

A diverticulitis diet should also be a high fiber diet is recommended which includes foods like fresh fruits (apples, bananas, peaches) and vegetables (cabbage, broccoli, spinach) that have both a high fiber content and high water content. Both fiber and water are recommended to help ease bowel movements. A fiber diet must accompany a sufficient amount of water in order to make bowel passage easier. A high fiber diet with insufficient water can cause constipation.

Most physician recommend that slowing down the progression of diverticulitis or preventing it altogether requires 20 to 35 grams of fiber daily.

List Of Foods To Avoid When You Have Diverticulitis

While there are plenty of foods you should be eating if you are suffering from diverticulitis, there are also certain foods you should avoid during the treatment period. These foods may cause you to increase the pressure on the colon during bowel movements or worsen the pain the rectal region.

Traditionally doctors have warned diverticulitis patients against corn, nuts and seeds but there is little evidence to support this. However due to political and economic factors in some parts of the world, avoiding corn is recommended as it is difficult to digest for many.

Foods you should avoid with diverticulitis include:

  • Spicy foods
  • Hot peppers & spices
  • High fat foods
  • Deep fried food
  • Raw onions
  • Seedy fruits and vegetables such as strawberries and blackberries, cucumbers, eggplant and okra.

Prognosis

In general the prognosis for diverticulitis is quite positive. Most patients fully recover over time, particularly when treated early. However if the symptoms have progressed before you seek treatment more serious problems can occur. The most common problems that arise are infections such as:

  • Abscess
  • Perforation of the intestine, can lead to infection
  • Fistula
  • Peritonitis
  • Bleeding
  • Blockage

Prevention

All of the recommended methods for preventing diverticulitis are lifestyle changes. By making certain changes to your diet and lifestyle habits, you can not only prevent this disease but you can slow it down as well.

Diet is essential which is why doctors often recommend an increase in fiber intake of at least 20 grams per day and reducing the amount of fat in your diet. Of course it is preferable that you get your fiber through fresh fruits, whole grains and fresh vegetables but you can also use fiber supplements as long as you enjoy a sufficient amount of water each day.

Drink at least 64 ounces of water each day to increase the softness of your bowels. This will make it easier to eliminate feces without excess pressure to your colon. Water also acts as an effective method of flushing out waste.

Regular exercise is also recommended as a way to reduce the pressure in your colon and produce normal bowel movements. When combined with a healthy diet and increased water consumptions, you can improve the ease of your bowel movements.

Avoid putting off your need to go to the bathroom. By delaying or ignoring a bowel movement, you can make your stools harder than necessary which will require far more force to get rid of them. If you feel the urge to go, do it as soon as possible.

 

Written By Sabrina Meacham

Dr. Meacham is board certified in Allergy & Immunology. She earned her undergraduate degree in Nutritional Biology from the University of California Davis. Dr. Meacham received her Medical Degree at Indiana University School of Medicine. Coming from a military family, Dr. Meacham completed her Internal Medicine residency at Tripler Army Medical Center and accepted a Fellowship in Allergy & Immunology at Walter Reed Army Medical Center.

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