What is Diverticulitis?
Diverticulitis is a condition which affects the large intestine. It causes inflammation in small pouches or sacs which have developed along the colon wall.
These small pouches are formed due to a condition called diverticulosis. When these develop they push outwards against the wall of the colon where pieces of poop can get stuck and cause inflammation.
The chances of developing diverticulosis and diverticulitis increase with age, where women generally present a higher risk. (1)
Symptoms
The small pouches (diverticular) can develop anywhere along the colon, but most often found in the lower part. Their presence doesn’t always cause symptoms or complications, neither does it mean you will definitely develop diverticulitis.
It was believed for a time this condition was caused by a low-fiber diet. However, today some would argue against that theory and say it’s a mixture of different factors.
Smoking, being overweight, an imbalance of digestive bacteria and lack of physical exercise appear to form a common theme for diverticulitis. (2)
Sometimes diverticulitis can occur with only mild symptoms. In these cases the person affected will be treated with bedrest, medication and a liquid diet. (3)
In other more acute cases symptoms will begin suddenly and cause complications, these may involve anything from an abscess, to a perforation (a tear or hole in the tissue). These need to be treated quickly before they progress further. (4)
Symptoms include the following:
Abdominal Pain
When the small pouches become inflamed the predominant symptom is sudden pain or tenderness in the lower left side of the abdomen. This can come on abruptly and feel severe or it can intensify over a period of time. Some people may even describe it as cramps or spasms in the stomach. (5, 6)
The pain generally begins just under the belly button, where it quickly spreads to the lower left side.
Changes in Bowel Habits
This can be a symptom of diverticulosis as well as diverticulitis. (7)
The person affected will most likely see either episodes of constipation or bouts of diarrhea. A typical pattern is several trips to the bathroom passing pellet-like stools. (8)
Fever
When the body encounters an infection or inflammation its natural response is to elevate core temperature in order to support the immune system and fight off the problem. (9)
When the fever begins it can trigger shivering as the body increases its temperature. As the fever subsides it can result in chills. Some people may also feel nauseous or develop a headache.
Nausea or Vomiting
Nausea can be explained as a feeling of discomfort within the stomach, giving a sensation of wanting to vomit.
It’s a typical sign of an issue in the stomach or bowel. People affected by diverticulitis can experience this, although some may only feel nauseous while others might also vomit. (10)
Stages
The first staging of the disease was completed by a man named Hinchey, his version has since been modified over the decades. (11)
The stages below is a combined version which explains the progression from diverticular disease to the infection of the pouches and its complications. (12)
Different complications can arise from diverticulitis, some of which can be life threatening.
Stage A
During the first stage the person affected will experience signs indicating inflammation or an abscess within the colon wall. Symptoms such as pain in the lower left side, fever and a change in bowel habits could manifest.
This stage is classified as uncomplicated. It requires simple treatments and can be prevented by limiting fiber and antibiotics. (13)
Stage B
In this stage the condition is now classified as a chronic complicated disease, meaning it can be long lasting and disrupt daily life.
People in this stage are likely to experience recurrent blood loss from the rectum and a weakened bowel passage, which means control of bowel movements could be affected.
The person is also likely to have developed a fistula. This can be explained as a tunnel caused by either an injury or infection between a hollow organ and the body surface. In cases of diverticulitis it’s either between the colon and the bladder or vagina. (14)
Stage C
During the last stage the condition will be classified as acute. Symptoms and complications can be more severe and begin suddenly.
The affected person can expect a fever followed by a bowel obstruction (ileus), and large abscesses. This can be followed by blood loss from the rectum.
Another complication which can result is peritonitis. This occurs when pus or stool leak through a hole in the lining of the abdomen. This ends up on the tissue which covers the abdominal organs and causes inflammation. (15)
Peritonitis needs urgent medical care because it can be life threatening.
Treatment
Treatment of diverticulitis highly depends on which stage it is in. If it’s in the early stage with only mild symptoms, treatment is fairly simple and is typically resolved with a course of antibiotics.
