Diverticulitis is not so common condition and about 1/3rd of American population has the condition and is asymptomatic about it. According to a study in Clinical Gastroenterology and Hepatology only 4% of patients of diverticulitis develop diverticulitis. Now let us understand diverticulitis in depth.
The word diverticulitis can be split as diverticula meaning “pouch” and “itis” which stands for inflammation. It is a condition wherein pouches form in intestine and the pouches may get infected and or inflamed.
Diverticulosis is a milder condition wherein pouches are formed in the intestine and remain asymptomatic. They come to notice while diagnosing other condition. The severe form of diverticulosis is diverticulitis. Complications of diverticulitis may include one or more small abscesses in the digestive tract mostly in the descending and sigmoid colons. It can also perforate intestine.
Diverticulitis symptoms appear as there is infection and or inflammation. Symptoms appear as pain in the abdomen and high body temperature. In severe cases blood comes in the stools.
Diverticulitis can be acute or chronic. In acute diverticulitis, as the name says the symptoms are sharp attacks of pain and inflammation. In chronic diverticulitis the symptoms may subside but the infection or inflammation retains.
Diverticulitis can results in constipation, diarrhea, abdominal pain and bloating. Persistent diverticulitis can result in nausea and vomiting.
If left untreated, it may result in:
- Abscess formation
- Scarring of the intestine
- Fistulas can form in large intestine and the bladder
- Blood loss can result in need of blood transfusion; study says 17 % of people suffering from chronic disease condition experience bleeding.
There are various disease conditions whose symptoms appear to be similar to that of diverticulitis. The doctor may look for the symptoms, medical history and also take into consideration of existing medication.
The doctor may recommend following tests:
- Blood test – To check for inflammation, infection, anemia
- Urine test – for infection
- Stool test – to check for gastrointestinal infections which can lead to diarrhea
- Pelvic exam – to check for gynecological problems
- Check for pregnancy which can also be the cause of abdominal pain
- Liver function test
- Digital rectal examination
- Abdominal CT scan, which can help in identification of inflammation and infection of pouches which confirms diverticulitis. Abdominal CT scan is the most useful tool as it helps in checking severity of the disease and guides treatment. This test helps in differential diagnosis of diverticulitis.
There are several risk factors which cause diverticulitis. Fecal blockage seems to be responsible for diverticula which cause inflammation and infection resulting in abdominal pain and inflammation on the left side. Constipation can no longer be considered as the risk factor for diverticulitis:
- Diet: Low fiber diet seems to be one of the factors responsible for diverticulitis.
- Genetics: A study says that diverticulitis can be in genetics. There is 50% risk of having the condition if siblings suffer from diverticulitis.
- Obesity: is also considered as a risk factor.
- Sedentary lifestyle: lack of exercise can also result in diverticular disease.
- NSAIDs, opioids and steroids increases the risks of diverticulitis and can also result in perforation.
- Vitamin D deficiency: according to a study people with diverticulitis has low vitamin D
- Men younger than 50 years are likely to have diverticulitis more common than women of same age group. After the age of 50, diverticulitis is more common in women.
Diverticulitis Diet/ Foods to Avoid
As a treatment option doctors may advise dietary changes in the individuals who are at the risk of diverticulitis or who are suffering from diverticulitis. You can discuss with your doctor diet to be taken. Doctor may ask you to avoid or lower the consumption of following foods
FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) should be avoided or consumed in less quantity in patients with IBD (irritable bowel syndrome). FODMAPs includes:
- Fruits – apples, plums etc
- Dairy foods – milk, yogurt, and ice cream
- Vegetable – beans, cabbage, onions and garlic
High – fiber diet
People with diverticulitis are asked to avoid high – fiber diet as it adds bulk to intestine, resulting in bowel movement. Avoiding bowel movement helps ease abdominal pain and gives rest. High fiber foods whose consumption should be limited or restricted are:
- Beans and legumes
- Whole grains
Foods to Prevent Diverticulitis
Western diet – As this diet is rich in fat and sugar and low in fiber, it can help prevent diverticulitis and or reduce its symptoms:
- Red meat
- Full – fat milk products
- Fried foods
Other foods to be avoided are nuts, popcorn
Diet in Acute Diverticulitis:
In acute diverticulitis your doctor may recommend low fiber diet or clear liquid diet to rest the intestine until pain and inflammation is subsided.
A clear liquid diet which is given for a brief period may include water, ice pops with fruit puree, electrolyte drinks, gelatin etc. Solid diet will start with low fiber diet of white rice, white bread, dry cereals, cooked spinach, vegetables and fruits.
Can stress cause diverticulitis flare up:
Abdominal pain and spams can cause emotional stress which results in spams and can also be responsible for the formation of pouches.
Diverticulitis Treatment Guidelines
Acute Diverticulitis – patients are given clear liquid diet and then gradually moved to low fiber diet to avoid bowel movement and hence pain. The patient may be given antibiotics, analgesics and electrolyte fluids. Last but not the least patients are advised to take plenty of rest. Doctors may recommend high fiber diet to prevent future attacks.
Chronic Diverticulitis – Initial treatment is the same for both acute and chronic diverticulitis, antibiotics and pain killers are prescribed.
If pain is severe and patient is unable to drink, then it is advisable for hospital stay. The doctors may give IV antibiotics, intravenous fluids and nutrition.
If the patient is vomiting, then stomach contents are emptied by sucking with nasogastric tube.
Diverticulitis can be treated with immediate medical attention. Patients should follow doctor’s prescription and continue treatment as advised. Treatment should not be stopped abruptly. Doctor may advise for colonoscopy or barium enema X – ray to check for other problems such as inflammatory bowel disease (IBD) or colon cancer.
There are 6 in 100 people who need surgery for diverticulitis. In complicated diverticulitis there can be abscess formation, perforation or bowel obstruction, in such cases it is advisable to remove the affected part of intestine by surgery. Surgery is also performed in cases of peritonitis, sepsis, severe bleeding, and repeated attacks of diverticulitis
The non – surgical treatment option is to drain the abscess with the help of a needle. A CT scan guides the doctor to the abscess.
Diverticulitis treatment without antibiotics:
There are various randomized controlled trials which advocate non – antibiotic treatment of diverticulitis. One such study is published in British Journal of Surgery which states uncomplicated diverticulitis can be treated without antibiotics. Dr. Norton Greenberger, a gastroenterologist and professor of medicine at Harvard Medical School states antibiotics to be advised only if patient suffers from pain, fever, elevated white blood cell count, and an abnormal physical exam.