Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Diverticulitis

(Acute Diverticulitis; Acute Colonic Diverticulitis)
by Debra Wood, RN
Definition

A pouch that forms in the wall of the large intestine is called a diverticulum. When it becomes infected or inflamed it is called diverticulitis.

Causes

It is not clear why the pouches form. Doctors believe a constant pressure is built up when food moves too slowly through the bowel. This pressure increases then pushes along the side walls creating pouches. Digested food or stool can become trapped in one of the pouches. This leads to inflammation and infection.

The following may contribute to diverticulitis:

  • Chronic constipation
  • Defects in the colon wall
  • Increased pressure in the bowel from straining to pass a hard stool
  • Low-fiber diet—Fiber softens stools and makes them pass through the bowel more easily
Risk Factors

Factor that increases your chance of getting diverticulitis include:

  • Age: 50 or older
  • Chronic constipation
  • Eating a low-fiber diet
  • High meat or protein diet
  • Previous episodes of diverticulitis
Symptoms

Symptoms can come on suddenly. They vary depending on the degree of the infection.

Symptoms include:

  • Abdominal pain
  • Both diarrhea and constipation
  • Chills
  • Constipation
  • Cramping
  • Diarrhea
  • Fever
  • Nausea
  • Poor appetite
  • Rectal bleeding
  • Swollen and hard abdomen
  • Tenderness, usually in the left lower abdomen
  • Vomiting
Diagnosis

The doctor will ask about your symptoms and medical history. A physical and rectal exam will be done.

Finding the disease early is important. The pouch can break, releasing stool into the abdomen. This is a surgical medical emergency.

Tests may include:

  • Analysis of a stool sample to look for blood
  • Blood tests to look for signs of infection, inflammation, and bleeding
  • CT scan or ultrasound to locate and determine the size of the inflamed pouch
  • X-rays to look for a rupture

Once the inflammation subsides, other tests may be performed, including:

  • Barium enema —injection of a dye into the rectum that makes your colon show up on an x-ray so the doctor can see abnormal pouches in your colon
  • Colonoscopy —a thin, lighted camera is inserted through the rectum and into the colon to examine the entire lining of the colon
  • Flexible sigmoidoscopy —a thin, lighted camera is inserted into the rectum to examine the rectum and the lower colon
Treatment

The goals of immediate treatment are to:

  • Prevent complications
  • Resolve the infection and inflammation
  • Rest the bowel

Treatments include:

Medications

Antibiotics and other drugs are given to fight the infection. Pain medications and drugs are given to decrease the abdominal pain.

Fluids

For mild inflammation, you can drink clear liquids for the first two to three days. For a more severe case, you will be admitted to the hospital, where fluids are given intravenously (IV). Antibiotics will be given to you through IV. If you have nausea and vomiting, a plastic tube may be inserted through your nose into your stomach. This will help with the vomiting and make you feel more comfortable.

Preventive Care

Changes in your diet can help prevent future attacks.

  • Avoid laxatives, enemas, and narcotic medications that can lead to constipation
  • Increase the amount of fiber you eat by eating more fruits, vegetables, and whole grains
  • Supplement your diet with a fiber product, as recommended by your doctor
Surgery

Surgery to remove the section of the bowel with pouches may be recommended if:

  • A pouch breaks and the contents spread into the abdominal cavity (will require cleaning out the abdominal cavity)
  • When surgery is done on an elective basis, the surgeon will remove part of the disease bowel and hook the normal bowel together
  • You have had multiple attacks during a two-year period

Surgery is also used to treat complications of diverticulitis, such as:

  • Abscess—occurs if the infected pouch fills with pus
  • Blocked bowel—scar tissue that forms and blocks movement of stool through the intestine
  • Fistula—occurs if the infection spreads and colon tissue attaches to another organ, such as the bladder or the uterus/vagina

When surgery is done on an emergency basis, the surgeon will remove the diseased bowel. Because of the serious infection, the two ends of the bowel will not be hooked together. You will most likely end up with a piece of bowel coming out to your abdomen ( colostomy ). After a period of 6-12 weeks, the surgeon will go back and hook the bowel back together.

If you are diagnosed with diverticulitis, follow your doctor's instrucitons .

Prevention

The following recommendations may help prevent diverticulitis by improving the movement of stool through the bowel and decreasing constipation:

  • Drink eight 8-ounce glasses of water each day
  • Eat a balanced, high-fiber diet with plenty of fruits, vegetables, and whole grains
  • Exercise regularly

Last reviewed: September 2011 by Daus Mahnke, MD.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Conn HF, Rakel RE. Conn's Current Therapy . 2001. Philadelphia, PA: WB Saunders Co;2001.
  • Diverticulosis and Diverticulitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www2.niddk.nih.gov/ . Accessed July 28, 2008.
  • Diverticular Disease. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/diverticular_disease/ . Accessed July 28, 2008.
  • Goroll AH, Mulley AG. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2000.
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