Evidence based

Diverticulitis – symptoms, causes, treatment and more

Jun 10, 2019 |
8 min read

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Diverticulitis is a gastrointestinal disease of the colon. The disease is common in the Western world, with about 35 percent of the population diagnosed with diverticulitis.  Moreover, it is a disease that can strike the young and old. However, it is more commonly seen in individuals 50 years of age and older.

Diverticulitis is characterized by inflammation of abnormal pouches called diverticula. Furthermore, diverticula causes the wall of the colon to experience weak spots as the pouches or sacs form and push outward in the wall of the colon. As a result, the large intestine can also be affected when the pouches become inflamed and infected, and diverticulitis results.

Patients can experience different symptoms, including abdominal pain, diarrhea, and nausea. The disease can be fatal, and inpatient care may be necessary. (1)

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Diverticulitis definition

According to the online medical dictionary, diverticulitis is an inflammation of a diverticulum, especially inflammation involving diverticula of the colon. Hence, when the colon muscles weaken, chronic constipation can result, and diverticula can result.

Small pouches form in the colon wall lining. Bacteria or other irritating agents can get trapped in the pouches. As a result, patients can experience various painful symptoms when inflammation or infection occur.

Diverticulitis background

  • Thirty percent of patients diagnosed with the disease (the base condition where the pouches form) are diagnosed by age 60 years.
  • Seventy percent of patients are diagnosed with the disease by age 85 years.
  • Seventy percent of patients remain asymptomatic.
  • Thirteen percent of patients diagnosed with the disease are age 40 years and younger.
  • In the USA, diverticular disease is nearly exclusive to the left-sided colon.
  • Micro perforation results from inspissated fecal material erosion of the diverticular wall.

Diverticulitis classifications

Hinchey diverticulitis classification, based on radiographic features, is as follows:

Stage 1a

Phlegmon- acute inflammation of the soft tissues in a localized area.

Stage 1b

The disease is associated with pericolic or mesenteric abscess. Meaning, abscesses or masses have inflamed the fat surrounding the colon or the folds of the small intestine. (2)

Stage 2

The disease is associated with walled off pelvic abscess. Meaning, outside of the peritoneum or intra-abdominal space, infected fluid or pus-filled abscesses are trapped.

Stage 3

The disease is associated with generalized purulent peritonitis. Meaning, abscesses have burst in the abdomen. The bursting abscesses cause inflammation, resulting in a discharge of pus into the abdomen.

Stage 4

The disease is associated with generalized fecal peritonitis. In this stage, feces are present in the peritoneal cavity. Feces presence is due to the rupture of abscesses into the peritoneal cavity. The result is an infection.

Typically, treatment for stages 1 and 2 is a clear liquid diet and antibiotics.  In stages 3 and 4, abscesses have ruptured, and surgical removal of the affected portion of the sigmoid colon may be required.

Diverticulitis symptoms

Diverticulitis can be painless. However, localized abdominal pain in the left lower quadrant is common. Onset of pain is often sudden and can last for days. (3)

Diverticulitis symptoms include:

  • Left lower quadrant abdominal pain
  • Constipation
  • Diarrhea
  • Nausea
  • Blood in the stool
  • Melena
  • Distention
  • Vomit

Half of 521 patients of a natural history disease study of diverticular disease experienced symptoms for less than a month upon hospital submission.

Diverticulosis, diverticular bleeding, and diverticulitis are forms of diverticular disease. (4)

Symptoms of diverticular bleeding include:

  • Red or maroon-colored blood in the stool
  • Weakness
  • Dizziness or light-headedness

If experiencing symptoms, consult your physician.

Diverticulitis pain

Pain with diverticulitis is not uncommon. Diverticulitis pain includes:

  • Pain in the lower left side of the abdomen. However, the pain can be on the right side of the abdomen, especially in Asian patients.
  • Abdominal tenderness.
  • Severe infection attacks
  • Inflammation
  • Lower back pain
  • Bloating

Pain can be associated with fever, nausea and vomiting, constipation, or diarrhea.

Diverticulitis causes

It is uncertain what causes diverticulitis. However, researchers are studying several risk factors that may contribute to, or cause, the disease.

Causes include:

Fiber

Initial research suggested that a low fiber diet can lead to diverticulosis. However, recent research indicates the opposite. Studies conclude a high fiber-diet with more frequent bowel movements increases the risk of diverticulitis development.

Genes

Researchers are studying the role genes play in diverticulitis development. While there is no substantial evidence, some studies suggest that genes may influence the development of the disease.

Other factors

  • Obesity
  • Lack of exercise
  • Smoking
  • Certain medicines including non-steroidal anti-inflammatory drugs like aspirin
  • Onset may stem from bacteria or stool caught in a pouch in the colon. Healthy bacteria in the colon then decrease and disease-causing bacteria increases. (5)

Diverticulitis diagnosis

Tests are administered to confirm a diverticulitis diagnosis.

Diagnosis tests include:

  • CT Scan or X-rays of the intestines and surrounding tissue and bone
  • Colonoscopy
  • Barium enema (also called a lower GI series).
  • Flexible sigmoidoscopy.

