Diverticulitis: All you need to know!

Diverticulitis is a condition that occurs when small pouches in the wall of the colon, called diverticula, become inflamed or infected. While many people with diverticula (a condition known as diverticulosis) never experience symptoms, diverticulitis can cause significant discomfort and, in some cases, lead to serious complications. This article provides a detailed overview of diverticulitis, including its causes, symptoms, diagnosis, treatment options, and long-term management.

What is diverticulitis?

Diverticulitis is the inflammation or infection of diverticula, which are small, pouch-like structures that can form in the wall of the colon. These pouches develop at weak spots in the colon’s muscular wall, often where blood vessels pass through. While diverticulosis (the presence of diverticula) is common and often asymptomatic, diverticulitis occurs when these pouches become irritated, inflamed, or infected.

Causes of diverticulitis

The exact cause of diverticulitis is not fully understood, but it is believed to result from:

Increased pressure within the colon, which can weaken the colon wall.
Trapped stool or bacteria in the diverticula, leading to inflammation or infection.
A low-fiber diet, which can contribute to harder stools and increased pressure in the colon.

Symptoms of diverticulitis

The symptoms of diverticulitis can vary depending on the severity of the inflammation or infection. Common symptoms include:

Abdominal pain: Usually felt in the lower left side of the abdomen, though it can sometimes occur on the right side.
Fever and chills: Signs of infection.
Nausea and vomiting: Often due to the body’s response to inflammation.
Changes in bowel habits: Constipation, diarrhea, or both.
Urinary symptoms: Pain or burning during urination, or the frequent need to urinate, if the inflammation affects nearby organs like the bladder.

In severe cases, diverticulitis can lead to complications such as:

Abscess: A collection of pus in the affected area.
Fistula: An abnormal connection between the colon and another organ, such as the bladder.
Bowel obstruction: A blockage in the colon.
Peritonitis: A life-threatening infection of the abdominal cavity.
Sepsis: A severe, body-wide infection that can lead to organ failure.

How is diverticulitis diagnosed?

If you experience symptoms of diverticulitis, your doctor may perform the following tests to confirm the diagnosis:

Physical Examination: Your doctor will check for tenderness in your abdomen, particularly in the lower left side.
Blood Tests: To check for signs of infection, such as an elevated white blood cell count.
CT Scan: The most common imaging test used to diagnose diverticulitis. It can show inflammation, abscesses, or other complications.
Ultrasound or MRI: Alternative imaging tests that may be used in certain situations.

Tests like colonoscopy or barium enema are typically avoided during an acute episode of diverticulitis due to the risk of perforation.

Treatment for diverticulitis

The treatment for diverticulitis depends on the severity of your symptoms and whether you have any complications.

Mild diverticulitis

If your symptoms are mild and you are otherwise healthy, your doctor may recommend:

Antibiotics: To treat the infection (if prescribed).
Liquid Diet: To rest your colon and allow it to heal. This may include clear broths, juices, and water.
Pain Relief: Over-the-counter pain relievers like acetaminophen (avoid NSAIDs like ibuprofen, as they can worsen symptoms).
Rest: To help your body recover.

If your symptoms worsen (e.g., fever, severe pain, or inability to tolerate fluids), seek medical attention immediately.

Severe or complicated diverticulitis

If your symptoms are severe or you have complications, you may need:

Hospitalization: For intravenous (IV) fluids and antibiotics.
Drainage: If an abscess has formed, it may need to be drained using a needle or surgery.
Surgery: In cases of peritonitis, fistulas, or recurrent episodes, surgery may be necessary. This can involve:
- Removing the diseased part of the colon.
- Creating a colostomy (an opening in the abdomen for waste removal) in emergency cases.
- Reconnecting the colon in a second surgery after the initial colostomy.

Long-term management after diverticulitis

After recovering from an episode of diverticulitis, your doctor may recommend the following steps to prevent future episodes and monitor your health:

High-Fiber Diet: Increasing your fiber intake can help soften stools and reduce pressure in the colon. Good sources of fiber include fruits, vegetables, whole grains, and legumes.
Colonoscopy: If you haven’t had one recently, your doctor may recommend a colonoscopy to evaluate the colon and rule out other conditions, such as polyps or cancer.
Regular Follow-Ups: To monitor your condition and address any recurring symptoms.
Hydration: Drinking plenty of water to support digestion and prevent constipation.

