Diverticulitis: Symptoms, Causes, Diagnosis & Treatment

 

Introduction

 

Diverticulitis is a common gastrointestinal condition that occurs when small pouches, called diverticula, that form in the wall of the colon (large intestine) become inflamed or infected.

These pouches, when not inflamed, are called diverticulosis, which is generally harmless.

However, when the pouches become inflamed, diverticulitis can lead to severe abdominal pain, fever, and complications if not treated promptly.

This article aims to provide a detailed overview of diverticulitis, including its symptoms, causes, diagnosis, treatment, and prevention strategies.

 

Understanding Diverticulosis and Diverticulitis

 

What Are Diverticula?

Diverticula are small, bulging pouches that can form in the lining of your digestive system, usually in the lower part of the large intestine (colon).

Diverticula are common, particularly after the age of 40, and they are often harmless. However, when these pouches become inflamed or infected, the condition is referred to as diverticulitis.

 

What Is Diverticulitis?

Diverticulitis occurs when one or more of these pouches become inflamed, often due to bacteria becoming trapped within the pouch.

This can lead to localized infection, inflammation, and sometimes more serious complications such as abscesses, perforation of the colon, or peritonitis (inflammation of the abdominal lining).

In severe cases, surgery may be required to treat complications.

 

Symptoms of Diverticulitis

 

The symptoms of diverticulitis can vary in severity, depending on whether the condition is mild, moderate, or severe. In general, the most common symptoms include:

• Abdominal pain: The most common symptom is sudden, sharp pain in the lower left abdomen, though the location may vary depending on where the diverticula are located.
• Fever: Mild to moderate fever may develop as a sign of infection.
• Nausea and vomiting: The infection and inflammation can lead to digestive upset, causing nausea or vomiting.
• Bowel habit changes: This may include constipation, diarrhea, or alternating between the two.
• Bloating: Some patients may experience bloating and discomfort due to the accumulation of gas in the digestive tract.
• Blood in the stool: In some cases, diverticulitis can cause bleeding from the diverticula, resulting in blood in the stool, though this is less common.

 

In more severe cases, additional symptoms may occur, including:

• Severe abdominal pain that worsens over time
• Inability to pass gas or have a bowel movement
• High fever (above 100.4°F or 38°C)
• Signs of shock (such as confusion, fainting, or rapid heart rate) if a perforation or abscess occurs

 

 

Causes and Risk Factors of Diverticulitis

 

While the exact cause of diverticulitis is still not completely understood, several factors have been associated with an increased risk of developing the condition:

 

1. Aging

As people age, the walls of the colon may weaken, making it easier for diverticula to form. Diverticulitis is more common in individuals over the age of 40, with the risk increasing as people get older.

 

2. Dietary Factors

A diet low in fiber has long been thought to be a contributing factor to the development of diverticulitis. Fiber helps add bulk to stools and promotes regular bowel movements. A low-fiber diet can lead to constipation and increased pressure within the colon, which may contribute to the formation of diverticula and subsequent diverticulitis.

 

3. Genetics

There is evidence to suggest that diverticulitis may run in families. Having a family history of diverticulitis increases your risk of developing the condition.

 

4. Obesity

Being overweight or obese has been linked to a higher risk of developing diverticulitis, particularly severe cases of the condition that may require surgery.

 

5. Sedentary Lifestyle

A lack of physical activity is associated with a higher risk of diverticulitis. Regular exercise helps maintain healthy bowel function and may reduce the risk of diverticula forming or becoming inflamed.

 

6. Medications

Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, and steroids, may increase the risk of diverticulitis by irritating the lining of the colon.

 

7. Smoking

Smoking is another known risk factor for diverticulitis, possibly due to its impact on overall health and inflammatory responses.

 

Diagnosis of Diverticulitis

 

The diagnosis of diverticulitis typically involves a combination of a patient’s medical history, physical examination, and diagnostic testing.

 

1. Medical History and Physical Exam

A healthcare provider will begin by asking about your symptoms, medical history, and risk factors for diverticulitis. During the physical examination, they may press on your abdomen to check for tenderness, particularly in the lower left quadrant.

