What to Know About Getting a Diverticulitis Diagnosis

The diagnostic process for diverticulitis often begins with going to a healthcare provider with symptoms such as abdominal pain, constipation or diarrhea, and fever. However, these are common to many other conditions.

The healthcare provider will assess your physical condition and review your medical history. Further diagnostic procedures may involve blood, urine, stool, and imaging tests.

This article will discuss how diverticulitis might be diagnosed, other conditions with similar symptoms, and some potential complications.

Signs You Should Get Tested for Diverticulitis

Most people don't know they have diverticular disease, a common condition that causes outpouchings (diverticula) in the large intestine.

Diverticular disease usually doesn’t cause any symptoms. Most people don’t know they have diverticula unless they’re found, for instance, during a colonoscopy (a procedure in which a flexible tube with a camera is used to see the inside of the colon).

Sometimes the diverticula can become infected or inflamed (called diverticulitis) and cause symptoms such as abdominal pain. If you don’t know you have diverticular disease, it might not be the first thing you think of when you have abdominal pain.

However, the symptoms of diverticulitis, including abdominal pain or discomfort, diarrhea or constipation, nausea, vomiting, and mucus in the stool, are reasons to see a healthcare provider as soon as possible. If you’ve been told you have diverticula or diverticular disease, it’s important to provide that history.

Many people over the age of 60 have diverticula in their colon. Healthcare providers may suspect diverticulitis based on the symptoms and other factors such as age.

How to Diagnose Diverticulitis

In some cases, diverticulitis might be diagnosed after a clinical assessment: A healthcare provider takes a history of the symptoms and then examines the abdomen. However, the symptoms of diverticulitis can be similar to many other conditions. 

For that reason, there is usually a need for testing to be sure that it is diverticulitis. A healthcare provider may use one or more tests to confirm or rule out a diagnosis of diverticulitis.

Blood Test

A blood test that measures C-reactive protein (CRP) may be helpful in diagnosing diverticulitis. CRP is a protein in the blood produced by the liver. It becomes elevated when there is inflammation somewhere in the body.

A high CRP level isn’t specific to diverticulitis. Because this blood test is usually easy to access and can be done quickly, it might be done to help narrow down the reason for symptoms. Other blood tests might also be done if needed.

Urine Test

A urine test won’t be able to diagnose diverticulitis. However, sometimes people with diverticulitis may have urinary symptoms. A urinalysis might be done to look for any signs in the urine that there could be an infection.

Digital Rectal Exam

A digital rectal exam is a test used to feel inside the rectum for abnormalities. It is a test that may be uncomfortable. It can’t be used to diagnose diverticulitis without other test results, but it can be done quickly and inexpensively.

In the case of abdominal pain or other symptoms in the lower digestive tract, it might be used to rule in or out other suspected causes.

Stool Test

A stool test may be done to help rule out other potential reasons for digestive symptoms, such as an infection.

CT Scan

A computed tomography (CT) scan is a test that is used frequently to diagnose diverticulitis. It is also helpful in telling between complicated or uncomplicated diverticulitis. In addition, it has good specificity, meaning that the chances of misdiagnosis are lower. It can also be done relatively quickly.

In cases of acute diverticulitis, a CT scan might be done using rectal contrast. The contrast medium is inserted through the anus and into the rectum. It can help in seeing if there are any complications in the lower part of the large intestine.

Colonoscopy

Diverticular disease might be found during a routine colonoscopy. However, when there are acute diverticulitis symptoms, a colonoscopy is not usually done. A follow-up colonoscopy might be recommended after the diverticulitis has resolved to monitor healing and check for any other problems in the colon.

Magnetic Resonance Imaging (MRI)

An MRI is helpful in diagnosing diverticulitis. However, it does have some drawbacks. It can take time to get one scheduled, and completed and it’s expensive compared to other methods.

However, the benefits are that it can be used in pregnancy and might help find complications, such as a fistula (an abnormal tunnel connecting two body cavities).

Ultrasonography

An ultrasound is a test that is considered inexpensive and, in some cases might be as helpful in a diagnosis as a CT scan. It also has the benefit of not using radiation. However, it might be more time-intensive and difficult to obtain than a CT scan.