When should a colonoscopy be performed after diverticulitis?

After an episode of diverticulitis, it is important to evaluate the colon to rule out other conditions, such as polyps, cancer, or additional diverticula. However, the timing of a colonoscopy depends on the severity of the diverticulitis episode, the patient’s overall health, and whether a recent colonoscopy has already been performed. Below is a detailed guide on when and why a colonoscopy should be performed after diverticulitis.

Why is a colonoscopy needed after diverticulitis?

A colonoscopy is recommended after an episode of diverticulitis for several reasons:

Rule Out Other Conditions: Diverticulitis symptoms can sometimes mimic those of colorectal cancer or other gastrointestinal disorders. A colonoscopy helps ensure there are no underlying issues, such as polyps, tumors, or inflammatory bowel disease (IBD).
Assess the Extent of Diverticulosis: The procedure can determine how many diverticula are present and their locations in the colon.
Monitor for Complications: A colonoscopy can identify complications like strictures (narrowing of the colon) or fistulas (abnormal connections between organs).
Establish a Baseline: If you have not had a colonoscopy before, this provides a baseline for future comparisons.

When should a colonoscopy be performed after an episode of diverticulitis?

The timing of a colonoscopy after diverticulitis depends on the severity of the episode and whether complications were present. Here are the general guidelines:

1. After Uncomplicated Diverticulitis

Timing: A colonoscopy is typically recommended 6-8 weeks after recovery from an uncomplicated episode of diverticulitis.
Reason: This allows time for inflammation to subside, reducing the risk of complications during the procedure (e.g., perforation).
Exceptions: If you have had a colonoscopy within the past year, another one may not be necessary unless your symptoms or condition change.

2. After Complicated Diverticulitis

Timing: A colonoscopy should be performed after the acute episode has resolved, but the exact timing depends on the complication:
- Abscess or Fistula: Once the abscess has been drained or the fistula has healed.
- Bowel Obstruction or Peritonitis: After surgical treatment and recovery.
Reason: Complicated diverticulitis may indicate a higher risk of other conditions, such as cancer, so a thorough evaluation is essential.

3. If Symptoms Persist or Recur

If you continue to experience symptoms like abdominal pain, changes in bowel habits, or rectal bleeding after recovering from diverticulitis, a colonoscopy may be performed sooner to investigate the cause.

4. If No Recent Colonoscopy Has Been Done

If you have never had a colonoscopy or it has been more than 10 years since your last one, your doctor will likely recommend the procedure after recovery from diverticulitis.

Are there risks to having a colonoscopy after diverticulitis?

While colonoscopy is generally safe, there are some risks, especially if the colon is still inflamed from diverticulitis. These risks include:

Perforation: A small tear in the colon wall (rare but more likely if inflammation is present).
Bleeding: If polyps are removed or biopsies are taken.
Infection: Rare but possible.

To minimize risks, your gastroenterologist will ensure that the inflammation from diverticulitis has fully resolved before performing the procedure.

Diverticulitis: Prognosis and recurrence

First Attack: About 85% of people with uncomplicated diverticulitis recover well with medical treatment. After recovery:
- One-third of patients remain symptom-free.
- One-third experience occasional cramps or discomfort.
- One-third have a second attack of diverticulitis.
Recurrent Attacks: The risk of complications does not necessarily increase with subsequent attacks. However, surgery may be considered for patients with frequent or severe episodes.

Conclusions

Diverticulitis is the inflammation or infection of diverticula in the colon and can cause symptoms like abdominal pain, fever, and changes in bowel habits.
Mild cases can often be treated at home with antibiotics, a liquid diet, and rest, while severe cases may require hospitalization or surgery.
A high-fiber diet and regular follow-ups with your doctor can help prevent future episodes and maintain colon health.
If you experience symptoms of diverticulitis, seek medical attention promptly to avoid complications.

By understanding your condition and following your gastroenterologist’s advice, you can effectively manage diverticulitis and maintain a good quality of life. If you have any concerns or questions, don’t hesitate to reach out to your doctor.