Diverticulitis: The Top 13 Questions

1 Is it diverticulitis or IBS?

Diverticulitis and IBS (irritable bowel syndrome) are disorders that affect the gastrointestinal system, particularly, the colon. Diverticulitis is the infection or inflammation of diverticula, small pouches that have formed in the intestine. On the other hand, irritable bowel syndrome is a functional disorder of the colon. Both conditions are characterized by recurrent bouts of abdominal pain, diarrhea, and constipation. The causes of both conditions are not exactly known but diverticulitis is thought to be caused by increased pressure on diverticula, while IBS is related to stress.

Symptoms of diverticulitis are severe abdominal pain, usually in the lower left part of the abdomen, fever, nausea, vomiting, and constipation, or less commonly, diarrhea. Symptoms of IBS, on the other hand, include diarrhea or constipation (sometimes alternating bouts of both), excess gas, and abdominal cramps or pain.

The risk of diverticulitis increases with age. Other risk factors for diverticulitis include obesity, lack of exercise, smoking, and a diet low in fiber and high in animal fat. On the other hand, the risk factors for irritable bowel syndrome are being female, having a family member with IBS, being under 45 years old, and having psychological problems or being under a lot of stress.

2 Is diverticulitis painful?

Yes, diverticulitis can be painful. The most significant symptom of diverticulitis is abdominal pain, usually felt on the left side of the abdomen. This is because diverticula are commonly found in the sigmoid colon. The abdominal pain is aggravated by movement.

3 Is diverticulitis fatal?

Diverticulitis is a manageable condition if it is caught early on. If diverticulitis is left untreated, it can lead to complications that could be fatal. Abscesses may develop in the intestinal wall and around diverticula. This occurrence can lead to the rupture of a diverticular pouch. This empties the contents of the bowel into the abdominal cavity and quickly leads to peritonitis (the infection of the lining of the abdominal cavity), which could quickly prove fatal if not treated immediately.

4 Does diverticulitis cause bleeding?

Diverticulitis may cause some bleeding as diverticula may bleed. The blood exits through the rectum, making the color of stool bright red, or sometimes maroon and even black and tarry. In some cases, however, the blood may not always be seen with the naked eye. Bleeding is usually mild, sudden, and painless, and stops on its own most of the time.

5 What is sigmoid diverticulitis?

Sigmoid diverticulitis is the inflammation of diverticula (tiny pockets that are formed through increased pressure on the weak spots of the intestinal wall) in the sigmoid colon. This area is the region of the large intestine where diverticula are most commonly found.

6 What can you eat when you have diverticulitis?

A high-fiber diet helps prevent the development of diverticular disease, especially diverticulitis. Adults must consume between 20 and 35 grams of fiber a day, depending on their height and weight. At least five portions of vegetables, fruits, and whole grains must be consumed each day.

When the body is not getting enough fiber, the colon has to exert a lot more effort to contract so that stool can be expelled. This extra pressure on the colon increases the possibility of diverticulitis.

Fiber-rich food eases and speeds up the process of waste elimination. However, a sudden and drastic increase in fiber intake is ill-advised, as it will likely cause uncomfortable side effects such as flatulence, bloating, and constipation. One should increase the fiber in one's diet gradually and remember to drink plenty of fluids to prevent the said side effects.

Refined carbohydrates should be avoided as these deny you of fiber. Seeds, nuts, and corn may aggravate the symptoms of diverticulitis because they are known to cause blockages in diverticula.

7 What are the causes of diverticulitis?

The exact reason for the occurrence of diverticulitis has not been identified. The theory is that diverticula are formed when the colon needs to work harder to move stool. The increased pressure is thought to encourage the formation of pouches in weak spots of the colon. Bacteria grow in the diverticula and this may be the factor that leads to inflammation or infection, that is, diverticulitis. 

A diet low in fiber is thus thought to play a key role in diverticulitis. Also, some studies have found that stronger contractions of the colon appear to cause the thickening of the intestinal wall, which then results in the development of diverticula. 

Another factor being linked to the development of diverticulitis is trapped fecal matter. When diverticula are damaged, perforations can allow bacteria in fecal matter to infect healthy and normal adjacent tissue.