Conditions With Similar Symptoms

Symptoms of diverticulitis are similar to other conditions. Part of diagnosing diverticulitis will be in ruling out other potential problems.

Some of these, which are called differential diagnoses, can include:

• Appendicitis: An inflammation of the appendix
  
• Bowel obstruction: A blockage in the intestinal tract
  
• Bowel perforation: A hole in the intestinal tract
  
• Colon cancer: A tumor or growth in the rectum or large intestine
  
• Ectopic pregnancy: A fertilized egg that has implanted in a place other than the uterus and can not grow into a fetus
  
• Endometriosis: When tissue similar to that which is in the uterus grows in other places in the body
• Inflammatory bowel disease (IBD, Crohn’s disease, ulcerative colitis): A condition that causes inflammation in the digestive tract
  
• Infectious gastroenteritis: A bacterial or viral infection of the gastrointestinal tract sometimes called stomach flu
  
• Irritable bowel syndrome (IBS): A brain-gut disorder that can cause symptoms of diarrhea and/or constipation
  
• Ischemic colitis: A lack of blood flow to the intestine that can cause pain and bloody stools
  
• Nephrolithiasis: Kidney stones, which can cause abdominal pain
• Ovarian cyst: A fluid-filled sac that forms on the ovary, which may cause pain and pressure in the abdomen
  
• Pelvic inflammatory disease: An infection of the ovaries, uterus, and fallopian tubes
• Torsion: The ovaries or the testicles can become twisted, causing abdominal pain
• Tubo-ovarian abscess: An inflammatory mass that can occur in the organs in the pelvis
  
• Urinary tract infection: An infection of the urinary bladder that can cause abdominal pain
  

Diverticulitis vs. Diverticulosis Diagnosis

Diverticulosis and diverticulitis are together known as diverticular disease. Diverticulosis is when there are diverticula in the colon. They are common and usually don’t cause any symptoms.

Most people don’t need to make changes when diverticula are found, although eating more fiber, exercising, and quitting smoking may be recommended.

In some people, the diverticula can become inflamed or infected. This is called diverticulitis and can cause symptoms such as abdominal pain, diarrhea, and fever. Therefore, getting an accurate diagnosis of diverticulitis is important to get treatment. 

What to Expect After a Diverticulitis Diagnosis

A diagnosis of diverticulitis will usually mean that some treatment is needed. This can mean treating the inflammation, managing the symptoms, and, if possible, preventing it from happening again. 

Complications

Diverticulitis can have complications. If the inflammation keeps returning, there may be an increased risk of serious complications. 

This can include:

• Fistula
• Perforation (hole) in the intestine
• Peritonitis: Infection of the abdominal tissue
• Pockets of infection (abscesses)
• Stricture: A narrowed section of the intestine
  

Treatment

Pain is usually managed with Tylenol (acetaminophen) at home with other pain medications in the hospital. The diet might change to soft foods or liquids for a few days until symptoms get better.

If the diverticulitis is serious or complicated, it might need treatment in a hospital. This could mean pain medications, antibiotics, or other medications given intravenously (IV).

Preventing diverticulitis in the future may be important for some people at risk. As many as a third of people may have a recurrence. Some lifestyle changes might be recommended, including eating more fiber, quitting smoking, and getting enough exercise.

Rarely, surgery may be recommended. Removing the section of the colon with the diverticula is a treatment option for some people with diverticulitis that keeps coming back or causes complications.

When to See a Healthcare Provider

People who have had diverticulitis before may recognize the symptoms if they return. However, most people don’t know that they have diverticular disease, so it's important to see a healthcare provider about any new symptoms. This includes abdominal pain, diarrhea, constipation, nausea, and vomiting. 

In the case of symptoms such as abdominal pain, a person may be referred to a gastroenterologist (a specialist in digestive system conditions) or a colorectal surgeon for an exam or testing.

Summary

Diverticulosis is common and, in some cases, may lead to diverticulitis. People with diverticulitis may have abdominal pain and other digestive symptoms that a healthcare provider should check out.

The diagnostic process will include a physical exam, review of symptoms, and medical history. A digital rectal exam, blood tests, urinalysis, and imaging tests may be performed. Many conditions with similar symptoms will need to be considered before making a diagnosis.