 

2. Blood Tests

Blood tests can help detect signs of infection or inflammation. A high white blood cell count may indicate an infection associated with diverticulitis.

 

3. Imaging Studies

– CT (Computed Tomography) scan: A CT scan is the most commonly used imaging test to confirm the diagnosis of diverticulitis. It can provide detailed images of the colon and identify inflamed or infected diverticula, abscesses, perforations, or other complications.

– X-ray or ultrasound: In some cases, an X-ray or ultrasound may be used to assess the extent of the inflammation or detect complications.

 

4. Colonoscopy

While a colonoscopy is not typically used to diagnose acute diverticulitis, it may be performed later to rule out other conditions, such as colon cancer or inflammatory bowel disease. However, during a flare-up of diverticulitis, a colonoscopy is avoided as it can increase the risk of complications.

 

Treatment of Diverticulitis

 

The treatment of diverticulitis depends on the severity of the condition. Mild cases can often be managed with conservative treatment, while more severe cases may require hospitalization or surgery.

 

1. Mild Diverticulitis

Mild cases of diverticulitis can usually be treated on an outpatient basis with:

• Rest: Patients are advised to rest and avoid strenuous physical activity.
• Dietary changes: Initially, a liquid or low-fiber diet may be recommended to give the colon time to heal. As symptoms improve, patients can gradually reintroduce solid foods, starting with low-fiber options and eventually returning to a high-fiber diet.
• Antibiotics: In cases where infection is suspected, oral antibiotics may be prescribed to target the bacteria causing the infection.
• Pain relief: Over-the-counter pain relievers, such as acetaminophen, may be used to manage mild pain. However, NSAIDs should be avoided as they may irritate the colon.

 

2. Moderate to Severe Diverticulitis

Severe cases of diverticulitis may require hospitalization and more intensive treatment, including:

• Intravenous antibiotics: If the infection is more severe, IV antibiotics may be needed to quickly reduce inflammation.
• Intravenous fluids: Patients who are unable to eat or drink due to severe symptoms may require IV fluids to prevent dehydration.
• Surgery: In cases of complicated diverticulitis, such as when there is an abscess, perforation, or blockage in the colon, surgery may be required. There are two main types of surgery for diverticulitis:
• Bowel resection: In this procedure, the affected part of the colon is removed, and the healthy ends are reconnected.
• Colostomy: In some cases, a temporary or permanent colostomy may be performed, in which the healthy part of the colon is attached to an opening (stoma) in the abdominal wall to allow waste to exit the body.

 

Prevention of Diverticulitis

 

Preventing diverticulitis involves managing risk factors and adopting a healthy lifestyle:

 

1. High-Fiber Diet
   Eating a diet rich in fiber can help prevent constipation and reduce pressure on the colon. Fiber-rich foods include whole grains, fruits, vegetables, and legumes.
2. Regular Exercise
   Engaging in regular physical activity can improve digestion, reduce the risk of constipation, and help maintain a healthy weight.
3. Stay Hydrated
   Drinking plenty of water is important to keep the digestive system functioning smoothly.
4. Avoid Smoking
   Quitting smoking can reduce the risk of developing diverticulitis and other gastrointestinal conditions.
5. Limit NSAID Use
   Avoid using NSAIDs (nonsteroidal anti-inflammatory drugs) unless absolutely necessary, as these medications can increase the risk of diverticulitis.

 

 

Conclusion

 

Diverticulitis is a common and sometimes painful condition that can range from mild to severe. Early recognition of symptoms and prompt treatment are essential to prevent complications.

Managing diverticulitis with dietary changes, medication, and lifestyle modifications can help prevent future flare-ups. In severe cases, surgical intervention may be required.

By adopting a healthy lifestyle and working closely with healthcare professionals, individuals can manage diverticulitis and improve their quality of life.

Over the years, Dr Eduan Deetlefs has earned the reputation of a trusted health expert providing consultative, diagnostic, and therapeutic endoscopic and related services to patients in
Cape Town and beyond.

If you would like to book an appointment with a gastrointestinal (GI) specialist or would simply like more information on a particular GI topic, don’t hesitate to use our online booking form or call Dr. Deetlefs at 021 551 867.