How do you live with diverticulitis?

What is diverticulitis?

Diverticulitis is a digestive condition that affects the diverticula in your colon. Diverticula are small pouches that can form in the lining of your digestive tract. When these pouches become inflamed or infected, it leads to diverticulitis. Symptoms of diverticulitis can include:

• Abdominal pain and cramping, usually in the lower left side
• Fever
• Chills
• Bloating
• Constipation or diarrhea
• Nausea and vomiting

Diverticulitis ranges in severity from mild to life-threatening. Mild cases can often be treated at home with rest, antibiotics, and a modified diet. More severe cases may require hospitalization and possibly surgery. Recurrent bouts of diverticulitis can lead to complications like abscesses, fistulas, bowel obstructions, and bleeding.

What causes diverticulitis?

Diverticula form when weak spots in the colon’s muscular wall bulge outward from pressure. Potential contributing factors include:

• A low-fiber diet – Fiber keeps stool soft and aids regular bowel movements. A low-fiber diet allows waste to harden and congest the colon.
• Constipation and straining during bowel movements
• Obesity
• Lack of exercise
• Smoking
• Genetic factors
• Use of certain painkillers like aspirin and ibuprofen

As we age, the wall of the colon also weakens. By age 50, over 50% of people have diverticula, although only 20% develop symptoms. Diverticula are more common in Western countries, likely due to low-fiber diets.

What are the stages of diverticulitis?

Diverticulitis can be classified into different stages based on severity:

Stage 1 (Uncomplicated): Mild infection of one or a few diverticula. No abscess, fever, nausea/vomiting, obstruction, or free air. Can often be treated as an outpatient with oral antibiotics and liquid diet.

Stage 2 (Complicated): Moderate infection with abscess formation. Needs intravenous antibiotics and hospitalization. May require percutaneous drainage.

Stage 3 (Complicated): Severe infection with abscess, fever, obstruction, free air, fistula, or peritonitis. Requires hospitalization and IV antibiotics. May need surgery.

Stage 4 (Complicated): Life-threatening infection with sepsis, diffuse peritonitis, organ dysfunction/failure. Emergency surgery usually needed. Can be fatal if not treated promptly.

Early diagnosis and treatment is key. Tell your doctor about any episodes of abdominal pain, bloating, constipation, or diarrhea lasting more than 2-3 days. Schedule a colonoscopy if over age 50.

How is diverticulitis diagnosed?

Diverticulitis can be tricky to diagnose as symptoms may mimic other conditions like irritable bowel syndrome (IBS), colitis, or appendicitis. Diagnostic tests may include:

• Medical history and physical exam: Looking for tenderness in the lower left quadrant, fever, elevated white blood cell count.
• Imaging tests: CT scan, colonoscopy, barium enema, ultrasound to check for inflammation and rule out other causes.
• Complete blood count (CBC): Looks for elevated white blood cell count signaling infection.
• Stool sample: Checks for blood which may indicate colonic bleeding.
• Urinalysis: Helps exclude urinary tract issues which can mimic diverticulitis.

The exam, lab work, and imaging provide a comprehensive picture to diagnose diverticulitis. Follow up tests may be ordered after acute infection resolves to assess damage and plan treatment.

What foods should you avoid with diverticulitis?

Diet modifications are a key part of managing diverticular disease. During acute episodes, a clear liquid diet is recommended, followed by a low-fiber, low-residue diet as symptoms improve. Foods to avoid during flares include:

• Nuts, seeds, popcorn
• Whole grains – wheat, oats, brown rice
• Raw fruits and vegetables with skins, husks, seeds
• Dried fruits and prunes
• Beans, lentils, legumes
• Corn and corn products
• Spicy, fried, and fatty foods

Focus on low fiber foods that are soft, easy to digest, and low residue:

• White bread, pasta, rice, crackers
• Eggs, poultry, fish, tofu
• Canned fruit without seeds, skinless cooked vegetables
• Yogurt, milk, cheese
• Clear broths, soups

Avoid any trigger foods identified during flares. Reintroduce higher fiber foods slowly once symptoms resolve. Stay hydrated with water, juices, tea, broths.

