How Diverticulitis Is Treated

Diverticulitis is a disease that can strike suddenly and last or several days, causing lower abdominal pain, bloating, cramping, nausea, and bloody stools. Treatment may involve rest and a liquid diet to take some of the stress off your intestines. Antibiotics may be also prescribed, especially if there is fever, chills, or persistent or worsening symptoms.

Severe cases may require hospitalization and surgery.

If you are suffering from severe or recurrent bouts of diverticulitis, it is important to seek care from a board-certified gastroenterologist who specializes in diseases of the gastrointestinal tract. Together, you can build a comprehensive treatment plan that may include medications, dietary changes, and supplements to aid in your digestion.

Lifestyle

Diverticulitis is a complex and poorly understood disease that can often strike with no apparent cause. While a low-fiber diet is considered a strong risk factor for the disorder, no special diet has proven effective in preventing attacks and no specific foods are known to trigger an attack.

The first step in treating diverticulitis is to give your digestive tract a rest. This includes limiting what you eat and, in some cases, avoiding all solid foods until symptoms fully resolve.

During an Attack

If your symptoms are uncomplicated without fever or bleeding, your doctor may recommend that you take a couple of days off work and adhere to a strict liquid diet. Since acute attacks can last for several days, you need to maintain proper nutrition by bolstering your diet with either a daily supplement or a no-fiber nutritional shake, like Ensure Plus.

Other acceptable foods include:

• Broth
• Fruit juice without pulp
• Popsicles (without bits of fruit or fruit pulp)
• Sports drinks
• Gelatin
• Water
• Tea or coffee without cream

During this time, you also need to keep well hydrated, especially if you have diarrhea. While sports drinks can be useful in replacing lost electrolytes, never use them as your sole source of hydration as the high sugar content can aggravate diarrhea.

During Recovery

As you start to feel better, you can begin introducing low-fiber foods into your diet. Though a low-fiber diet is considered a contributor to diverticulitis, eating high-fiber foods as you are working to recover can strain your intestines. The aim of a restricted fiber diet is to reduce the amount of undigested food passing through the bowels so that you make smaller amounts of stool.

Acceptable foods include:

• Poultry, fish, and eggs
• Canned or cooked vegetables, peeled
• Canned or cooked fruit, peeled
• Refined white bread
• Vegetable juice without pulp
• Low-fiber cereals
• Milk, yogurt, and cheese
• White rice and plain pasta

After Recovery

Once you are back on your feet, you can start gradually adding fiber back into your diet until your daily intake is between 25 and 30 grams. While research is largely split on whether a high-fiber diet can prevent future flare-ups, it is important to sustain these goals if only to normalize your bowel movements and avoid constipation.

Ideals source of dietary fiber include:

• Beans and lentils
• Brown rice, barley, and quinoa
• Fruits and vegetables
• Nuts and seeds
• Whole-grain bread, cereals, and pasta

While nuts, corn, and popcorn were once considered off-limits for people with diverticulitis, research from the University of Washington School of Medicine has concluded that they are not only acceptable but can actually help improve long-term colonic health.

Prescriptions

Antibiotics are commonly used to treat diverticulitis at all stages of the disease, and that may be a mistake. According to a ​Cochrane review in 2012, the use of antibiotics to treat uncomplicated diverticulitis did nothing to improve the outcome, severity, duration, or frequency of an attack compared to taking no antibiotics.

Antibiotics are appropriate, though, in people with persistent or worsening symptoms (including high fever and chills) and those with complications such as bowel obstruction or rectal bleeding.

For mild to moderate diverticulitis, the doctor will usually prescribe a broad-spectrum antibiotic able to treat a diversity of bacterial types. If symptoms are severe, blood tests and stool cultures may be used to identify the specific bacterial strain so that targeted antibiotics can be selected.

Depending on the type and severity of symptoms you have, the antibiotics may be delivered either orally (by mouth) or, in cases where patients are admitted to the hospital, intravenously (into a vein). Options include Augmentin XR (amoxicillin/clavulanate), metronidazole, Timentin (ticarcillin/clavulanate), among several others.

If oral antibiotics are prescribed, it is important to take the entire course even if your symptoms improve. Stopping short can allow bacteria to mutate and develop drug resistance, making it all the more difficult to treat your symptoms if they return.

Surgery

Between 15 percent to 30 percent of people hospitalized for diverticulitis will require surgery to repair damage to the intestines. Indications for surgery include:

• Abscess (a confined pocket of pus in the intestinal lining)
• Fistula (an abnormal connection between the intestines and either the bladder, small intestine, or vagina)
• Intestinal perforation with peritonitis (a potentially life-threatening inflammation of the abdominal cavity)

Diverticulitis surgery involves a bowel resection (removal of a portion of your bowel) performed under general anesthesia.

Depending on the severity of the complication, the surgery may either be performed laparoscopically (known as "keyhole" surgery) or require open surgery, in which an incision is made in the abdomen. Of the two, laparoscopic surgery is associated with shorter hospital stays and fewer post-surgical complications.

Surgical options include:

• Bowel resection with anastomosis, in which the diseased portion of the bowel is removed and the cut ends are stitched together
• Bowel resection with a colostomy, in which the healthy end of the colon is diverted from the rectum to an artificial hole in your abdomen

Elective surgeries can be scheduled no less than eight weeks after an acute attack. Emergency surgeries resulting from an intestinal rupture carry between a 12 percent and 25 percent risk of mortality, according to research from the Yale University School of Medicine.

Complementary Medicine (CAM)

One of the common contributors to the formation of the diverticula is constipation. If you have chronic constipation, the persistent stress in the intestines can cause weak spots to suddenly "pop out" and form permanent pockets. These are the areas most vulnerable to infection and inflammation.

To prevent or treat constipation, doctors will sometimes recommend psyllium husk, a form of fiber derived from the seed husk of the Plantago ovato plant. The bulking effect of psyllium promotes the production of mucilage, a slippery substance that lines the colon and increases the contractions of the lower bowel.

Psyllium husk is available in powder, capsule, and wafer form. While the supplement is considered safe when used as directed, it may cause gas and stomach cramping. Speak with your doctor before using psyllium or any other alternative medications to treat diverticulitis.

Sources:

McGillicuddy, E.; Schuster, K.; Davis, K. et al. "Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients." Arch Surg. 2009; 144(12):1157-62. DOI: 10.1001/archsurg.2009.203.

National Institute of Diabetes and Digestive and Kidney Diseases. "Eating, Diet, & Nutrition for Diverticular Disease: What should I eat if I have diverticulosis or diverticulitis?" Bethesda, Maryland; updated May 2016.

Shabanzadeh, M. and Wille-Jørgensen. P. "Antibiotics for uncomplicated diverticulitis." Cochrane Database Syst Rev. 2012; (11):CD009092. DOI: 10.1002/14651858.CD009092.pub2.

Strate, L.; Liu, Y.; Syngal, S. et al. "Nut, corn, and popcorn consumption and the incidence of diverticular disease." JAMA. 2008; 300(8):907-14. DOI: 10.1001/jama.300.8.907.

Wilkins, T.; Embry, K.; and George, R. "Diagnosis and Management of Acute Diverticulitis." Am Fam Physician. 2013; 87(9):612-620.