Brief overview
- Treatment: Medical treatment is necessary, depending on the severity of the inflammation, ranging from dietary measures and physical rest to antibiotics and surgery.
- Symptoms: Pain in the affected bowel area, often in the lower left lower abdomen, flatulence, constipation, diarrhea, nausea
- Causes and risk factors: inflamed diverticula lead to the disease, risk factors: unhealthy diet, obesity, lack of exercise as well as certain diseases and medications
- Diagnosis: Medical interview, physical examination (such as palpation, listening), blood test for signs of inflammation, urine test, ultrasound and/or computer tomography, rarely magnetic resonance imaging (MRI)
- Prevention: High-fiber, vegetarian or at least low-meat diet, adequate fluid intake, physical exercise, weight reduction, abstinence from smoking.
What is diverticulitis?
Diverticulitis is a condition in which bulges in the large or small intestine become inflamed. These protrusions are called diverticula by physicians. If several diverticula exist, this is defined as diverticulosis. They are particularly susceptible to infection, as it is possible for germ-laden stool to linger longer in the outpouchings.
Intestinal diverticula are not in themselves pathological and do not initially cause any symptoms. The incidence increases with age. In people between 70 and 85 years of age, about one in two in western industrialized nations has diverticula.
If the diverticula become inflamed, symptoms such as abdominal pain, fever, constipation and flatulence may occur.
Doctors distinguish between different forms or stages of diverticulitis:
- For the most part, acute uncomplicated diverticulitis is present. In this case, the diverticula cause unpleasant symptoms, but do not lead to further complications and damage to the intestinal wall. Almost always, conservative diverticulitis therapy is possible – that is, treatment without surgery.
- In acute complicated diverticulitis, the inflamed outpouchings bring further problems. These are, for example, abscesses, fistulas, an intestinal obstruction or a hole (perforation) in the intestinal wall. Diverticulitis surgery is then usually necessary to avoid serious health consequences.
Often, inflammation is limited to the area surrounding individual diverticula (peridiverticulitis). However, it is possible for larger sections of the intestine to become inflamed (pericolitis).
Diverticulosis
Diverticulitis usually develops from initially harmless protrusions of the intestinal wall (diverticulosis). You can read more about this in the article Diverticulosis.
How can diverticulitis be treated?
Diverticulitis therapy depends on what symptoms the affected person has and which structures in the abdomen are inflamed. In many cases, doctors base their treatment on so-called guidelines. These are treatment recommendations for certain diseases based on current scientific knowledge. For diverticulitis, these include the following recommendations.
Treatment for uncomplicated diverticulitis
- Sufficient fluid intake
- Easily digestible liquid diet, sometimes also the so-called “astronaut diet” (small intestine-absorbable, low-molecular formula diet)
- In the acute phase of the disease, a low-fiber diet; later, usually a high-fiber, low-meat diet
Similarly, doctors sometimes prescribe antibiotics (for example, metronidazole and ciprofloxacin) for diverticulitis, especially if risk factors exist. In addition, they sometimes use anti-inflammatory agents such as aminosalicylates. In the case of pain, antispasmodic preparations such as metamizole and butylscopolamine support diverticulitis treatment.
The duration of treatment for acute, uncomplicated diverticulitis or the inability to work in this form of diverticulitis is usually about six to eight weeks. In severe cases, patients often need longer to recover.
Treatment for complicated diverticulitis
In the case of pronounced diverticulitis or complications, for example intestinal perforation (rupture of the intestinal wall), surgeons recommend removing the damaged section of intestine. In the case of intestinal perforation, it is imperative that surgery be performed as soon as possible.
In milder courses of diverticulitis, doctors schedule surgery after the inflammation has subsided, about six to eight weeks after starting antibiotic therapy. In some circumstances, surgery may take place earlier if the symptoms do not disappear despite antibiotic infusions.
If one or more diverticula have burst, it is imperative that doctors remove the affected piece of intestine as soon as possible (within six hours). Otherwise, there is a high risk that the entire peritoneum will become inflamed (peritonitis). The peritoneum is a thin skin that lines the inside of the abdominal cavity and coats the internal organs. Peritonitis is one of the life-threatening diseases.
In addition, doctors also often recommend surgical treatment for recurrent (chronic recurrent) diverticulitis, as well as for fistulas or narrowing (stenosis) of the intestine.
What happens during diverticulitis surgery?
During surgery, surgeons remove the section of intestine with the diverticula and sew the remaining ends of the intestine back together.
If individual diverticula have burst (perforation) in the course of diverticulitis, open surgery is necessary in any case. This is usually an emergency operation.
In the case of an emergency operation or a particularly severe inflammation, it is sometimes necessary to create an artificial anus (anus praeter). This allows temporary relief of the intestinal suture. However, it is usually not a permanent condition.
Usually, doctors put the artificial outlet back after a short time in a second operation. Sometimes, however, this is not possible, in which case the intestine ends at a hole in the skin. Stool is excreted through a pouch that is attached to the skin.
