Diverticular Disease Symptoms and Complications
Learn the symptoms of diverticulitis, when to seek medical attention, and the associated potential complications. Explore the differences between diverticulosis and diverticulitis, risks, diagnostic procedures, and treatment options.
Introduction to Diverticulitis Symptoms
Diverticulitis is a common digestive condition due to inflammation of the tiny, bulging pouches in the colon’s lining. These pouches are called diverticulum and their presence is diverticulosis, and they are inflamed with or without infection in diverticulitis. Diverticula themselves may not cause significant issues; when they become infected or inflamed, they give rise to uncomfortable symptoms and potential complications (1).
Diverticulitis affects millions of people worldwide. Over the years, it has become more prevalent due to changes in dietary habits and the aging population. About 60% of individuals over 60 may develop diverticula, particularly in the colon. It is estimated that 10-25% of them experience diverticulitis once in their lifetime (2).
To manage and alleviate its effects, it’s crucial to understand the causes, symptoms, and available treatment options for diverticulitis. This comprehensive guide will provide all the critical insights into diverticulitis, its causes, typical symptoms, potential complications, and diagnosis and treatment approaches.
Differentiating Diverticulosis and Diverticulitis
The difference between Diverticulosis and Diverticulitis are as follows:
|Presence of diverticula without inflammation or infection||Inflammation with or without infection of the diverticula|
|Often asymptomatic||Characterized by symptoms such as severe abdominal pain, fever, nausea, and changes in bowel habits.|
|Typically a chronic, long-term condition||An acute condition that occurs when diverticula become inflamed with or without infection|
Health Conditions Confused with Diverticulitis
Following are the health condition often confused with diverticulitis (3):
Irritable bowel syndrome (IBS)
It is sometimes challenging to diagnose diverticulitis because IBS can present symptoms similar to diverticulosis. The symptoms can be bloating and changes in bowel movements. However, IBS can typically present with recurrent abdominal pain relieved by bowel movements, unlike diverticulitis which can cause constant pain. Furthermore, IBS would be expected to occur in younger patients with normal laboratory tests and imaging studies with the absence of evidence of systemic illness.
Gastroenteritis symptoms are similar to diverticulitis, producing abdominal pain, fever, and changes in bowel movements. Diverticulitis pain is often localized to the abdomen, particularly on the lower left side, accompanied by tenderness or swelling.
Other conditions mistaken as diverticulitis are (3-5)
- Ovarian cyst
- Peptic ulcer disease
- Ulcerative Colitis
- Crohn Disease
- Colorectal Cancer
Symptoms of Diverticulitis
Diverticulitis manifests various common symptoms. These symptoms may include (1, 3, 5)
- Abdominal pain (usually on the left lower side of the abdomen, however, can be mainly right-sided, especially in Asian people)
- Rectal bleeding
- Feeling of discomfort
Severity and Progression of Symptoms
The severity and progression of diverticulitis symptoms depend on the different people’s health and overall well-being. Mild cases may present with a low degree of pain (6).
Severe cases can lead to significant disruptions in daily life, such as (6, 7)
- Intense & persistent abdominal pain
- High fever
- Rigors and chills
- Severe vomiting
Understanding the symptoms of diverticulitis is important. If left untreated due to progression, it may worsen over time.
Potential Danger – Requiring Emergency Medical Attention
It is important to consult a doctor if you have mild to moderate or even unspecific symptoms in order to prevent dangerous and complicated situations. However, there are certain red flags or signs that warrant emergency and immediate medical attention as follows (8):
- Intolerable & severe abdominal pain
- High fever
- Increased heart rate
- Rectal bleeding
- Vomiting accompanied by the inability to tolerate oral intake
- Abdominal distension or swelling
- Not feeling the desire to eat
The possible complications are (9):
- Bowel obstruction
Without any delay, seek emergency medical treatment if you see any of the above dangerous signs and symptoms.
Potential Complications of Diverticulitis
The following are the potential complications as diverticulitis progresses and is left untreated (10):
If they go unchecked, infected pockets of pus may develop within the diverticula or around the colon. (11)
Inflammation or scarring may hinder the normal flow of digested food leading to the obstruction of bowel movement.
Diverticula (small pouches in the large intestine) can sometimes lead to a severe complication known as gut perforation. Gut perforation is characterized by a hole or rupture in the wall of the intestine. This can have significant implications for a person’s health and may require immediate medical attention.
