What Is Digestive Tract Inflammation (Diverticulitis)?
Diverticulitis is inflammation of diverticula, or sac-like outpouchings, in the wall of the colon (large bowel). Diverticulitis is a complication of diverticulosis, which is defined as the presence of diverticula, with or without complications [1,2].
Symptoms include abdominal pain that may be constant, worsening, or recurrent, as well as nausea and vomiting, constipation or diarrhea, fever, and rarely, symptoms of dehydration or an inflamed bladder.
Possible treatments include IV fluids and pain medication, antibiotics, drainage of any abscesses and surgery.
You should visit your the emergency room for imaging using CT or ultrasound. Treatment depends on severity - antibiotics are the norm and surgery is reserved for very severe cases.
How common is Digestive Tract Inflammation (Diverticulitis)?
Symptoms that never occur with Digestive Tract Inflammation (Diverticulitis):
- Pain below the ribs
- Pain in the upper right abdomen
- Pain in the upper left abdomen
Digestive Tract Inflammation (Diverticulitis) is also known as
- Acute colonic diverticulitis
- Chronic colonic diverticulitis
- Diverticular disease
Digestive Tract Inflammation (Diverticulitis) Symptoms
The main symptom of diverticulitis is abdominal pain. A few other common and less common symptoms may also occur.
Abdominal pain is experienced by most people with diverticulitis and it can be described by the following details:
- Location: The pain is usually located in the left lower part of the abdomen, but may be located on the right lower part, depending on the location of the inflamed diverticula.
- Constant or worsening
- Severe pain and tenderness: In rare cases, people with diverticulitis may develop severe abdominal pain and severe tenderness of the abdomen when pushed upon. This may be a symptom that the diverticulitis has caused a rupture of the bowel wall, which is a surgical emergency.
Symptoms that can occur in some cases of diverticulitis include:
- Nausea and vomiting: This can occur if the inflammation slows the function of the bowels or causes a blockage in the bowels.
- Constipation or diarrhea: Some people with diverticulitis may experience a change in their bowel habits, including either constipation or diarrhea. This is generally due to the inflammation in the bowel. Constipation may develop if the bowel becomes obstructed.
- Fever: This fever is usually low-grade. Fever may persist despite treatment with medications if a localized infection (abscess) develops.
Symptoms that occur less commonly in cases of diverticulitis include:
- Dizziness, lightheadedness, or passing out: These symptoms generally occur if the diverticulitis causes a rupture in the colon wall, which can cause widespread inflammation that leads to dehydration.
- Pain with urination, increased frequency of urination, and/or urge to urinate: These symptoms can occur if the inflammation in the colon causes irritation of the bladder, which is located close by.
- Air or fecal matter passing in the urine or through the vagina: In rare cases, people with diverticulitis may notice air or fecal matter passing in the urine or through the vagina. This can develop from long-standing inflammation, which can cause sinus tracts (fistula) to develop which connect the colon to adjacent organs such as the bladder or vagina.
Digestive Tract Inflammation (Diverticulitis) Causes
Approximately four to 15 percent of people who have diverticulosis will develop diverticulitis . Diverticulitis generally develops when increased pressure and/or trapped food particles cause the diverticula to tear, causing local inflammation that damages the tissue. Persistent inflammation can lead to the development of an infection (abscess), obstruction of the colon, or rupture of the gut wall.
The risk of developing diverticulitis increases with age and the average age for developing diverticulitis is older than 60 years. Many of the risk factors for developing diverticulitis are the same as for developing diverticulosis .
Factors leading to increased inflammation
The reason for why the following factors increase the risk of developing diverticulitis is unclear; however, they may be related to increased levels of inflammation in the body. These include:
- A diet low in fiber and high in fat and red meat: This may be because such a diet can increase inflammation in the gut and change the gut bacteria to predispose to the development of diverticulitis.
- Lack of physical activity
- Being overweight or obese
Taking certain medications can also lead to an increased risk of developing diverticulitis. These include:
- NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve)
- Steroids: Such as prednisone
- Opioids: Such as morphine, hydrocodone/acetaminophen (Vicodin), or oxycodone (OxyContin)
Treatment Options and Prevention
Diverticulitis is a condition that usually requires treatment. Mild cases can be treated on an outpatient basis, but severe cases may require hospitalization. Most cases can be treated with medications, although surgery may be warranted in some cases. More specifics regarding treatment options are described below [5,6].
IV fluids and pain medication
Intravenous fluids and pain medications are usually the first treatments given to people with diverticulitis who need to be treated in a hospital. Pain medications may include:
- Oral: Medications such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or oxycodone
- IV: Medications such as ketorolac (Toradol), morphine, orhydromorphone
Depending on the severity of your case, you may be treated with oral or IV antibiotics.
- Oral: People with mild diverticulitis who can be treated as outpatients may receive a course of oral antibiotics such as ciprofloxacin (Cipro), trimethoprim-sulfamethoxazole (Bactrim), amoxicillin-clavulanate (Amoxicillin), and/or metronidazole (Flagyl).
- IV: People with severe diverticulitis who need to be treated in the hospital may receive intravenous antibiotics such as piperacillin-tazobactam (Zosyn), cefazolin, ceftriaxone, ciprofloxacin and/or metronidazole, among others.
Drainage of abscesses
Some people with diverticulitis may develop a local infection, or abscess, at the site of inflammation. In these cases, the abscess needs to be drained to remove the infection.
- Details: A procedure called percutaneous drainage, in which a needle is inserted through the skin into the abscess, is performed to remove the infected fluid.
- After drainage: A small catheter is usually left in place to allow any new fluid that accumulates to drain.
Surgery to remove part of the colon may need to be done urgently in people with severe diverticulitis who are hospitalized and do not improve with medical treatment or develop a rupture in their colon wall. In some people, surgery can be scheduled electively after the acute episode of diverticulitis has been treated medically. This is usually recommended for those who are at a higher risk for developing complications of diverticulitis or have developed a complication such as a fistula. The surgery either can be done through an open incision in the abdomen or using laparoscopy, which involves making small incisions and inserting a camera and surgical instruments to complete the procedure.
When to Seek Further Consultation
If you develop any symptoms of diverticulitis, such as abdominal pain, nausea, vomiting, constipation, diarrhea, or fever, you should see your physician or go to the emergency room if the pain is severe. The physician can order laboratory and imaging tests to determine if you are experiencing diverticulitis and then offer the appropriate treatment.
Questions Your Doctor May Ask to Diagnose
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Are you sick enough to consider going to the emergency room right now?
- Have you lost your appetite recently?
- Are you experiencing a headache?
- Any fever today or during the last week?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
The above questions are also covered by our A.I. Health Assistant.
- Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: A comprehensive review with usual and unusual complications. Insights Imaging. 2016;8(1):19-27. NCBI Link
- Diverticulosis and diverticulitis. U.S. National Library of Medicine: MedlinePlus. Updated April 6, 2018. MedlinePlus Link
- Pemberton JH. Clinical manifestations and diagnosis of acute diverticulitis in adults. UpToDate. Updated April 23, 2018. UpToDate Link
- Boynton W, Floch M. New strategies for the management of diverticular disease: Insights for the clinician. Therap Adv Gastroenterol. 2013;6(3):205-213. NCBI Link
- Böhm SK. Risk factors for diverticulosis, diverticulitis, diverticular perforation, and bleeding: A plea for more subtle history taking. Viszeralmedizin. 2015;31(2):84-94. NCBI Link
- Diverticular disease. American Society of Colon and Rectal Surgeons. FASCRS Link