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The doctor will also complete patient medical history and a physical exam.

Diverticulitis treatment & management

The type of diverticulitis treatment will depend on the stage and severity of the disease. Consequently, once diverticula develop in the pouches, they remain unless surgically removed.

Diverticulitis treatment includes:

  • Diet modifications
  • Antibiotics
  • Surgery
  • Bed rest
  • Stool softeners
  • Liquid diet
  • Antispasmodic drugs

Patients that perforate or develop a more severe infection may require hospitalization. Intravenous feeding and antibiotics may be necessary. Infected abscesses may need draining, and a temporary colostomy performed.

Surgical removal of the affected portion of the intestine may be necessary for patients that experience ongoing acute attacks. Consequently, surgery may also be required if intravenous therapy is not effective. (6)

Diverticulitis management

Diverticulitis management is necessary to prevent the reoccurrence of symptoms and attacks.

Constipation

Patients should drink no less than eight 8-ounce glasses of water daily to prevent constipation. Furthermore, natural laxatives like prunes and prune juice can be useful during bouts of constipation.

Low-fat diet

A low-fat diet will help with the passage of food through the intestine. Of importance, fat is considered a leading contributor in slowing down the passage of food through the intestine.

Food allergies

Patients should be tested for food allergies and avoid all foods that can irritate their system.

Low-bulk foods

Physicians may recommend a low bulk foods diet like broths and low fiber bread for patients suffering acute diverticulitis attacks. Furthermore, during attacks of diverticula, intestines are inflamed and sensitive. Cooked vegetables, apples, and cooked fruits are soothing to the intestine.

Avoid dairy

Milk and milk products like yogurts and cheeses will worsen the disease. Because of this, patients with diarrhea should restrict dairy foods from their diets.

Diverticulitis diet

Doctors may recommend a diverticulitis diet to help control acute diverticulitis. The diet is a short-term treatment plan and consists of clear liquids and low-fiber foods. Antibiotics may also be prescribed.

The purpose of the diet is to give the digestive system a chance to rest.

Patients will consume clear liquids for the first few days of the diet. Clear liquids include:

  • Broth
  • Ice chips
  • Fruit juices without pulp
  • Gelatin
  • Ice pops without fruit bits or pulp
  • Tea or coffee without cream
  • Water

As the patient starts to feel better, low-fiber foods are introduced. Low fiber foods include:

  • Canned or cooked vegetables like carrots, green beans, and potatoes (without the skin)
  • Skinless and seedless canned or cooked fruits
  • Refined white bread
  • Eggs, poultry, and fish
  • Low fiber cereals
  • Fruit and vegetable juice with no pulp
  • White rice, pasta, and noodles
  • Milk, yogurt, and cheese

Typically, patients will feel better within the first few days of starting the diet and antibiotics. Most crucial, patients that see no results should contact their doctor, or if they experience:

  • Fever
  • Abdominal pain worsens
  • Difficulty keeping clear liquids down

Diverticulitis diet risks

Few risks are associated with the diverticulitis diet. However, patients should not continue a clear liquid diet for more than a few days. Clear liquids do not provide adequate nutrients for the body. Consequently, lack of nutrients can weaken the body and present other complications. Transitioning back to a regular diet as soon as possible is necessary.

Diverticulitis foods to avoid

Foods impact the severity of symptoms and diverticulitis attacks. Diverticulitis foods to avoid include:

  • Milk
  • Cheese
  • Coffee
  • Spicy foods
  • Corn
  • Broccoli
  • Nuts
  • Brussel sprouts
  • Fried foods
  • Fatty foods

Patients should consult with their doctors for a complete list of foods to avoid.

Diverticulitis and alcohol

Diverticulitis and alcohol do not mix. Patients that consume alcohol will only worsen their symptoms. Alcohol works against the gastrointestinal tract, straining the gastrointestinal tract. For patients, diverticulitis and alcohol consumption can cause pain and bloating. Alcohol consumption can also cause dehydration.

Diverticulitis complications

Diverticulitis diagnosis and treatment is necessary. If the disease is left untreated, the patient may experience severe complications that require surgery. Complications include:

Abscesses

When abscesses form around the infected diverticula, the condition is severe. Furthermore, peritonitis, inflammation of the peritoneum, can develop if the abscesses puncture through the wall of the intestine.

The peritoneum is a silk-like membrane that lines the inner abdominal wall, covering the organs within the abdomen. What’s more, peritonitis is an infection that can be fatal, and immediate treatment is necessary.

Scarring

If scarring occurs a blockage or stricture of the intestine can occur.

Fistulas

If an infected diverticulum reaches an adjoining organ and a connection forms, fistulas can develop. Fistulas development most often occurs between the large intestine and the bladder. When a connection is formed, the kidneys can become infected. Fistulas can also develop between the large intestine or the skin.

Severe bleeding

If severe bleeding occurs, the patient may require a blood transfusion.

If you experience symptoms, consult your physician. Severe cases of the disease can be fatal if left untreated.

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