Surgery complications
It is important not to lift heavy loads (over ten kilograms) for about four to six weeks after diverticulitis surgery. This is because lifting too heavy can cause the scar to rupture.
Tips against relapse
In about 20 percent of patients (without diverticulitis surgery), diverticulitis recurs after a while (relapse). However, the risk decreases if patients take into account behavioral measures that ensure healthy bowel activity. These include:
- Eat a diet high in fiber.
- Drink plenty of fluids, at least two to two and a half liters per day.
- Avoid constipation.
- Get regular exercise.
- Try to lose excess pounds.
What home remedies can help?
Generally, the use of home remedies and self-treatment for diverticulitis is not recommended without first consulting a doctor.
In some cases, sufferers report that heat applications in the form of hot water bottles or wraps can relieve the abdominal cramps or pain of diverticulitis somewhat. Ask your treating physician if this would be safe to use in your case.
Home remedies have their limitations. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.
What are the symptoms of diverticulitis?
You can learn more about the signs and symptoms of diverticulitis at: Diverticulitis – Symptoms.
How does diverticulitis develop?
The two main causes of diverticulitis are the increasing weakness of the connective tissue with age and constipation.
A low-fiber diet makes the stool hard and firm. The internal pressure in the intestine is thus higher than when the stool is soft and supple. This pressure and the less elastic connective tissue in old age cause the mucous membrane of the intestine to bulge outward in some places: diverticula form.
If stool remains in the diverticula, especially if the stool backs up during constipation, the bulges sometimes become inflamed and diverticulitis develops. It is possible for the inflammation to be confined to the diverticulum, but in some circumstances it spreads to the surrounding intestine.
Risk factors
There are conditions that contribute to a particular risk for diverticulitis. These are:
- A weakened immune system, for example, due to the use of immunosuppressants.
- Chronic kidney disease
- An elevated blood pressure (arterial hypertension)
- Allergic diseases
In addition, certain medications also lead to an increased risk as well as complications of diverticulitis such as bleeding. These medications include:
- Certain nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac, acetylsalicylic acid (ASA), and coxiben are excluded
- Corticosteroids
- Opioids
- Hormones given to women after menopause
The painkiller acetaminophen may also increase the risk of diverticular bleeding.
How is diverticulitis diagnosed?
The doctor obtains important clues for the diagnosis of diverticulitis from the patient’s medical history (anamnesis). For example, he asks the following questions:
- Where exactly is the pain located and how does it feel?
- Do you have a fever and/or constipation?
- Have you had such complaints before or are diverticula already known to you?
On physical examination, the inflamed diverticula can be palpated as a hardened structure in the left lower abdomen. It is possible that palpation may cause pain in diverticulitis. Usually, the doctor also palpates the anus with a finger to detect changes in the rectum (digital-rectal examination). Listening to the abdomen for bowel sounds is also often part of the physical examination.
Blood tests often reveal elevated levels of inflammation in diverticulitis – for example, an increased number of white blood cells (leukocytes), an altered blood cell sedimentation rate (ESR) and elevated C-reactive protein (CRP). Urinalysis provides information on whether there is a possible disease of the urinary tract and whether there are fistulas to the bladder.
Sometimes an X-ray of the abdomen in the standing position is necessary to diagnose diverticulitis: This is because if a diverticulum ruptures, free air enters the abdominal cavity. This accumulates under the diaphragm and is therefore clearly visible on the X-ray. Doctors use magnetic resonance imaging (MRI) less frequently.
What is the course of diverticulitis?
When inflamed diverticula rupture (perforate) in diverticulitis, a collection of pus (abscess) in the abdomen is possible. In some cases, diverticulitis spreads to the peritoneum (peritonitis). Bleeding occurs in about 15 percent of patients with diverticulitis.
In addition, diverticulitis sometimes causes a section of the intestine to become narrowed (stenosis). Further transport of the intestinal contents through this narrowing is no longer possible, which may result in intestinal obstruction (ileus). In this case, surgery is usually required.
After a first episode of diverticulitis, the risk of recurrence is 30 percent. The earlier in life diverticulitis occurs, the more likely it is to be treated by surgery at some point.
Is diverticulitis preventable?
Why diverticula form in some people is not clearly understood. General connective tissue weakness, bowel sluggishness and constipation seem to favor the bulging of the bowel wall and thus diverticulitis.
A healthy lifestyle prevents diverticula and the diverticulitis often associated with them and reduces the risk of inflammation. Take a few simple steps to keep your digestion moving:
- Exercise regularly, preferably two to three times a week, for at least half an hour. For example, do endurance sports such as jogging or swimming.
- Drink enough, at least two liters a day, preferably mineral water or herbal tea.
- Abstain from nicotine.
So, it is possible that you can protect yourself from diverticulitis with some small lifestyle changes.
What to look for in the diet?
What exactly is the right diet for a known diverticulitis or how to prevent with food, you can read in the article Diverticulitis – Nutrition.