What Is Diverticulitis – Symptoms, Diet, Treatment, Surgery

What Are Diverticula?

Diverticula are abnormal marble-sized pouches protruding out from the intestinal wall – most often from the sigmoid colon (Picture 1).

Diverticulosis as seen in colonoscopy

Picture 1. Diverticles in the colonic wall, as seen during colonoscopy

Symptoms of Diverticulosis

Diverticulosis refers to multiple intestinal (mostly colonic) diverticles, which commonly occur in old, but also in young constipated persons who constantly strain at defecation. Diverticula may cause no symptoms at all, or they may cause constipation, bloating, lower left side abdominal cramps or pain.

Symptoms of Diverticulitis

Diverticulitis refers to inflamed (mostly infected) diverticula. Symptoms may last from few hours to several days and include:

  • Lower left side abdominal pain and/or tenderness, or (in Asian populations) right side abdominal pain
  • Nausea
  • Diarrhea or constipation
  • Bloating and flatulence
  • Fever, chills
  • Vomiting (not common)

Complications

In both diverticulosis and diverticulitis the following complications may occur:

  • Inflammation of nearby organs: ureter, bladder, uterus.
  • Obstruction of the colon due to scaring after several episodes of  inflammation; urgent or planned surgery may be needed.
  • Collections of pus (abscesses) in or around the colonic wall. Abscesses may be treated with antibiotics or surgery.
  • Perforation of the colon, which can lead to life threatening inflammation of the lining of the abdominal cavity (peritonitis). Symptoms of perforation are severe pain, fever and (if shock develops) weak and fast heart pulse, rapid breathing, restlessness. Colon perforation often requires urgent surgery.
  • A fistula (a tunnel through the tissues) may connect colon with adjacent organs (small intestine, bladder, uterus, vagina, skin of abdominal wall..) and cause their inflammation.
  • Intestinal bleeding (not common); the source of bleeding should be found and treated.

Diagnosis of Diverticulitis

Diverticulosis or diverticulitis may be suspected from symptoms, mostly from lower left abdominal pain. The presence of diverticles can be confirmed by ultrasound or CT of the abdomen. Blood test may show increased leukocytes. X-ray with barium enema or colonoscopy to evaluate the extent of diverticulosis may be performed after the inflammation has subsided.

Treatment of Diverticulosis and Diverticulitis

Diverticles themselves are usually permanent – they do not disappear with time, diet or medications.

Measures during sudden diverticulitis attack:

  • Rest
  • Clear liquid diet (water, clear juices, pop-sickles without fruit particles, gelatin, broths) or low-fiber diet (white bread, white rice, pasta, eggs, poultry, fish without bones, fruits without peels, membranes, or seeds).  Avoid vegetables with hard skins, like beans or peas.
  • Oral antibiotics in mild and intravenous antibiotics in severe infection
  • Mild painkillers like paracetamol may be taken in pain. Strong painkillers (morphine) aggravate constipation so they should be avoided, if possible.

Diverticulosis and Surgery

If diverticles cause constant problems over the years, and diet does not help, a surgical removal of the affected part of the colon may help. Surgery can be performed through a classical open-abdomen surgery, or laparoscopic surgery with only few short incisions in the abdominal wall. In most cases, the remaining parts of the colon can be connected end-to-end but sometimes a temporary or permanent colostomy (a free end of the colon connected to abdominal wall) is needed.

Diet to Prevent Diverticulosis and Diverticulitis

After attack of diverticulitis is over, you can adjust your diet to avoid further developing of diverticles:

  • If you are constipated, eat enough fiber to soften the stool. Fruits, vegetables, cereals, nuts, whole-grain or half-white bread and fiber supplements, like psyllium husk, may all be appropriate. Introduce fibers slowly to prevent bloating (also do not exaggerate with an amount – you need enough, not a lot of fiber). Drink enough fluid together with the fiber.
  • If you are bloated, avoid fruits like apples, pears, plums, prunes and dried fruits in general, sugary foods and drinks. Citruses and berries may be fine.
  • Do not delay bowel movements when it is time to go, and avoid straining.
  • Be active. Exercise helps to prevent diverticles.

