What Is Diverticulitis?

Diverticulitis happens when one or more small pouches in the colon become inflamed or infected. These pouches are called diverticula and they are not something everyone is born with. They may develop when small areas in the wall of the colon weaken and bulge outward, most often in the lower part of the colon.

•  Diverticula are the small pouches that form in the colon wall.
• Diverticulosis means you have these pouches, but they are not causing symptoms or complications. Many people with diverticulosis do not have symptoms or problems.
• Diverticular disease is the broader term used when the pouches lead to chronic symptoms, bleeding, diverticulitis or complications.
• Diverticulitis means the pouches have become inflamed or infected. Diverticulitis can come on suddenly and may lead to serious complications in some cases.

Symptoms That May Need Medical Care 

Diverticulitis may cause abdominal pain that is often severe and sudden, though it can also start mild and worsen over several days. Symptoms may include:

• Abdominal pain, most often in the lower left side of the abdomen
• Constipation or diarrhea
•  Fever and chills
• Nausea or vomiting

Some symptoms may point to a possible complication and should be taken seriously, such as:

• Rectal bleeding, even a small amount
• Severe abdominal pain
• Fever or signs of infection
• Feeling very unwell, especially with worsening pain or other symptoms

If you or a loved one has symptoms of diverticulitis, contact a physician to help find the cause and decide whether treatment is needed.

How Diverticulitis Is Diagnosed Before Treatment 

Before recommending treatments for diverticulitis pain, a physician may review your symptoms, bowel movement patterns, diet, medical history, medicines and exam findings to understand whether your symptoms may be from diverticulitis, diverticular disease or another condition with similar symptoms.

Tests may also be used before treatment is started. These can include:

• Blood tests to check for signs of diverticulitis or complications, such as infection.
• Stool tests to help find out whether symptoms may be from diverticular disease or another health problem.
• Imaging tests, such as a CT scan, ultrasound or MRI, to help diagnose diverticular disease.
• Colonoscopy to confirm a diagnosis, rule out other conditions or help find and treat diverticular bleeding.

A CT scan is often used when diverticulitis is suspected. CT scan is often described as the “gold standard” for diagnosing diverticulitis because it can show which part of the colon is involved and whether there are signs of complications, such as an abscess, stricture or fistula.

Once your physician has a clearer diagnosis, they can recommend care based on whether the diverticulitis is mild, severe or linked to complications.

What Is the Treatment for Diverticulitis? 

Diverticulitis treatment depends on how severe it is and whether there are complications. Some people may be treated at home, while others may need care in a hospital. If diverticulitis does not have complications, a physician may recommend treatment at home. Care may include:

• Antibiotics, when needed. Not everyone with diverticulitis needs them.
• Short-term clear liquid diet to rest the colon, with solid foods added slowly as symptoms improve.
• Pain medicine, such as acetaminophen or antispasmodics, instead of NSAIDs when recommended because NSAIDs may raise complication risk.
• Temporary diet changes, such as a low-fiber or liquid-only diet until symptoms improve.

Hospital treatment may be needed if diverticulitis is severe, causes complications or if a person has a higher risk for complications. In the hospital, diverticular disease treatments may include:

• Fluids through a vein to help with hydration.
• Intravenous antibiotics, especially when symptoms are more serious or do not improve with oral antibiotics.
• Treatment for an abscess, if one forms. Small abscesses may be treated with antibiotics, while larger abscesses or abscesses that do not improve may need to be drained.

If diverticulitis does not improve with treatment or leads to certain complications, surgery may be considered to remove the affected part of the colon.

Does Diverticulitis Require Surgery? 

Not always. Many people with uncomplicated diverticulitis may be treated without surgery and some may be treated at home. However, diverticulitis surgery may be considered if the condition does not improve with home or other hospital treatment or if it leads to complications. Aggressive treatment, including surgery, may be required for some people who are immunocompromised.

Surgical treatment for diverticular disease depends on the person’s condition and the reason surgery is being done. Surgical options may include:

• Removing the affected part of the colon, with or without creating a colostomy
• Washing out the abdominal cavity and leaving the colon in place in selected cases
• Creating an ostomy to divert stool without removing the colon in some cases

A colostomy means the end of the bowel is brought through the abdominal wall so stool can empty into a bag attached to the skin. An ileostomy uses a piece of the small intestine to help divert stool while the bowel heals. In some cases, an ostomy may be temporary.

What Is the Success Rate of Surgery for Diverticulitis? 

Planned surgery for diverticulitis may usually be successful, but it may not completely cure symptoms for everyone. About 1 in 12 people may have symptoms of diverticular disease and diverticulitis return after surgery.

In an emergency setting, the result may depend on how unwell the person is when surgery is needed. This is one reason surgery decisions should be made carefully, with a clear discussion of the possible benefits and risks.

Colon surgery can carry significant risks, so the benefits need to outweigh those risks. Surgery may be considered to help prevent recurrent attacks or to treat complications such as a stricture or fistula. The decision can depend on the number and severity of past attacks, ongoing symptoms, age and overall medical condition.

Recovery and Follow-Up Care 

After an initial diverticulitis episode, a follow-up colonoscopy may be recommended several weeks later to check for another cause, such as cancer or another inflammatory condition of the colon. If diverticulitis was complicated, ask your physician whether follow-up colonoscopy is needed.

Diet and lifestyle changes may help lower the chance of future problems. This may include eating more fiber, eating less red meat, increasing fiber gradually, being physically active, not smoking or quitting smoking and reaching or maintaining a healthy weight.

Frequently Asked Questions About Diverticulitis Care