TL;DR:
Diverticulitis occurs when small pouches in the colon become inflamed or infected. Mild cases may be treated at home, but severe abdominal pain, fever, vomiting, or signs of infection require immediate medical attention. Most people recover without surgery, and a high-fiber diet, regular exercise, and healthy lifestyle habits may help reduce future flare-ups.
Diverticulitis is a common digestive condition that affects hundreds of thousands of Americans each year. While many cases are mild and do not require medical attention, diverticulitis can quickly become a serious medical emergency requiring hospitalization or surgery.
Knowing the signs and symptoms of diverticulitis, understanding when to see a doctor, and knowing when to call 911 are essential.
What Are Diverticula?
Diverticula are small pockets or sacs in the digestive tract. The most common ones are found in the colon or large intestine. These pockets are present in about half of all people over the age of 60.
What Is Diverticulitis?
Diverticulitis is a painful condition that can cause severe abdominal pain. In addition to abdominal pain, it can cause nausea, bloating, gas, diarrhea, constipation, and fever. Symptoms may be mild, moderate, severe, or life-threatening. Diverticulitis occurs when diverticula become inflamed and/or infected. The most common location for an infection is within the sigmoid colon. During severe flare-ups, an abscess can form, causing severe pain, intestinal blockage, and in extreme cases, a perforated colon
Diverticulosis vs Diverticulitis
Having diverticula without symptoms is known as diverticulosis. Most people with diverticulosis never develop noticeable symptoms.
Diverticulitis occurs when one or more of the diverticula become inflamed or infected.
Who Is at Risk?
Risk factors for diverticulitis include;
- Age: Over 40, with risk increasing after age 60
- A low-fiber diet
- Obesity
- Smoking
- Lack of regular exercise
- Family history
- Certain medications. Long-term NSAID use (such as ibuprofen or naproxen) have been linked to diverticulitis
- Previous episodes of diverticulitis
Common Symptoms of Diverticulitis
Symptoms usually develop suddenly, although mild discomfort may begin gradually.
Common symptoms include:
- Persistent abdominal pain, usually in the lower left side
- Fever
- Chills
- Nausea or vomiting
- Loss of appetite
- Constipation or diarrhea
- Bloating
- Abdominal tenderness
Pain often worsens with movement or pressure.
After the first painful episode, most people can easily recognize future flare-ups when they first begin.
When Should You See a Doctor?
If you develop symptoms that could be diverticulitis, contact your healthcare provider promptly.
You should schedule a medical evaluation if you have:
- New or worsening abdominal pain
- Fever with digestive symptoms
- Ongoing constipation or diarrhea lasting more than a couple of days
- Pain that doesn’t improve after 24 hours
- Recurrent episodes of abdominal pain
- If you recognize the pain from a previous diverticulitis flare-up
Your doctor may order blood work and a CT scan to confirm the diagnosis and determine whether the infection is uncomplicated or has developed complications.
Early treatment often prevents hospitalization and reduces permanent damage.
When Should You Go to the Emergency Room?
Some cases of diverticulitis become medical emergencies.
Go to the nearest emergency department or call 911 immediately if you experience:
- Severe or unbearable abdominal pain
- A rigid or swollen abdomen
- High fever with shaking chills
- Persistent vomiting that prevents you from keeping down fluids
- Rectal bleeding
- Fainting or severe dizziness
These symptoms may indicate serious complications such as:
- A perforated colon (hole in the intestine)
- An abdominal abscess
- Peritonitis (infection of the abdominal cavity)
- Bowel obstruction
- Severe bleeding
These conditions require immediate emergency treatment.
How Is Diverticulitis Diagnosed?
Healthcare providers usually diagnose diverticulitis using:
- CT scan
- Physical examination
- Blood tests to check for infection
A CT scan is considered the best imaging test because it can identify inflammation and detect complications like abscesses or perforations.
A colonoscopy is highly recommended after a complete recovery. The extent of diverticula can be evaluated, along with any other colorectal conditions.
Treatment for Diverticulitis
Treatment depends on how severe the infection is.
Mild Diverticulitis Flare-ups
Many uncomplicated cases can be treated at home with medical supervision.