However, if it’s in advanced stages, treatment will focus on the complications before they progress. (16)
Home Treatment
In the case of mild diverticulitis, your doctor will often allow it to be treated at home. It will be managed with antibiotics, followed by a liquid diet in order to improve the symptoms. (17)
During recovery your doctor will most likely ask you to follow a low-fiber diet so that less poop is passed through until your bowels have fully recovered. Once it’s back to normal, a high-fiber diet is likely to be recommended.
Hospital Treatment
If diverticulitis is severe and involves complications, doctors will treat it at the hospital. You will be given antibiotics through an intravenous (IV) drip as well as fluids to keep you hydrated and nourished. This is to compensate for a few of days of “nil by mouth” to completely rest the colon. (18)
Surgery
Surgery is only performed under certain circumstances because it does have its own set of complications.
Whether or not surgery is an option will depend on: whether you have previous history relating to complications from diverticulitis, if you’ve experienced symptoms of diverticular disease from a young age or if you have a weak immune system therefore a higher risk of developing infections. (19)
Different types of surgeries can be used, these can include:
Colectomy
During this surgery your doctor will remove the affected part of the large intestine.
This can be done in two ways: open colectomy which is where the surgeon makes a large cut to remove the affected part. The alternative is a laparoscopic colectomy, where only a small incision is made and the operation is performed using a camera and special tools. (20)
Stoma Surgery
This type of surgery involves attaching a bag to the colon in cases where it either needs to recover or a too much has been removed so it’s impossible to reattach.
The bag will work as the last part of the colon where the poop is passed to. This means you wear a small pouch on the side of your stomach which is attached to your large intestine.
In most cases these are only temporary and once the colon has recovered it will be removed. However there are other cases where it can be permanent.
Surgery might also be needed to drain an abscess or to repair a hole or tear in case a perforation has taken place. (21)
If you have peritonitis, which is possible during the last stage, you may need immediate surgery to clean the tissue. Some cases require a colectomy or may even need a blood transfusion in case of severe blood loss. (22)
FAQ
What is diverticulitis? Diverticulitis is inflammation of the small sacs or pouches called diverticular. These develop in the colon due to another condition called diverticular disease or diverticulosis.
What are the signs of diverticulitis? A classical symptom is abdominal pain which can be severe and sudden or it can be mild and increase in intensity. Other signs may include symptoms of infection such as fever or chills, nausea and vomiting.
How do you develop diverticulitis? It was believed to be caused by a low-fiber diet, however today many argue against that claim. However, there are certain factors which can increase the risk, such as: certain medicines, smoking, obesity or lack of exercise. (23)
How are you diagnosed for diverticulitis? Your doctor will start out by asking a few questions about your medical history, diet, health and symptoms. After this a physical exam will likely follow, as well as blood tests and a computerized tomography (CT) scan. (24)
What is the best treatment for diverticulitis? Depending upon which stage the condition is diagnosed, will determine the best treatment. In early stages it can be treated with medicine and a liquid diet. During advanced stages it may require surgery.
What are the long term complications of diverticulitis? Most people have a good chance of recovering without major complications. However once you have had diverticulitis your chances of developing it again increase. (25)
Is diverticulitis considered a disability? It’s not considered to be a disability. Though in some cases you can qualify for disability benefits. (26)
Is there a cure for diverticulitis? Yes people can recover from the disease, either with the help of surgery and treatment or a change in diet and lifestyle.
Is diverticulitis life threatening? The disease in itself is for most parts easily treated, however some of the complications which sometimes follow can be fatal.
Summary
Diverticulitis is inflammation of diverticular which are the formation of small sacs or pouches within the colon. Poop and other substances can get stuck and cause infection.
People affected will experience sudden abdominal pain followed by signs of infection such as fever or chills, nausea and vomiting.
This disease in the early stages is not always serious and sometimes can be treated successfully just by a change in diet. However certain complications can be a real cause of concern therefore it’s always best to seek medical advice.