The colon’s lining undergoes rupture or perforation, which can result in the formation of a fistula, an abnormal connection between the colon and adjacent organs, such as the bladder or the vagina. As a result, stool and bacteria can release into the abdominal cavity, worsening this condition further.
Resolutions and Treatment Options
The resolution of diverticulitis and its complications depends on the conditions’ severity and health considerations.
To manage mild or asymptomatic cases of diverticulitis, an often conservative approach is used such as (12):
- Dietary changes
- Increased fluid intake
In severe or complicated cases, hospitalization is typically needed for intravenous antibiotics, as well as possible abscesses drainage, or surgical intervention.
Surgery may be necessary in cases of acute rectal bleeding, recurrent diverticulitis, or disease that doesn’t respond to other treatments, or when there is a risk of future complications (13).
Treatment options are changed according to the specific needs and severity of the condition.
Seeking Medical Help and Diagnosis
Consulting a Healthcare Professional
Depending on the symptoms or concerns related to diverticulitis, it is essential to seek medical help from a healthcare professional.
Seek consultation from general practitioners, gastroenterologists, proctologists, or specialists in digestive health for valuable insights and guidance. They expertly evaluate symptoms, perform examinations, and order tests to reach precise diagnoses (14).
Timely medical attention is important to manage diverticulitis effectively and to prevent potential complications.
Overview of Diagnostic Procedures and Tests
The diagnosis of diverticulitis involves (15, 16)
- Clinical assessment
- Medical history
- Specific diagnostic procedures
- Diagnostic imaging techniques
- Laboratory tests, e.g. liver enzyme test, stool test, complete blood test
The main imaging techniques used in the diagnosis of diverticulitis are (15, 16):
CT scan of the abdomen with oral contrast is a commonly used imaging technique for the diagnosis and evaluation of diverticulitis. It provides detailed information about the condition of the colon, the presence of diverticula, and any signs of inflammation or complications.
Ultrasound and MRI
Ultrasound or magnetic resonance imaging (MRI) may be used to diagnose diverticula and it’s possible complications such as perforation, obstruction or abscesses. These imaging techniques can provide accurate diagnosis and help in treatment decisions.
Treatment Options for Diverticulitis
1. Conservative Approaches
These are effective In mild or asymptomatic cases of diverticulitis such as (17):
In acute cases, clear liquids, and a low-fiber diet are advised in the first few days of presentation to allow the inflamed diverticula to heal, with increasing quantities of fiber in the diet as the patient recovers. A high-fiber diet is usually recommended in patients with diverticulosis in order to prevent acute attacks and relieve the symptoms. It is also recommended to increase fluid intake to prevent dehydration.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen, ibuprofen,, etc., to alleviate pain and discomfort.
Rest and avoiding strenuous physical activities can aid in the healing process.
Antibiotics are prescribed to treat or prevent infection. While painkillers, antispasmodics, and prokinetics may be prescribed to manage pain, cramping, and bowel irregularities associated with diverticulitis.
3. Surgical Interventions
In severe and recurrent cases of diverticulitis, surgical interventions are necessary.
In surgical procedures, the affected part of the colon is removed or repaired, such as perforations or fistulas. Colorectal surgery can be minimally invasive; the techniques depend on individual circumstances. (18)
Prevention and Lifestyle Modifications
To prevent diverticulitis flare-ups, lifestyle modifications such as maintaining a healthy weight, engaging in regular physical activity, managing stress levels, and avoiding smoking are recommended.
While it is widely believed that a high-fiber intake may be helpful in preventing diverticular disease, research studies indicate that there is no evidence to advocate for such dietary modification. (19, 20)
Maintaining an adequate weight through a healthy diet, periodic exercise, and adequate sleep can be helpful in preventing overweight and obesity, which increase the risk of complications of diverticular disease. (21)
There are various symptoms of diverticulitis, from high-grade fever to persistent abdominal discomfort. Left untreated leads to potential risks and complications, i.e., abscess, fistula, and rectal bleeding.
To reduce the risks of progression and flare-ups, lifestyle modifications and a healthy diet is a must. Treatment approaches are recommended, from conservative management to surgical interventions.
You can take proactive steps to support your digestion and minimize the impact of diverticulitis by taking a high-fiber diet, maintaining a healthy weight, regular exercises, and low-stress levels. It is important to consult a healthcare professional to determine the most appropriate treatment plan and effective preventive strategies.
