Diverticulosis and Diverticulitis

Diverticulosis is a condition where small pouches called diverticula form in your digestive system, usually in your colon (large intestine). They develop when pressure causes weak spots in your colon to bulge out. 

Diverticulitis is when these pouches get inflamed or infected. Diverticulitis can cause a lot of discomfort and may need medical treatment, ranging from antibiotics to surgery.

Understanding diverticulosis

Diverticulosis isn’t considered a disease. The small pouches in the colon are often found in older people and it may not cause any symptoms. But it increases the risk for diverticulitis. You might find out you have diverticulosis during a medical exam or test for another reason.

Sometimes, diverticulosis causes mild symptoms like bloating, cramps, discomfort in the lower belly (abdomen), constipation or diarrhea.

You’re at higher risk of diverticulosis if you:

• Are over age 50.
• Eat a lot of red meat.
• Eat a low-fiber diet. Fiber helps keep stools soft and bulky, so you don’t need as much pressure to move them through the colon.
• Have obesity, since excess body weight can increase pressure in your colon.
• Lead a sedentary lifestyle. Regular physical activity helps promote healthy bowel movements.
• Take nonsteroidal anti-inflammatory drugs (NSAIDs), steroids or opioids.
• Smoke.
• Have genes that increase your risk.

Diagnosing diverticulosis

Diverticulosis may be diagnosed during a routine colonoscopy or with an imaging test like a CT scan. You might need a CT scan if a colonoscopy was incomplete or if there were concerns after it.

Treating diverticulosis

If you have diverticulosis, your health care provider may recommend:

• A high-fiber diet: Since fiber keeps stools soft and bulky, it lowers pressure on your colon. Choose fruits, vegetables, whole grains, beans and legumes and limit red meat and fat. Ask your provider about taking fiber supplements.
• Staying hydrated: Drinking plenty of water throughout the day helps keep stools soft and helps you have healthy bowel movements.
• Regular exercise: Walking, jogging, swimming or cycling for at least 30 minutes a day can promote healthy digestion and lower the risk of constipation.
• Quitting smoking and limiting alcohol: This can decrease your risk of diverticulitis.

Understanding diverticulitis

With diverticulitis, the pouches in your colon get inflamed or infected. You’re at higher risk of diverticulitis if you have diverticulosis. You may notice the following symptoms:

• Sudden, intense abdominal pain, usually in the lower left side. The pain may be constant and may get worse over time. Your abdomen may feel tender.
• Fever, since you may be fighting an infection.
• Nausea and vomiting.
• Changes in bowel habits like constipation, diarrhea, bloating, having a bowel movement more often or less often than usual or bowel movements that are softer or harder than normal.
• With severe diverticulitis, blood in your stool, weakness, feeling like you need to urinate a lot and a rigid, sensitive abdomen.

The same risk factors that raise your risk of diverticulosis also increase your risk of diverticulitis. It’s also possible that other risk factors may play a role in diverticulitis, including:

• Stool or bacteria getting trapped in the diverticula.
• Changes in your gut microbiome (the bacteria and other microbes in your digestive tract).
• Issues with the muscles or nerves in your large intestine.
• Immune system problems.

Diagnosing diverticulitis

To diagnose diverticulitis, your provider may:

• Review your medical history.
• Perform a medical exam and check for pain or tenderness in your abdomen, especially on the left side.
• Recommend an imaging study like a CT scan or ultrasound to look at your colon closely, check for signs of infection and look for complications like pus-filled pockets (abscesses) or tears (perforations).
• Suggest a colonoscopy to confirm a diagnosis or rule out other conditions.
• Test your blood for signs of infection or inflammation.
• Test your urine, stool or liver enzymes.

Treating diverticulitis

Treatment for diverticulitis depends on whether you have a mild case or a severe case:

• Mild cases: Treatment for milder cases, called uncomplicated diverticulitis, usually includes:
  • Rest with a heating pad on your abdomen.
  • Acetaminophen (Tylenol) for pain. NSAIDs like ibuprofen (Advil, Motrin) aren’t recommended because they can make diverticulitis worse.
  • Antibiotics like metronidazole (Flagyl), amoxicillin or moxifloxacin to treat the infection.
  • A liquid diet so your colon can heal. Good choices are broth, pulp-free fruit juices and ice pops, tea or coffee without milk or cream and water. As you get better you can add solid foods back in.
• Severe cases: You might need intravenous (IV) antibiotics or blood transfusions in the hospital for more severe cases, called complicated diverticulitis.