What medicines treat diverticulitis?

Medications used for diverticulitis include:

• Antibiotics: Ciprofloxacin, metronidazole, amoxicillin target infection causing inflammation.
• Pain relievers: Acetaminophen, tramadol help relieve cramping and pain.
• Anti-spasmodics: Hyoscyamine alleviates colon cramping and spasms.
• Anti-diarrheals: Loperamide, bismuth subsalicylate control diarrhea.
• Laxatives: May be needed for constipation after infection clears.

For mild cases, a 7-10 day course of oral antibiotics and pain/anti-spasmodic medications allows recovery at home. IV medications in the hospital combat more severe infection. Avoid aspirin and NSAIDs as they may worsen inflammation.

How can diet and lifestyle changes help prevent diverticulitis?

Diet and lifestyle adjustments help minimize flare ups long term:

• Eat 25-35g fiber daily from fruits, vegetables, whole grains.
• Drink fluids to soften stool and prevent constipation.
• Exercise regularly to support digestion and prevent obesity.
• Manage stress levels which influence GI function.
• Quit smoking which inflames the colon lining.
• Avoid medications that irritate the GI tract.
• Supplements like probiotics and vitamin D support gut health.

Fiber supplements like psyllium or methylcellulose add bulk safely to stool. Talk to your doctor before taking any new supplements. Monitor symptoms and avoid triggers that seem to provoke flares.

When should you see a doctor for diverticulitis?

Contact your doctor promptly if experiencing:

• Severe or persistent abdominal pain
• Fever over 101 F
• Rectal bleeding
• Nausea/vomiting lasting over 2 days
• Inability to pass stool
• Fatigue, dizziness, confusion

Seek emergency care for:

• Sudden, severe pain
• High fever with shaking chills
• Vomiting bile or blood
• Marked abdominal swelling
• Inability to urinate

Recurrence of symptoms after recent improvement warrants medical attention to check for complications. While many cases of diverticulitis resolve with rest and medication, more advanced disease may require interventions like antibiotics, drainage, or surgery.

What are treatment options for recurring diverticulitis?

For those with repeated episodes of acute diverticulitis, treatment options may include:

• High fiber diet: Reduces pressure and irritation within colon to limit inflammation.
• Probiotics: Help restore healthy gut bacteria balance to optimize GI function.
• Antibiotic therapy: Low dose antibiotics prescribed between episodes may prevent recurrence.
• Mesalamine medications: Anti-inflammatory drugs like mesalamine enemas or pills help heal inflamed tissue.
• Surgery: For those failing medical management, surgery removes the affected segment of colon. This may be done laparoscopically.

Treatment is tailored to the individual based on severity, frequency of episodes, response to medications, and presence of complications. Goals focus on allowing colonic rest and healing between flares.

What complications can arise from diverticulitis?

Potential complications of diverticulitis include:

• Abscesses: Pockets of pus form within tissues near the colon, requiring drainage.
• Fistulas: Abnormal channels develop between colon and other organs like bladder or vagina.
• Bowel obstruction: Severe inflammation/scarring blocks passage of stool.
• Perforation: Rupture or hole forms in the colon wall allowing leakage.
• Peritonitis: Colon leakage leads to dangerous infection of the abdominal lining.
• Sepsis: Widespread systemic infection from diverticulitis bacteria entering blood.

Most cases resolve without complications. But prompt medical care for worsening infection can prevent more serious outcomes. Know warning signs like high fever, vomiting, diarrhea, swelling.

Can you prevent diverticulosis from becoming diverticulitis?

Diverticulosis refers to the presence of diverticula pouches in the colon lining. About 20% of those with diverticulosis develop inflammation or infection known as diverticulitis. To help prevent this:

• Maintain a high fiber diet with 25-35g daily.
• Stay hydrated with fluids to keep stool soft.
• Exercise regularly to support digestion.
• Manage constipation with laxatives if needed.
• Take probiotics to optimize gut bacteria.
• Maintain a healthy weight.
• Avoid smoking, NSAIDs, and opiate pain medications.

