Diverticulitis

What Is Diverticulitis?

  • Diverticulitis is a medical condition affecting the large intestines (colon). Because of certain factors, “outpouchings” are formed in the lining of the colon’s mucosa. These pouches are called diverticula’s, and the condition is called diverticulosis.
  • If these pouches become infected or inflamed, the condition is called "diverticulitis."
  • Diverticulosis is commonly a disease of older age, with most diagnoses made after the age of 60 years. It is more common in westernised countries, and mostly affects the left side of the large intestines called the sigmoid colon. In African and Asian countries, diverticulosis is more common in the right colon.
  • Diagnosis is based on clinical examination, history, and special investigations. Special investigations performed in suspected acute diverticulitis include a contrasted CT scan of the abdomen and blood tests.
  • During acute diverticulitis blood tests may show an increase in infective markers such as CRP and white blood cells (called leucocytosis). The CT scan will show areas of inflamed diverticula’s and can show if there are any other complications present such as bowel perforation or abscess formation.    

What Is Diverticulitis?

  • Diverticulitis is a medical condition affecting the large intestines (colon). Because of certain factors, “outpouchings” are formed in the lining of the colon’s mucosa. These pouches are called diverticula’s, and the condition is called diverticulosis.
  • If these pouches become infected or inflamed, the condition is called "diverticulitis."
  • Diverticulosis is commonly a disease of older age, with most diagnoses made after the age of 60 years. It is more common in westernised countries, and mostly affects the left side of the large intestines called the sigmoid colon. In African and Asian countries, diverticulosis is more common in the right colon.
  • Diagnosis is based on clinical examination, history, and special investigations. Special investigations performed in suspected acute diverticulitis include a contrasted CT scan of the abdomen and blood tests.
  • During acute diverticulitis blood tests may show an increase in infective markers such as CRP and white blood cells (called leucocytosis). The CT scan will show areas of inflamed diverticula’s and can show if there are any other complications present such as bowel perforation or abscess formation.    

What Are The Symptoms Of Diverticulitis?

  • Symptoms of diverticulitis are the abdominal pain- most often in the left lower region, abdominal cramps, constipation or diarrhoea, nausea or vomiting, and fever. Fresh red bleeding per rectum may also occur.
  • Diverticulitis can either be complicated or uncomplicated.
  • Complicated diverticulitis can occur when one of the diverticula rupture and cause intestinal bacteria to leak into the abdominal cavity, infecting the lining of the abdomen (called peritonitis).
  • Abscess formation, obstruction due to narrowing of the colon, fistula formation (when the colon forms an abnormal connection to another organ in the abdomen) may all be part of complicated diverticulitis.
  • Complicated diverticulitis can be potentially life-threatening if not promptly treated. Perforated or ruptured bowel/diverticula’s need emergency surgery.
  • Diverticulosis may be asymptomatic, or patients may have constant, dull lower abdominal pain. They may be unaware that they have diverticulosis until an acute episode of diverticulitis occurs.    

What Are The Causes Of Diverticulitis?

  • The is no clear aetiology for diverticulosis, but several factors play a role. The structure of the colon's lining appears to be important. Pouches usually occur at weaker sites in the colon's muscular wall, where blood vessels enter and exit.
  • Studies done have shown that people with diverticulosis may have abnormal peristaltic movements of the colon, resulting in a temporary or functional obstruction, which increases pressure in segments of the colon and can lead to outpouchings.
  • Diets low in dietary fibre and high in refined and processed foods (westernised diet) seem to be another possible cause.
  • Other factors that are thought to play a role: NSAID (non-steroidal anti-inflammatory) use, caffeine, a sedentary lifestyle and being overweight. Smoking has been linked to worse outcomes in diverticulosis.
  • Diverticulitis occurs when outpouching in the colon become inflamed and infected by normal bacteria that colonise the gut.    

What Are The Things One Should Do To Manage Diverticulitis?

  • Increase exercise (at least 30minutes of moderate exercise, three times per week)
  • Lower your body weight to a healthy BMI (body mass index)
  • Drink enough water (at least two litres per day) to help with normal bowel peristalsis
  • Consider adding a fibre supplement, like psyllium and methylcellulose (bulk-forming laxatives) to your diet, to keep your stools soft and bowel movements regular.    

What Are The Things One Should Avoid To Manage Diverticulitis?

  • Do not smoke. Smoking has been linked to more frequent cases of complicated diverticulitis as well as worse outcomes    

What Are The Best Foods For Diverticulitis?

  • Initial studies thought that low-fibre diets and avoidance of nuts, popcorn, and corn were useful in diverticulosis. Recent studies, however, found that there is little evidence in this regard.
  • A high fibre diet is now recommended and evidenced by most studies
  • Foods that are fibre rich include:
  1. Fresh fruits and vegetables (apples, pears, potatoes, squash)
  2. Whole wheat pasta, bread, brown rice
  3. Beans such as kidney beans or black beans

What Are The Worst Foods For Diverticulitis?

  • Avoid caffeine
  • Low fibre and refined sugars and carbohydrates    

What Are The Medicines For Diverticulitis?

