Does Diverticulitis Go Away?

During a flare-up of diverticulitis, you may wonder whether diverticulitis can go away. Treatment that can help the condition improve and possibly go away completely include antibiotics, lifestyle changes, and home remedies. The condition may be treated at home with conservative methods or in the hospital for more complicated cases.

This article will cover treatments for diverticulitis, including how it may be treated at home or in the hospital, as well as when surgery might be recommended.

How Diverticulitis Goes Away 

Diverticular disease is a common condition with outpouchings (called diverticula) in the colon. In some cases, these pouches can become inflamed or infected and cause symptoms such as abdominal pain. When this happens, it is called diverticulitis.

To improve a flare-up of diverticulitis and possibly have the condition go away and not return, treatment can take different forms. Some of the options will depend on the seriousness of the condition. For diverticulitis without any complications, the treatment might include rest and changes to lifestyle and diet.

Antibiotics 

In recent years, there’s been a change in the role of antibiotics in treating diverticulitis. It was thought that diverticulitis could be caused by a bacterial infection and that antibiotics would help clear the infection.

However, in studies comparing the outcome of those treated with antibiotics vs. those not treated, antibiotics made little difference in people with a first flare-up of diverticulitis. Treating with antibiotics didn’t shorten hospital stays, improve symptoms, or prevent diverticulitis from coming back.

The American Gastroenterological Association (AGA) recommends that antibiotics be used in more complicated cases. This includes people who are immunocompromised (have a weakened immune system) have complicated diverticulitis, or have other signs and symptoms that may put them at higher risk for complications.

Lifestyle Changes 

Diverticular disease is tied to genetics and lifestyle. It’s thought that eating more fiber, stopping smoking, and getting regular exercise can ward off diverticular disease. 

Preventing diverticulitis may be difficult, though, since most people don’t know they have it. However, diverticula are common in people over age 60. In this group, lifestyle changes may help prevent diverticular disease.

For those who already have had diverticulitis in the past, avoiding nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen), may be recommended.

Home Remedies 

When symptoms of diverticulitis start, it’s important to get a diagnosis from a healthcare provider. After that, the treatment used will depend on certain factors. This includes whether it’s complicated or uncomplicated diverticulitis, if it’s a first flare-up or a recurrence, and if there are any other health problems to consider.

A liquid diet is usually recommended for the first three to five days after diagnosis. After that, the diet may be changed to include more foods from a low-fiber diet. When symptoms improve, more foods can be added back in until fiber can be tolerated again.

Probiotics haven’t been proven to help in preventing diverticulitis and are not recommended by the AGA.

When Does Diverticulitis Not Go Away?

In some cases, a flare-up of diverticulitis might not improve. There could be what might be called “smoldering” diverticulitis, with symptoms or inflammation that continue at a low level. There could also be another bout of diverticulitis that happens not long after the initial flare-up, which might be called chronic diverticulitis.

If symptoms aren’t getting better, it’s important to discuss them with a healthcare provider. A different type of treatment may be needed.

One study showed that 3% of people who were treated at home without antibiotics were admitted to the hospital within two weeks of their diverticulitis symptoms starting. Those people were put on antibiotics in a hospital, did well, and didn’t need surgery.

While having a flare-up of diverticulitis, it’s important to keep track of symptoms. If things are getting worse, it’s time to bring that up with your healthcare provider. Treatment might need to be stepped up in order to get the flare-up under control.

Getting more treatment could involve starting antibiotics and/or being admitted to the hospital. It could also include resection surgery to remove the part of the colon that is affected. Whether to have surgery and when is a topic of active discussion and study.

A healthcare provider might suggest surgery when diverticulitis is complicated. This could mean that a related problem (such as an abscess—a pocket of infection) has developed or if there’s a second flare-up close after the first one.

The surgery used might be a resection, in which the affected part of the colon is removed. Surgery could also mean placing a colostomy, in which the large intestine is brought outside a hole in the abdomen and an appliance is worn on the abdomen to collect stool.

It’s estimated that about one-third of people who have one diverticulitis flare-up may have another one. It used to be that surgery was always recommended after a second flare-up, but in recent years, a more personalized approach has been favored.

Surgery itself isn’t always a cure, however, after five years, diverticulitis might recur in as many as 15% of people.

Diverticulitis that’s not getting better may lead to a decision to hospital treatment with antibiotics or with surgery. This should be a joint decision between the healthcare provider and the patient.

Healing From Newly Diagnosed Diverticulitis 

Many people don’t know that they have diverticular disease, making a flare-up of diverticulitis difficult and unexpected. Treatment decisions are based on whether the flare-up is considered complicated or uncomplicated.

Acute Recovery

For uncomplicated diverticulitis, people might be given instructions to go on a liquid diet for the first two days. When feeling better, more foods might be added back into the diet.

Tylenol (acetaminophen) is usually recommended for pain relief. Other medications might be prescribed, such as antibiotics, if the healthcare provider thinks there is a need for them.

Complicated diverticulitis will be diagnosed if there is a perforation (hole in the colon), abscess, fistula (an abnormal tunnel between the colon and another part of the body), or an obstruction.

Cases in which people have other medical conditions or are immunocompromised usually are considered complicated. In these cases, hospitalization might be recommended. Treatment might include antibiotics, fluids, and pain medications.

Any complications will also need to be treated. What’s recommended will depend on how sick the person is and the specific complication. In some cases, resection or colostomy surgery may be recommended. 

Flares    

A flare-up of diverticulitis may subside with treatment, but there is the risk that it could happen again. It may be difficult to prevent another flare-up.

If symptoms of diverticulitis return, it’s important to speak to a healthcare provider right away and take steps to get it under control. Quality of life might be significantly lowered with diverticulitis that becomes chronic. With repeated flare-ups, surgery might be considered. 

When diverticulitis has healed enough, a colonoscopy will likely be recommended. This is to have a look at the colon and see which areas might have diverticula. Also, some studies have found that people who have diverticulitis may be at a higher risk for colon cancer. A colonoscopy can screen for colon cancer and also be used to remove any colon polyps (growths) that are present.

How to Prevent Recurrent Diverticulitis 

It may be difficult to prevent diverticulitis flare-ups or chronic diverticulitis. 

Using antibiotics to treat uncomplicated diverticulitis has not been shown to prevent another flare-up or shorten healing time. For that reason, antibiotics might not always be recommended to treat diverticulitis.

Different drugs have been tested to see if they might be helpful in treating or preventing diverticulitis flare-ups. There’s no evidence that antibiotics, Asacol (mesalamine), or probiotics are helpful in treating or preventing diverticulitis.

There is not much in the way of hard evidence behind the recommendations to prevent diverticulitis. However, some of the diet and lifestyle changes that have a growing level of evidence to support them include:

• Eating enough dietary fiber
• Getting enough exercise
• Maintaining an appropriate weight
• Stopping smoking

There is currently no evidence that emotional stress can cause a flare-up of diverticulitis. However, inflammation is physically stressful on the body. Following a healthcare provider’s instructions while recovering and giving yourself the time and rest needed to get a flare-up under control are going to be key parts of managing diverticulitis. 

Summary

Diverticular disease (diverticula in the colon) is common, especially as people age. Having a diverticulum carries a risk of developing an inflammatory condition called diverticulitis. Uncomplicated diverticulitis might be treated at home, but complicated diverticulitis might need treatment in the hospital with medications and/or surgery.