While diverticulosis itself causes no issues, the pouches can allow waste to become trapped and infected. A colonoscopy can check for diverticula development so preventive steps can be taken. Monitor for any symptoms like pain or changes in bowel habits.

Should you avoid nuts, seeds, corn and popcorn with diverticular disease?

In the past, people with diverticulosis or diverticulitis were told to eliminate nuts, seeds, corn, popcorn, and other high residue foods from the diet. But recent research indicates these restrictions may be outdated.

Small studies show that the fiber content of nuts, seeds, and corn do NOT increase complications or flares for most patients with diverticular disease. The recommendations are now:

• Try reintroducing these foods in moderation, especially during symptom-free periods.
• Chew very thoroughly to minimize irritation.
• Stay well hydrated to ease passage through the colon.
• Stop any items that seem to trigger individual symptoms.
• Avoid problem foods during active episodes until diverticulitis improves.
• Focus on achieving 25-35g fiber from a wide variety of plant foods.

Talk to your doctor about current dietary guidelines for diverticular disease. Be aware of your unique intolerances. While many patients handle previously restricted foods without issue, eliminate any that provoke GI distress.

Can dietary changes help manage and prevent diverticular disease?

Yes, diet can significantly impact the development and course of diverticular disease. Recommended eating habits include:

• Adequate Fiber Intake: 25-35g daily from fruits, vegetables, whole grains. Improves stool bulk and colon motility.
• High Fluid Intake: Helps maintain soft stools and prevent constipation which can worsen diverticula inflammation.
• Limit Fatty, Greasy Foods: These foods slow GI transit time and may irritate the colon’s diseased pouches.
• Avoid Food Triggers: Nuts, seeds, and corn do not need routine restriction but eliminate any individual problem foods.
• Probiotics: Support healthy gut microbiome. Yogurt, kefir, fermented foods contain probiotics.
• Anti-Inflammatory Foods: Omega-3s, olive oil, ginger, berries help reduce colonic inflammation.

Avoid restrictive diets unless medically required during acute flare ups. Work with a dietitian to develop a nutritious, high fiber diet tailored to your needs long term. Lifestyle changes also reduce diverticular disease risk.

What role does surgery play in treating diverticulitis?

Surgery may be recommended for diverticulitis in certain cases:

• Recurrent episodes: For those with repeated bouts of acute diverticulitis failing medical therapy, elective surgery may prevent future flares.
• Uncontrolled infection: Emergency surgery is needed with abscesses, perforation, peritonitis unresponsive to antibiotics and drainage.
• Bowel obstruction: Partial colon removal treats chronic blockages from severe inflammation and scarring.
• Fistulas/sinus tracts: Surgery repairs abnormal connections between colon and other organs.
• Heavy bleeding: Surgery locates source of hemorrhage and removes affected colon segment.

The diseased section of colon is removed and healthy ends reconnected. Laparoscopic approaches allow faster recovery. With severe disease complications or spread, open abdominal surgery may be required. Most patients experience no further diverticulitis episodes after surgery.

What is the recovery like after surgery for diverticulitis?

Recovery after surgery for diverticulitis depends on the type of procedure but generally involves:

• Hospital stay of 2-7 days for monitoring, pain control.
• Gradually advancing diet from clear liquids to solid foods over 5-7 days.
• Pain medications and stool softeners initially.
• 6-8 weeks of rest before returning to normal activities.
• Most can resume driving after 2 weeks.
• No heavy lifting over 10-15 lbs for 6 weeks.
• May need to progress back to high fiber foods slowly.
• See your surgeon for follow up 1-2 weeks after discharge.

Recovery is faster with laparoscopic versus open surgery. Listen to your body and increase exertion slowly. Report any wound problems, bleeding, fevers or other concerns promptly. Support from family and friends can ease the recovery process. Most feel significantly better by 6 weeks post-op.

Conclusion

Living with diverticulitis involves managing acute flare ups, preventing recurrent episodes, and minimizing complications through diet, lifestyle changes, medications, and possibly surgery. Work closely with your medical team to find the most effective treatment approaches for your situation. While diverticulitis can negatively impact quality of life, appropriate care allows most people to keep symptoms under control and enjoy long lasting remission.