Diverticulitis

What is Diverticulitis?

Diverticulitis is an inflammation or infection of one or more pockets or outpouchings called diverticula that develop in the gastrointestinal tract. The formation of these pockets is a relatively benign condition known as diverticulosis that occurs due to a weakening in the lining of the digestive tract. It is more common in Western societies and thought to be caused at least in part by a diet low in fiber and high in animal fats and processed foods. When pockets become blocked with waste, bacteria can build up and irritate the surrounding tissue resulting in inflammation and infection, known as diverticulitis.

What are the symptoms of Diverticulitis?

Diverticulitis is an acute infection that typically presents with abdominal pain, fever, and a change in your bowel habits from what was previously described as normal.

Common symptoms include:

1. Acute, severe abdominal pain or cramping in the lower abdomen, more commonly on the left lower side, although pain can occur anywhere,
2. Fever, chills, sweats,
3. Nausea, and
4. An acute change in bowel habits from what was previously described as normal, including diarrhea or constipation.

Who gets Diverticulitis?

1. Overweight individuals,
2. Cigarette smokers,
3. Those who lead a sedentary lifestyle (vigorous activity appears to lower your risk),
4. Individuals with a diet low in fiber and high in animal fats and processed foods,
5. Those who take certain medications such as steroids, opioids, and nonsteroidal anti-inflammatory drugs.

How is the Diagnosis made?

Diagnosis is typically made during an acute attack. Because abdominal pain could indicate a number of conditions, a comprehensive history and physical exam is necessary to rule out other causes of your symptoms. Lab tests may be ordered to look for an elevated white blood cell count (which can suggest infection), anemia or other coexisting conditions, changes in your liver function tests, electrolyte imbalances, and to rule out pregnancy and urinary tract infection as other potential causes of your symptoms. Stool studies may be used to rule out infection if diarrhea is present. CT scan of the abdomen and pelvis is used to identify inflamed or infected pouches and to confirm the diagnosis of diverticulitis and other complications of the disease such as abscess or fistula. It can help us to indicate the severity of your disease and guide a personalized treatment plan for you.

How is Diverticulitis Treated?

Diverticulitis is an infection that requires prompt medical attention.

Mild diverticulitis is typically treated outpatient with bowel rest, a liquid diet, complete elimination of roughage from the diet for a period of time before slowly advancing the diet back to normal, and oral antibiotics.

Patients are advised to AVOID fiber rich foods during an acute attack. This allows the bowel time to rest, heal, and recover. Advancing your diet too quickly can result in recurrent or smoldering disease.

Severe or recurring diverticulitis may require inpatient hospitalization, IV antibiotics, and/or surgical intervention to remove the affected portion of your colon depending upon the severity of your disease.

Because roughly 25% of patients with acute diverticulitis will develop complications, prompt and aggressive medical attention is recommended.

What are the complications of Diverticulitis?

If left untreated serious complications can occur. Complications include:

1. Bleeding,
2. Abscess (or a collection of pus),
3. Bowel obstruction (or blockage),
4. Perforation (or rupture of the affected portion
5. Fistula (an abnormal passageway or channel that can form between sections of your bowel and other adjacent structures allowing fecal material to pass into these structures, like your bladder), and
6. Peritonitis (a painful, generalized infection of your abdominal cavity that occurs when pouches rupture and spill digestive contents into your abdomen).

How can I prevent Diverticulitis?

Once diverticula develop in your colon, they do not disappear. Simple lifestyle and dietary modifications, in addition to a good bowel routine can, however, help to prevent the disease from progressing.

1. In order to prevent recurrent attacks of Diverticulitis, avoid food triggers. Research is mixed on whether or not certain foods directly contribute to acute attacks; nonetheless, we know that for some patients certain foods such as corn, nuts, seeds, popcorn, and whole grains can be problematic. Keep a food and symptom diary and avoid all food triggers specific to you.
2. Exercise regularly. Exercise promotes normal bowel function and helps to reduce pressure inside your colon. Try to exercise at least 30 minutes a day, most days of the week. Always check with a medical provider first before starting any exercise routine.
3. Outside of an acute attack, eat more fiber. This will help to prevent any further diverticula from forming in your digestive tract. Always AVOID fiber and high roughage foods during an acute attack!
   • Daily fiber recommendations are 20 to 35 grams of fiber per day.
   • Fiber-rich foods, such as fresh fruits, vegetables, and whole grains, soften waste material and help it to pass more quickly through your digestive tract.
   • Examples of fiber rich foods include: apples, pears, peas, broccoli, squash, beans, legumes, whole grain pastas, oatmeal, barley, strawberries, raspberries, chia seeds, almonds, pistachios, turnips, and brussel sprouts.
   • Keep a food diary and avoid any food triggers specific to you. If it’s hard for you to tolerate a high fiber diet due to gas or bloating, make sure to drink plenty of water. Water may help to minimize these symptoms. Fiber supplements may be another option. Avoid constipation and straining with bowel movements.
4. Drink plenty of fluids. Fiber works by absorbing water and increasing the soft, bulky waste in your colon. If you don't drink enough liquid to replace what's absorbed in the stool, fiber can be constipating.
5. Get on a good bowel routine. Avoid constipation and straining with bowel movements.

Follow-up care

After you recover from acute diverticulitis, colonoscopy is often advised, especially if you haven’t had the procedure performed within the past year or within the timeframe for current screening guidelines. There doesn't appear to be a direct link between diverticular disease and colorectal cancer; however, colonoscopy can help to exclude colon cancer as a cause of your symptoms. Colonoscopy should never be performed during an acute attack due to the high risk for perforation of your colon when the tissue is inflamed and infected. Typically it’s recommended to wait anywhere from 3-6 months after the resolution of an acute attack before proceeding with a colonoscopy.

Please call us at 908-788-8200 or visit our office for a comprehensive and personalized medical evaluation to determine if Diverticulitis or another gastrointestinal disorder is the cause of your symptoms.

DISCLAIMER: PLEASE READ CAREFULLYThe information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self diagnoses should not be made based on information obtained online. It is important to consult a best in class gastroenterologist regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.