Treatment may include:
- Clear liquid or low-fiber diet
- Antibiotics
- Pain control
- Gradual return to normal eating
Most people begin feeling better within several days.
Severe Diverticulitis Attacks
Severe symptoms and complications require hospitalization.
Hospital treatment may include:
- IV fluids
- IV antibiotics
- Pain medication
- Bowel rest
- Drainage of an abscess if present
- Surgery
When Is Surgery Necessary?
Most people with diverticulitis never need surgery.
However, surgery may be recommended if:
- The colon has perforated.
- An abscess cannot be drained
- There is a bowel obstruction.
- Episodes recur often and significantly affect quality of life.
The most common operation removes the damaged portion of the colon and reconnects the healthy ends. This procedure is called a colon resection or colectomy.
In severe emergencies, surgeons may perform a temporary colostomy, allowing the colon time to heal before it is reconnected during a later operation.
What Should You Eat During and After Diverticulitis?
Diet recommendations depend on whether you’re having an active flare-up or recovering.
During an Acute Flare
Your healthcare provider may recommend:
- Drink plenty of water
- Clear liquids for a short period
- Gradually advancing to low-fiber foods
- Slowly returning to a normal diet as symptoms improve
Examples of low-fiber foods include:
- White rice
- White bread
- Applesauce
- Yogurt
- Eggs
- Skinless chicken
- Mashed potatoes
Always follow your healthcare provider’s recommendations. Dietary requirements vary with the severity of your illness.
After Recovery
Long-term, most experts recommend a high-fiber diet to help reduce the risk of future episodes.
Good high-fiber foods include:
- Fruits
- Vegetables
- Whole grains
- Beans
- Lentils
- Oats
It’s also important to:
- Drink plenty of water
- Increase fiber gradually
- Exercise regularly
- Maintain a healthy weight
Can Diverticulitis Be Prevented?
There is no guaranteed way to prevent diverticulitis, but healthy lifestyle habits appear to reduce the risk.
Helpful strategies include:
- Eat a fiber-rich diet.
- Stay physically active.
- Drink plenty of water
- Avoid smoking.
- Maintain a healthy weight.
- Limit unnecessary NSAID use if advised by your healthcare provider.
These habits also improve overall digestive and cardiovascular health.
Can Diverticulitis Cause Permanent Damage?
Yes, each flare-up can cause a permanent change to the colon. Repetitive infections can cause a thickening of the muscle wall in the colon and a buildup of scar tissue. This will cause a decrease in the size of the pathway through the colon. In addition, the decreased size can cause an increase in pressure and strain.
Common Myths About Diverticulitis
Myth: Nuts and seeds cause diverticulitis.
Fact: New research has not shown that eating nuts and seeds increases the risk of diverticulitis or flare-ups. Most people with diverticulosis can safely eat nuts and seeds. Flare-ups are often caused by foods that are difficult to digest.
Myth: Everyone with diverticulosis eventually develops diverticulitis.
Fact: Most people with diverticulosis never develop diverticulitis.
Myth: Antibiotics are always required.
Fact: Not every flare-up develops an infection. Minor flare-ups with no signs of an infections can be treated with a temporary change in diet.
Myth: Surgery is inevitable.
Fact: Most people can reduce or eliminate flare-ups with changes to their diet and lifestyle and will not require surgery.
Myth: Once you’ve had a diverticulitis attack, it will keep coming back.
Fact: Once you’ve had an attack, you will have an increased risk of having another attack. However, many people will never experience another attack after they recover.
Final Thoughts
Diverticulitis is a common condition that ranges from mild inflammation and discomfort to a painful infection to a life-threatening emergency. Early recognition of symptoms, prompt medical evaluation, and proper treatment can help prevent serious and long-term complications.
If you develop persistent lower abdominal pain (especially lower left), fever, or digestive symptoms, contact your healthcare provider. However, if the pain is severe or accompanied by a high fever, vomiting, or bleeding, seek emergency medical care immediately.
A healthy diet rich in fiber, regular exercise, staying hydrated, and avoiding smoking may help reduce the risk of future episodes. With appropriate treatment and lifestyle changes, most people recover fully and continue to live active, healthy lives.