Rarely, an abscess, perforation or blockage may require surgery. Surgery may involve:

• A simple endoscopic procedure to drain an abscess or stop bleeding.
• Removing the diseased part of the colon and reconnecting the healthy areas.
• Separating the healthy and diseased parts so the diseased section can heal. After it heals, the two sections are reconnected. While it is healing, you have a colostomy bag outside of the body to collect waste through an opening in the abdomen.

Your provider may recommend a colonoscopy after you heal to make sure you don’t have an underlying issue such as colon cancer.

Complications of diverticulitis

Untreated or poorly managed diverticulitis may lead to:

• Gastrointestinal (GI) bleeding: Bleeding in your digestive system can cause anemia.
• Abscess: A collection of pus that causes severe pain and fever. Abscesses need to be drained with a procedure guided by imaging techniques.
• Perforation: An inflamed pouch (diverticulum) that bursts or tears. With a perforation, the contents of your intestine leak into your abdominal cavity. It’s a medical emergency and a life-threatening condition.
• Scarring: Your colon could get narrow or blocked because of scar tissue.
• Peritonitis: The lining of your abdominal cavity (peritoneum) can become infected, usually due to a perforation. It’s a medical emergency that needs immediate antibiotics and, sometimes, surgery.
• Fistula: An abnormal connection can develop between parts of the intestine or between the intestine and other organs like the bladder or skin. You could develop a fistula if you have severe diverticulitis or diverticulitis that keeps coming back. You may need surgery for treatment.
• Bladder inflammation: Diverticulitis could irritate your bladder.
• Intestinal obstruction: Scarring from diverticulitis can make your intestine narrow or block it. You might need medical intervention to open it up.

When to get medical care

Contact your health care provider if you have any concerns about your digestive health. Get medical care right away for:

• Severe abdominal pain, especially on the lower left side of the abdomen.
• A fever of 100.4°F (38°C) or higher.
• Persistent nausea and vomiting, especially if you can’t keep fluids down.
• Sudden, major changes in bowel habits, like persistent diarrhea or constipation.

These symptoms could be signs of a serious complication, so it’s important to get care immediately.

Living with diverticulosis and diverticulitis

You’ll want to follow up regularly with your provider if you have either of these conditions. Your provider can help manage your condition, change your treatment plan if needed and recommend screenings or tests.

Take these steps to help keep your colon healthy and avoid complications:

• Continue eating a high-fiber diet, drinking plenty of water and getting physical activity.
• Avoid spicy foods or foods high in refined sugar if they trigger your symptoms.
• Don’t smoke.
• Manage your body weight.
• Reduce stress with techniques like meditation, deep breathing, mindfulness, yoga, spending time in nature or relaxation exercises.

It can be challenging for people with diverticulosis and diverticulitis to live with diverticular disease. It may help to:

• Get care from a provider who specializes in gastroenterology or digestive health.
• Join an in-person or online support group to connect with emotional support and share experiences and tips for managing symptoms.
• Get educational materials so you can understand your condition and make decisions about your treatment and lifestyle. Ask your provider for recommendations.

Getting Care

At Banner Health, we’re dedicated to high-quality, compassionate care. Choosing Banner Health for your digestive system concerns means:

• State-of-the-art technology and facilities for accurate diagnosis and effective treatment.
• A team of experienced specialists including gastroenterologists and surgeons with extensive experience treating diverticulosis and diverticulitis.
• Personalized care plans designed for your unique needs.
• Access to nutrition counseling, lifestyle management programs and support groups.

If you have symptoms of diverticulosis or diverticulitis or concerns about your digestive health, get medical care right away. Early diagnosis and treatment can help manage symptoms, prevent complications and improve your quality of life.