References:

  1. Diverticulitis  (merck.com)
  2. Diet in diverticulitis  (mayoclinic.com)
About Jan Modric (249 Articles)
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  • tracey bryan

    My husband has suffered over the last four years with constant bouts of severe stomache cramps, diarrhea, gas, bloating, then also with constipation, up to one week without a BM. He believes that everytime he tries to eat anything, he becomes violently ill, thus he has been trying not to even eat. Two years ago he had a fistula, which was repaired, but his symptoms this time are worse. We are at our wit’s end, could someone please help us?

  • Jan Modric

    To tracey bryan?

    Has your husband got any official diagnosis so far? Fistules are common in Crohn’s disaese – this can be usually diagnosed by colonoscopy.

    Did he have stool tests for parasites? Is there any food that he thinks it triggers his symptoms? Are symptoms related to meals and, if yes, in what time after the meal he gets symptoms (minutes, hours?) Any blood in the stool?

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  • brenda

    I went on the internet this morning frantically looking for some info. about what has been happening to me. My biggest fear is that my stool is covered in this whitish substance that almost looks like skin. After reading the article about Diverticulitis I was able to kind of piece some things together. I have had lower left abdominal pain for several years. It started after some complications when I had a partial hysterectomy. I had internal bleeding, and my stomach distended. I had a lower G.I., and was told that I have a 4 inch section of my intestine that spasms. Currently, I am just getting off of Hydrocodone that I took for over 2 years because of a work injury. I sometimes go 2 weeks with no bowel movement. Now that I’m off the pain killer I am still having trouble going to the bathroom and the mucus is still there. I’m really worried about this. Should I be? I have no health insurance to even go see a doctor, so any advice is very helpful. Thank you.

  • Jan Modric

    Brenda,

    what was said to be a cause of the spasming part of the intestine? Were some diverticles revealed at lower GI?
    What was the reason for histerectomy? Do you have/had raised temperature?

    Is the substance that covers the stool translucent, so mucus?

    Mucus may be from prolonged stay of the stool in the colon, from hemorrhoids, IBS, intestinal parasites or bowel inflammation.

    Have you tried to adjust the diet? Avoiding sugars and eating some high-fiber food and drinking enough water and regular physical activity, like walking, can help.

    Diverticulosis should be seen during lower GI. Diverticulitis is usually present with diarrhea and fever.

    The spasming part of the colon may be due to injury of nerves during histerectomy or later complications.

  • deb308

    Hi, I have been reading through all the posts on here trying to figure out what the heck is going on! I have been having fevers (99.2-100.5) for the past six months but for a year been having major upper tummy pain. I have spams happening, I have major constipation and several trips to the hospital to get the spasms to stop. I was on buscapan for eight months to help get them to stop and got switched to dicetel and it manages it but there is a constant pain in my stomach, above my belly button and off to the right hand side. I get fever aches because of the constant fever and have dropped 60lbs (which I needed to lose anyway) from what ever it is I am suffering with. I have had a scope and all it showed was my IBS (which I have had since the age of 9) and hermoroides which they left even though they told me they would take them out but agreed they are big the guy who did the scope said he does not do that. I have had a catscan and it did show another cyst on my left ovary (no biggie I get them a lot) it also showed three diverculiti on my bowel but from everything I have read up on it they are suppose to be on the left side and my pain is not there. I have the constipation and take doctor perscribed meds for that, I watch my diet, am bed ridden because of weakness, and dizzyness. Have had the fever as a constant for six months and am getting very upset with no answers coming. I have been set up to see a gastro doc but am not sure there is much he can do. I suffer from stomach acid and have even lost my voice because of the acid in the past so if I do not take my medication for it I lose it. I had brain surgery four years ago and have many issues and take meds to help with those problems and now with this new thing I am beyond upset. Life seems useless. Its full of pain, weakness, dizzyness, muscle aches, bleeding from my bowel, constant bathroom issues (bounces from stool so large it rips its way out to so runny and desperate need to go)stress from watching the world around me fall apart because I am unalbe to even care for myself. Does anyone have any suggestions??? I can’t do this much longer!

