Diverticulitis

2 January 2025

This common condition that involves inflammation or infection of small pouches in the colon can cause a range of symptoms. With prompt diagnosis, treatment and lifestyle changes symptoms can be alleviated to improve quality of life.

What is Diverticulitis?

Diverticulitis is a condition characterized by inflammation or infection of small pouches (diverticula) that develop in the lining of the colon, particularly in the sigmoid colon, which is the lower part of the large intestine.

Diverticula are common, especially in older adults, and often do not cause symptoms. However, when they become inflamed, infected, or irritated, it can lead to a range of symptoms and complications.

Causes

The exact cause of diverticulitis is not fully understood, but it is thought to involve a combination of factors, including:

Diverticula Formation: Diverticula develop when weak areas of the colon wall protrude outward, forming small pouches. These pouches may become more prominent with age, as the colon weakens and loses its elasticity.
Obstruction: Faecal matter, undigested food particles, or seeds can become trapped in the diverticula, leading to inflammation, infection, or irritation of the surrounding tissue. Constipation or irregular bowel movements can increase the risk of obstruction and diverticulitis.
Bacterial Overgrowth: Bacteria normally present in the colon may multiply and proliferate within the diverticula, leading to infection and inflammation. This bacterial overgrowth can occur when there is an imbalance in the gut microbiota or when there are disruptions in bowel motility and transit.
Dietary Factors: Low-fiber diets, high in refined carbohydrates, processed foods, and low in fruits, vegetables, and whole grains, may contribute to diverticulitis by promoting constipation, straining during bowel movements, and alterations in gut microbiota composition. Fiber helps promote regular bowel movements, prevent constipation, and maintain healthy gut flora.
Genetic Factors: There may be a genetic predisposition to developing diverticulitis, as it tends to run in families. Certain genetic factors or inherited traits may contribute to an increased risk of developing diverticular disease.
Lifestyle Factors: Factors such as obesity, sedentary lifestyle, smoking, and excessive alcohol consumption have been associated with an increased risk of diverticulitis. These lifestyle factors can affect bowel function, gut motility, and inflammation in the gastrointestinal tract.

Symptoms

Diverticulitis can cause a range of symptoms, which may vary in severity depending on the extent of inflammation or infection. Common symptoms include:

Abdominal Pain: Typically located in the lower left side of the abdomen, although it may occur on the right side or be diffuse. The pain may be crampy, sharp, or dull, and may be constant or intermittent. It may worsen with movement, coughing, or pressure on the abdomen.
Fever and Chills: Infection associated with diverticulitis can lead to fever, chills, and flu-like symptoms. Fever may be low-grade or high-grade, depending on the severity of the infection.
Change in Bowel Habits: Diverticulitis may cause changes in bowel habits, such as diarrhoea, constipation, or alternating between the two. Some individuals may experience urgency or a feeling of incomplete evacuation.
Nausea and Vomiting: Some individuals with diverticulitis may experience nausea, vomiting, or loss of appetite. These symptoms may be more common in severe cases or if there is associated obstruction or ileus.
Rectal Bleeding: In severe cases, diverticulitis may cause rectal bleeding, which may present as bright red blood in the stool or as dark, tarry stools. Rectal bleeding may occur due to inflammation, ulceration, or erosion of the diverticular wall.
Abdominal Tenderness: The abdomen may be tender to palpation, especially in the lower left quadrant, where the sigmoid colon is located. The tenderness may be localized or diffuse and may worsen with deep palpation or movement.

Diagnosis

If you experience symptoms of diverticulitis, your healthcare provider will perform a thorough evaluation, which may include:

Medical History and Physical Examination: Your doctor will ask about your symptoms, medical history, medications, and lifestyle factors, followed by a physical examination to assess your abdomen for tenderness, swelling, or masses. Digital rectal examination (DRE) may be performed to assess for rectal tenderness, masses, or blood.
Diagnostic Tests: Depending on your symptoms and clinical presentation, your doctor may order additional tests such as blood tests (complete blood count, inflammatory markers), imaging studies (such as CT scan, ultrasound), or colonoscopy to confirm the diagnosis and evaluate the extent of inflammation or infection. Imaging studies are particularly useful for identifying complications such as abscess formation, perforation, or fistula.