8 What are the symptoms of a diverticulitis attack?

• Abdominal pain – This is the most common symptom of diverticulitis. Pain can occur in any part of the abdomen but is usually felt in the lower left part of the abdomen because diverticula are commonly seen in the sigmoid colon. For people of Asian descent, abdominal pain is more pronounced on the right side. The pain may be aggravated by movement.
• Fever – Another common symptom of diverticulitis is fever, caused by the infection. Fever may be accompanied by chills.
• Urinary urgency, frequency, or discomfort – This symptom is particularly common in men. It usually occurs when the inflamed sigmoid colon is up against the bladder.
• Rectal bleeding – Diverticula may bleed, and the bleeding then passes through the anus, or bright red, maroon, or black and tarry blood may appear in the stool. This rectal bleeding is typically mild, painless, sudden, and usually ceases on its own, although less commonly, it may also be severe. In some cases, the blood is not visible to the naked eye.
• Tenderness in the abdomen – This is the most common sign of diverticulitis.
• Nausea or vomiting
• Loss of appetite
• Diarrhea
• Constipation
• Bloating
• Abdominal cramps
• A general feeling of being unwell

These symptoms usually last for a few hours but could last for several days, and range from mild to severe depending on the presentation of the patient. The mild symptoms of diverticulitis can be managed through rest, the use of antibiotics, and dietary changes. On the other hand, surgery may be required for severe and recurring symptoms of diverticulitis.

9 What happens if a person with diverticulitis does not receive immediate medical attention?

If someone with diverticulitis does not receive immediate medical attention, serious complications may develop. Complications typically cause further symptoms. If a fistula (abnormal opening) develops between the colon and urethra or the colon and vagina, stool or air may pass from the urethra or vagina.

10 How long does it take to recover from diverticulitis?

Managing diverticulitis is a lifelong task as it requires the commitment to living a healthy lifestyle. How long a person typically recovers from diverticulitis depends on the severity of the condition and the treatment given.

In mild cases of diverticulitis, a liquid diet and antibiotics are enough to manage the symptoms and the condition itself. These patients usually improve within 2 to 3 days. However, some people with diverticulitis need surgery to treat their condition. For these cases, it full recovery may take several months.

11 Can diverticulitis cause back pain?

Diverticulitis may cause lower back pain in some patients. This is because a majority of the problems of the digestive tract cause lower back pain along with abdominal pain. The pain in the abdomen radiates toward and reaches the back. Women and the elderly commonly experience back pain due to diverticulitis. However, diverticulitis is not a common cause of back pain. 

12 What food should be avoided for the prevention or management of diverticulitis?

Avoid Red Meat

Eating red meat is one of the likely risk factors for the development of diverticulitis. Aside from red meat consumption, other risk factors are obesity, cigarette smoking, and the use of non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen.

Avoid Food High in Fat

Another risk factor for the occurrence of diverticulitis is the consumption of food rich in fat. Food high in fat could block the opening of the diverticula and thus lead to inflammation.

Avoid Spicy Food

Spicy food intensifies the condition of the affected areas of the large intestine by stimulating inflammation. Consequently, recovery time is longer.

13 What is diverticulitis surgery?

Diverticulitis surgery is done when the weakened sections of the abnormal pouches or diverticula have become obstructed or have ruptured. Colon resection, also called colectomy, is performed for this condition. With colon resection, the damaged part of the large intestine is removed while the healthy segments are re-attached to one another. This prevents the perforation of the intestinal wall and further attacks. In some cases, a total colectomy is performed to remove the entire large intestine.

Laparoscopic surgery is now widely offered as a new surgical option for diverticulitis. During this procedure, surgeons make small cuts in several regions of the lower abdomen. The incisions are used to access the colon using endoscopic equipment. These tools are slim tubes that have a scope and self-lit lens attached at the end. An endoscope allows the surgeon a good view of the colon during surgery. Using this method, the surgeon performs the surgery while watching a video monitor showing images of the body's internal parts and the surgical instruments being used. The laparoscopic technique provides a safe way into the patient’s abdomen for the surgeon to cut and repair the intestine without having to open the patient’s abdomen. Laparoscopic surgery is a much easier procedure for patients to undergo, compared with the conventional, open type of surgery. 

Laparoscopic surgery has been widely used and is steadily becoming more popular. It means less blood loss, less pain, a shorter hospital stay, faster recovery, quicker healing, and a quicker return to normal activities. On the other hand, patients suffering from more severe inflammation may require the traditional type of surgery.

Surgery is also an option if a patient has had two or more attacks of diverticulitis that were treated without surgery or a single attack of diverticulitis that required hospitalization. Surgery may also be called for where a patient possibly has colon cancer or whose diverticulitis attack has resulted in complications such as inflammation of the urinary tract, intestinal obstruction, or intestinal abscesses.

Emergency surgery is needed if bleeding is present or in case of peritonitis. Either the laparoscopic approach or open surgery may be used to address such complications. Multiple and severe attacks of diverticulitis, infection that has spread in the abdomen, an obstructed bowel, ruptured diverticula, and the presence of fistula are the other indications for surgery.

14