Diverticulitis

Cause

Doctors aren't sure what causes the pouches (diverticula) that form in the wall of the large intestine (colon) to become inflamed or infected. A low-fiber diet may play a role in making it harder to move stools out of the body. Bacteria can grow in the pouches and cause inflammation or infection.

It's not known why some people who have these diverticula get diverticulitis and others do not.

There is no proof that foods such as nuts, seeds, or berries cause it or make it worse.

A diet with good fiber, which makes stool bulky so that it can move easily through the colon, may reduce the risk of diverticulitis.

What Increases Your Risk

The possibility of having diverticulitis increases with age.

You may be more likely to develop diverticulitis if you:

• Eat a low-fiber diet.
• Have a family history of diverticulosis.
• Use nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin many days of the week for many years.
• Have obesity.
• Smoke.

Symptoms

Symptoms of diverticulitis include:

• Tenderness, cramps, or pain in the belly. This is often in the lower left side but may occur on the right. These symptoms are sometimes worse when you move. Pain is the most common symptom.
• Fever and chills.
• Bloating and gas.
• Diarrhea or constipation.
• Nausea and sometimes vomiting.
• Not feeling like eating.

Symptoms may last from a few hours to several days. They may last longer if the problem isn't treated.

What Happens

Diverticulitis occurs when pouches (diverticula) that have formed in the wall of the large intestine (colon) become inflamed or infected. It's not known why some people who have these pouches (diverticulosis) develop diverticulitis and others do not.

Mild flare-ups of diverticulitis, with few symptoms of infection or inflammation, sometimes heal on their own. Sometimes doctors prescribe oral antibiotics. They may also suggest a clear liquid diet to rest the bowel until it isn't inflamed.

When infection and symptoms are severe, diverticulitis is treated in the hospital. Treatment includes antibiotics given in a vein (intravenous, I.V.) and resting the bowel by limiting oral fluids. If symptoms are severe and not treated, problems such as an abscess or a fistula may happen. Surgery often is needed to treat these.

It's common to have lower belly pain after recovering from a flare-up of diverticulitis. But this pain doesn't always mean that it has returned.

When to Call

Call 911 or other emergency services immediately if the person:

• Is bleeding from the anus and has signs of shock, such as:
  • Passing out (losing consciousness).
  • Feeling very dizzy, weak, or less alert.

Contact your doctor now if you have:

• Belly pain. This is usually in the lower left side. It is sometimes worse when you move.
• Fever or chills.
• Nausea and vomiting.
• Unusual changes in your bowel movements.
• Bloating and gas.
• Blood in your stool.

Contact your doctor if you:

• Have cramping pain that does not get better when you have a bowel movement or pass gas.
• Have been losing weight without trying.

Contact your doctor if you are treating mild diverticulitis at home and:

• You have a fever.
• Your pain is getting worse.
• You can't keep down liquids.
• You are not better after 3 days.

Exams and Tests

To diagnose diverticulitis, your doctor will ask questions about your symptoms and examine you. The doctor may do tests to see if you have an infection or to make sure that you don't have other problems. Tests may include:

• Blood tests, such as a complete blood count (CBC).
• A digital rectal exam. This looks for tenderness or a mass in the lower pelvic area.
• A fecal occult blood test. This looks for blood in your stool.
• Other tests, such as a CT scan, an ultrasound, an MRI, or an X-ray of your belly. These may help find the cause of belly pain and other symptoms.
• Flexible sigmoidoscopy and colonoscopy. These may be done if you have bleeding or to look for narrow spots or growths in the bowel.

Treatment Overview

Treatment depends on how bad your symptoms are. If the pain is mild, you are able to drink fluids, and you have no signs of complications, treatment may include:

• Medicines such as antibiotics and pain relievers.
• Changes in diet. These changes start with drinking clear fluids or eating small amounts of low-fiber food. This allows the bowel to rest. You follow this diet until the pain goes away. You then increase how much fiber you eat.

If the pain is severe, you are not able to drink fluids, or you have complications of diverticulitis, you may need treatment in the hospital. Treatment will include:

• Antibiotics given in a vein (intravenous, or I.V.).
• Fluids and food given through your vein only (no food or drink by mouth) for up to a week. This allows the bowel to rest.

Sometimes surgery is needed to treat some problems or repeated flare-ups.

Self-Care

• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• Stay with clear fluids or start with small amounts of food until you are feeling better. Then you can return to regular foods and slowly increase the amount of fiber in your diet.
• Get extra rest until you are feeling better.
• Be safe with medicines. Read and follow all instructions on the label.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• Do not use laxatives or enemas unless your doctor tells you to use them.