  • Jan Modric

    Deb,

    how old are you? How did you lose weight – from not eating or from diarrhea?

    First, fever may be a symptom of inflammation or infection (anywhere in the body – tuberculosis, viral pneumonia, etc). It may also appear in hyperthyroidism, lymphoma and some cancers. Most of mentioned conditions would be reflected in the blood – did you have any blood test lately, if so, what were results?

    Diverticula in the sigmoid colon (?) can cause constipation, and resulting straining may cause hemorrhoids. Hemorrhoids can be treated by a simple outpatient procedure…Drugs, especially painkillers may also cause constipation.

  • deb308

    I am 41 an yes my blood work is up to date had then three weeks ago, few things were off but nothing major. Saw a gastro guy and he said yes I have what I thought but its not what is making me ill, he thinks its either in my stomach, gallblader or pancreas so he is sending me in for a scope down my throat and will not stop until he cannot get it down anymore, he is strongly suspecting its more then likey a combo of things hiting all at once making my life so miserable… thanks for the reply though, it was very kind of you to do this for me!!!!!

  • Tyler23456345

    I was 15 when i was diagnosed with diverticulitus. It is extremelly rare at my age to contract this disease but i was lucky enough to.
    It was so bad that my intestines wall continued to stretch until it ripped. It was the worst feeling ever. I could not even walk in my house. I finally got a call saying they had thought my appendix exploded.
    The ER took me for emergency surgery to find out that it was not my appendix at all.. it was diverticulitus. They said it was probably due to a defect . I’m pretty sure oi’m one of the youngest people to have this disease..

  • Jan Modric

    Tyler,

    have you had any additional testing? Diverticulosis appearing at early age can be connected with some genetic disease, like said here:
    http://www.springerlink.com/content/x550855722x1433v/

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  • BAUBSIE

    Please help me in what foods i should eat, and not eat. I eat lots of Fiberous foods. And i am never Constipated. Thank you very much…Baubsie

  • Jan Modric

    BAUBSIE,

    if you have no problems woth bowel movements, you can eat pretty much all you find appropriate. High fiber food can be ok, if it does not result in excessive gas.

  • roja karthik

    dear sir ,
    i was attacked by hepatitis a 5 months before and i took some home made medicines as aresult it shoot up and i became serious ,after that i was admitted in ahospital for treatment and took steroids treatment for a month after medicines are over i started to have left abdominal pain which continues till date. i conducted endoscopy two times first it was recogonised as gasteritis , dueodinistris, easophagitis , and took treatment for 45 days still not cured i went to another gastro dr and done endoscopy this time lax less with a small hiatus hernia has been determined. kindly guide me. i am unable to stand and work for more than two hours pain will come.

  • Jan Modric

    roja karthik,

    treatment you need now depends on what diagnosis you have now, and on the effect of your treatment so far. Hiatal hernia may cause reflux of the stomach acid up into the esophagus and cause its inflammation, so maybe acid reducing medications would be needed. So, the doctor should tell you what to eat and drink, and which medications to take, and if surgical repair of the hiatus hernia would be needed. Maybe you also need a blood test to check for anemia, glucose and vitamin and mineral levels, to find out if there is any deficiency that causes your symptoms.

  • stengo

    How can one who has a regular bowel movement i.e. 3/day and has never suffered from constipation get diverticulitis

  • Jan Modric

    stengo,

    it is an inherited weakness of the intestinal wall that makes one prone to get diverticulosis. If it’s a very weak intestinal wall, diverticles will be created easily without much straining.