- NHS Inform. Diverticular disease and diverticulitis symptoms and treatments [Internet]. Nhsinform.scot. 2018. Available from: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/diverticular-disease-and-diverticulitis
- Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, et al. Diverticulitis: An Update From the Age Old Paradigm. Current Problems in Surgery. 2020 Oct;57(10):100862. Diverticulitis: An Update From the Age Old Paradigm – PubMed (nih.gov)
- Conditions with Similar Symptoms as: Diverticular Disease | Complementary and Alternative Medicine | St. Luke’s Hospital [Internet]. www.stlukes-stl.com. [cited 2023 May 19]. Available from: https://www.stlukes-stl.com/health-content/medicine/33/000414.htm
- Diverticulosis and Diverticulitis – IFFGD [Internet]. [cited 2023 May 19]. Available from: https://iffgd.org/gi-disorders/diverticulosis-and-diverticulitis/#:~:text=Symptoms%20of%20diverticulosis%20and%20diverticulitis
- Living with diverticulitis: Get the full scope of symptoms, treatment, and prevention | Digestive | UT Southwestern Medical Center [Internet]. utswmed.org. Available from: https://utswmed.org/medblog/diverticulitis-symptoms-treatment/
- Mayo Clinic. Diverticulitis – Symptoms and causes [Internet]. Mayo Clinic. 2020. Available from: https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758
- Diverticulitis [Internet]. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/10352-diverticulitis
- Diverticulitis Information | Mount Sinai – New York [Internet]. Mount Sinai Health System. Available from: https://www.mountsinai.org/health-library/diseases-conditions/diverticulitis
- Common Signs of Diverticulitis and When to See a Doctor: Desert West Surgery : Minimally Invasive Surgeons [Internet]. www.desertwestsurgery.com. [cited 2023 May 19]. Available from: https://www.desertwestsurgery.com/blog/common-signs-of-diverticulitis-and-when-to-see-a-doctor
- Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. Insights into Imaging [Internet]. 2016 Nov 22;8(1):19–27. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5265196/figure/Fig6/
- Saini S, Mueller PR, Whittenberg J, et al. Percutaneous drainage of diverticular abscess: an adjunct to surgical therapy. Arch Surg. 1986 Apr;121(4):475-8. Percutaneous drainage of diverticular abscess. An adjunct to surgical therapy – PubMed (nih.gov)
- Welbourn HL, Hartley JE. Management of Acute Diverticulitis and its Complications. Indian Journal of Surgery. 2014 May 23;76(6):429–35. Management of acute diverticulitis and its complications – PubMed (nih.gov)
- Diverticulitis Treatment & Management: Approach Considerations, Medical Care, Surgical Care [Internet]. Medscape.com. 2019. Available from: https://emedicine.medscape.com/article/173388-treatment
- Diverticulitis – Diagnosis and treatment – Mayo Clinic [Internet]. www.mayoclinic.org. Available from: https://www.mayoclinic.org/diseases-conditions/diverticulitis/diagnosis-treatment/drc-20371764#:~:text=Uncomplicated%20diverticulitis&text=Your%20doctor%20is%20likely%20to
- Diagnosis of Diverticular Disease | NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/diverticulosis-diverticulitis/diagnosis
- Radiology (ACR) RS of NA (RSNA) and AC of. Diverticulitis [Internet]. Radiologyinfo.org. Available from: https://www.radiologyinfo.org/en/info/diverticulitis
- van Dijk ST, Rottier SJ, van Geloven AAW, Boermeester MA. Conservative Treatment of Acute Colonic Diverticulitis. Current Infectious Disease Reports [Internet]. 2017 [cited 2023 may 20];19(11). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610668/
- Information NC for B, Pike USNL of M 8600 R, MD B, Usa 20894. Diverticular disease and diverticulitis: Surgery for diverticulitis and diverticular disease [Internet]. www.ncbi.nlm.nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG); 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK506997/
- Peery AF, Sandler RS, Ahnen DJ, Galanko JA, Holm AN, Shaukat A, et al. Constipation and a low-fiber diet are not associated with diverticulosis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2013 Dec;11(12):1622–7. Constipation and a low-fiber diet are not associated with diverticulosis – PubMed (nih.gov)
- Peery AF, Barrett PR, Park D, Rogers AJ, Galanko JA, Martin CF, et al. A high-fiber diet does not protect against asymptomatic diverticulosis. Gastroenterology. 2012 Feb;142(2):266-272.e1. A high-fiber diet does not protect against asymptomatic diverticulosis – PubMed (nih.gov)
- Böhm SK. Excessive Body Weight and Diverticular Disease. Visc Med. 2021 Oct;37(5):372–82. Excessive Body Weight and Diverticular Disease – PubMed (nih.gov)