DIVERTICULITIS
Diverticula are small, bulging pouches that can form in the lining of your digestive system. They are
found most often in the lower part of the large intestine (colon). Diverticula are common, especially
after age 40, and seldom cause problems.
Sometimes, however, one or more of the pouches become inflamed or infected. That condition is known
as diverticulitis (die-vur-tik-yoo-LIE-tis). Diverticulitis can cause severe abdominal pain, fever, nausea and
a marked change in your bowel habits.
Mild diverticulitis can be treated with rest, changes in your diet and antibiotics. Severe or recurring
diverticulitis may require surgery.
CAUSES
Doctors aren't sure what causes diverticulitis. Bacteria grow in the pouches (diverticula), and this can
lead to inflammation or infection. Pressure may lead to a small perforation or tear in the wall of the
intestine. Peritonitis, an infection of the lining of the abdominal wall, may develop if infection spills into
the abdominal (peritoneal) cavity.
Diverticula usually develop when naturally weak places in your colon give way under pressure. This
causes marble-sized pouches to protrude through the colon wall.
Diverticulitis occurs when diverticula tear, resulting in inflammation or infection or both.
SYMPTOMS
The signs and symptoms of diverticulitis include:
Pain, which may be constant and persist for several days. Pain is usually felt in the lower left side of
the abdomen, but may occur on the right, especially in people of Asian descent.
Nausea and vomiting.
Fever.
Abdominal tenderness.
Constipation or, less commonly, diarrhea.
RISK FACTORS
Several factors may increase your risk of developing diverticulitis:
Aging. The incidence of diverticulitis increases with age.
Obesity. Being seriously overweight increases your odds of developing diverticulitis. Morbid obesity
may increase your risk of needing more-invasive treatments for diverticulitis.
Smoking. People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis.
Lack of exercise. Vigorous exercise appears to lower your risk of diverticulitis.
Diet high in animal fat and low in fiber, although the role of low fiber alone isn't clear.
Certain medications. Several drugs are associated with an increased risk of diverticulitis, including
steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB,
others) and naproxen (Aleve).
COMPLICATIONS
About 25 percent of people with acute diverticulitis develop complications, which may
include:
An abscess, which occurs when pus collects in the pouch.
A blockage in your colon or small intestine caused by scarring.
An abnormal passageway (fistula) between sections of bowel or the bowel and
bladder.
Peritonitis, which can occur if the infected or inflamed pouch ruptures, spilling
intestinal contents into your abdominal cavity. Peritonitis is a medical emergency
and requires immediate care.
TEST AND DIAGNOSIS
Your doctor will likely recommend:
Blood and urine tests, to check for signs of infection.
Pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain.
Liver function tests, to rule out other causes of abdominal pain.
Stool test, to rule out infection in people who have diarrhea.
CT scan, which can indicate inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT
can also indicate the severity of diverticulitis and guide treatment.
TREATMENT
Uncomplicated diverticulitis
If your symptoms are mild, you may be treated at home. Your doctor is likely to
recommend:
Antibiotics, to treat infection.
A liquid diet for a few days while your bowel heals. Once your symptoms improve,
you can gradually add solid food to your diet.
An over-the-counter pain reliever, such as acetaminophen (Tylenol, others).
This treatment is successful in 70 to 100 percent of people with uncomplicated
diverticulitis.
Complicated diverticulitis
If you have a severe attack or have other health problems, you'll likely need to be
hospitalized. Treatment generally involves:
Intravenous antibiotics
Insertion of a tube to drain an abscess, if one has formed
Surgery
You'll likely need surgery to treat diverticulitis if:
You have a complication, such as perforation, abscess, fistula or bowel obstruction
You have had multiple episodes of uncomplicated diverticulitis
You are immune compromised
There are two main types of surgery:
Primary bowel resection. The surgeon removes diseased segments of your
intestine and then reconnects the healthy segments (anastomosis). This allows you
to have normal bowel movements. Depending on the amount of inflammation, you
may have open surgery or a minimally invasive (laparoscopic) procedure.
Bowel resection with colostomy. If you have so much inflammation that it's not
possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An
opening (stoma) in your abdominal wall is connected to the healthy part of your
colon. Waste passes through the opening into a bag. Once the inflammation has
eased, the colostomy may be reversed and the bowel reconnected
To help prevent diverticulitis:
Exercise [Link] promotes normal bowel function and reduces pressure
inside your colon. Try to exercise at least 30 minutes on most days.
Eat more fiber. High-fiber foods, such as fresh fruits and vegetables and whole
grains, soften waste material and help it pass more quickly through your colon. This
reduces pressure inside your digestive tract. However, it isn't clear whether a high-
fiber diet decreases the risk of diverticulitis. Eating seeds and nuts isn't associated
with developing diverticulitis.
Drink plenty of fluids. Fiber works by absorbing water and increasing the soft,
bulky waste in your colon. But if you don't drink enough liquid to replace what's
absorbed, fiber can be constipating.