Treatment Options

Antibiotics: If you have mild diverticulitis without complications, your doctor may prescribe oral antibiotics to treat the infection and reduce inflammation. Commonly used antibiotics include metronidazole, ciprofloxacin, amoxicillin-clavulanate. In more severe cases or if you have complications such as abscess formation or peritonitis, intravenous (IV) antibiotics may be necessary.
Dietary Modifications: Following a clear liquid or low-fiber diet for a period of time can help rest the colon and alleviate symptoms during acute episodes of diverticulitis. Gradually reintroducing high-fiber foods can help prevent future flare-ups and promote regular bowel movements. High-fiber foods include fruits, vegetables, whole grains, legumes, and nuts.
Pain Management: Over-the-counter pain relievers such as paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) may help alleviate abdominal pain associated with diverticulitis. Avoiding medications that can increase the risk of bleeding, such as aspirin or ibuprofen, is recommended. In some cases, prescription pain medications or muscle relaxants may be necessary to relieve severe pain or discomfort.
Hospitalisation: In severe cases of diverticulitis with complications such as abscess formation, bowel obstruction, or peritonitis, hospitalisation may be necessary for close monitoring, intravenous fluids, antibiotics, and possible surgical intervention. Surgery may be required to drain abscesses, remove diseased segments of the colon, or repair perforations or fistulas.

Prevention and Lifestyle Modifications

While the exact cause of diverticulitis is not fully understood, you can take steps to reduce your risk and promote colon health by:

Eating a High-Fiber Diet: Consuming a diet rich in fruits, vegetables, whole grains, legumes, and nuts can help promote regular bowel movements, prevent constipation, and maintain healthy gut flora. Aim for at least 25 to 30 grams of fiber per day, gradually increasing fiber intake to avoid gastrointestinal discomfort. High-fiber foods also help bulk up stools and reduce pressure in the colon, which can prevent diverticula formation.
Staying Hydrated: Drinking plenty of fluids, especially water, can help soften stools and prevent constipation. Aim for at least 8 to 10 cups of fluid per day, including water, herbal teas, and clear broths. Adequate hydration helps maintain normal bowel function and prevents dehydration, which can exacerbate symptoms of diverticulitis.
Exercising Regularly: Engaging in regular physical activity, such as walking, swimming, cycling, or yoga, can help promote healthy digestion, reduce stress, and maintain a healthy weight. Exercise stimulates bowel motility and peristalsis, which can prevent constipation and reduce the risk of diverticulitis.
Avoiding Smoking and Excessive Alcohol Consumption: Smoking and heavy alcohol consumption have been associated with an increased risk of diverticulitis and other gastrointestinal conditions. Quitting smoking and moderating alcohol intake can help reduce your risk and improve overall health. Smoking cessation programs and support groups are available to help individuals quit smoking successfully.
Managing Stress: Chronic stress and anxiety can affect digestive health and contribute to gastrointestinal symptoms. Practicing stress-reduction techniques such as deep breathing, meditation, progressive muscle relaxation, or mindfulness can help promote relaxation, reduce stress hormone levels, and support overall well-being.
Regular Medical Check-ups: Regular medical check-ups and screening tests can help detect diverticular disease and other gastrointestinal conditions early, when they are more easily treatable. Discuss your risk factors, symptoms, and concerns with your healthcare provider, and follow their recommendations for preventive care and screening.

Conclusion

Diverticulitis is a common condition characterized by inflammation or infection of small pouches (diverticula) that develop in the colon.

While diverticulitis can cause a range of symptoms, including abdominal pain, fever, change in bowel habits, and rectal bleeding, prompt diagnosis and treatment can help alleviate symptoms and prevent complications.

By following a high-fibre diet, staying hydrated, exercising regularly, avoiding smoking and excessive alcohol consumption, and managing stress, you can promote colon health and reduce your risk of diverticulitis and other gastrointestinal conditions.

Arranging To Visit A Private GP

To discuss any worrying symptoms that could be an indication of diverticulitis make an appointment with one of our private GPs. Appointments are available to everyone and can often be booked for the same day. There is no need to be registered with our Buckinghamshire hospital, or live locally.

If you have insurance which covers a GP visit, we can in most cases invoice the insurer directly. Where you are paying directly, the cost for a 30 minute consultation is £125.

Any additional costs will always be discussed. They could apply if you are referred for an MRI scan, or to a consultant, or for other agreed decisions to support your health.

Our Resident Private GP

Dr Chamali is welcoming and highly experienced. He offers his patients sound diagnosis and treatment, along with individual care focused on their future health.