  • Acute diverticulitis’ management depends on whether the presentation is complicated or uncomplicated.
  • Asymptomatic diverticulosis often does not need any treatment. Probiotics have not been shown to be beneficial.
  • Uncomplicated acute diverticulitis can be treated conservatively as an outpatient. Oral antibiotics and analgesia are used. The antibiotics should be broad spectrum, with anaerobic and gram-negative bacteria cover. Usually, a combination of two or more antibiotics is used. Ciprofloxacin and Metronidazole are examples of antibiotics commonly used.
  • Treatment of complicated diverticulitis depends on the particular complication. Intravenous antibiotics are usually the mainstay of treatment, with or without surgical intervention. Estimated 15-30% of patients admitted for complicated diverticulitis will need surgery.
  • Any sign of ruptured bowel requires immediate surgery. Abscesses can be managed either by CT scan/ultrasound guided percutaneous (needle inserted through the skin overlying the abdomen) drainage if needed. Fistulas can be repaired with elective surgery once the acute inflammation has subsided.

What Are The Tips To Manage Diverticulitis?

  • Colonoscopy is contraindicated in acute diverticulitis but may be performed six weeks after discharge from hospital to exclude further complications. 

What Are The Symptoms Of Diverticulitis?

  • Symptoms of diverticulitis are the abdominal pain- most often in the left lower region, abdominal cramps, constipation or diarrhoea, nausea or vomiting, and fever. Fresh red bleeding per rectum may also occur.
  • Diverticulitis can either be complicated or uncomplicated.
  • Complicated diverticulitis can occur when one of the diverticula rupture and cause intestinal bacteria to leak into the abdominal cavity, infecting the lining of the abdomen (called peritonitis).
  • Abscess formation, obstruction due to narrowing of the colon, fistula formation (when the colon forms an abnormal connection to another organ in the abdomen) may all be part of complicated diverticulitis.
  • Complicated diverticulitis can be potentially life-threatening if not promptly treated. Perforated or ruptured bowel/diverticula’s need emergency surgery.
  • Diverticulosis may be asymptomatic, or patients may have constant, dull lower abdominal pain. They may be unaware that they have diverticulosis until an acute episode of diverticulitis occurs.    

What Are The Causes Of Diverticulitis?

  • The is no clear aetiology for diverticulosis, but several factors play a role. The structure of the colon's lining appears to be important. Pouches usually occur at weaker sites in the colon's muscular wall, where blood vessels enter and exit.
  • Studies done have shown that people with diverticulosis may have abnormal peristaltic movements of the colon, resulting in a temporary or functional obstruction, which increases pressure in segments of the colon and can lead to outpouchings.
  • Diets low in dietary fibre and high in refined and processed foods (westernised diet) seem to be another possible cause.
  • Other factors that are thought to play a role: NSAID (non-steroidal anti-inflammatory) use, caffeine, a sedentary lifestyle and being overweight. Smoking has been linked to worse outcomes in diverticulosis.
  • Diverticulitis occurs when outpouching in the colon become inflamed and infected by normal bacteria that colonise the gut.    

What Are The Things One Should Do To Manage Diverticulitis?

  • Increase exercise (at least 30minutes of moderate exercise, three times per week)
  • Lower your body weight to a healthy BMI (body mass index)
  • Drink enough water (at least two litres per day) to help with normal bowel peristalsis
  • Consider adding a fibre supplement, like psyllium and methylcellulose (bulk-forming laxatives) to your diet, to keep your stools soft and bowel movements regular.    

What Are The Things One Should Avoid To Manage Diverticulitis?

  • Do not smoke. Smoking has been linked to more frequent cases of complicated diverticulitis as well as worse outcomes    

What Are The Best Foods For Diverticulitis?

  • Initial studies thought that low-fibre diets and avoidance of nuts, popcorn, and corn were useful in diverticulosis. Recent studies, however, found that there is little evidence in this regard.
  • A high fibre diet is now recommended and evidenced by most studies
  • Foods that are fibre rich include:
  1. Fresh fruits and vegetables (apples, pears, potatoes, squash)
  2. Whole wheat pasta, bread, brown rice
  3. Beans such as kidney beans or black beans

What Are The Worst Foods For Diverticulitis?

  • Avoid caffeine
  • Low fibre and refined sugars and carbohydrates    

What Are The Medicines For Diverticulitis?

  • Acute diverticulitis’ management depends on whether the presentation is complicated or uncomplicated.
  • Asymptomatic diverticulosis often does not need any treatment. Probiotics have not been shown to be beneficial.
  • Uncomplicated acute diverticulitis can be treated conservatively as an outpatient. Oral antibiotics and analgesia are used. The antibiotics should be broad spectrum, with anaerobic and gram-negative bacteria cover. Usually, a combination of two or more antibiotics is used. Ciprofloxacin and Metronidazole are examples of antibiotics commonly used.
  • Treatment of complicated diverticulitis depends on the particular complication. Intravenous antibiotics are usually the mainstay of treatment, with or without surgical intervention. Estimated 15-30% of patients admitted for complicated diverticulitis will need surgery.
  • Any sign of ruptured bowel requires immediate surgery. Abscesses can be managed either by CT scan/ultrasound guided percutaneous (needle inserted through the skin overlying the abdomen) drainage if needed. Fistulas can be repaired with elective surgery once the acute inflammation has subsided.

What Are The Tips To Manage Diverticulitis?

  • Colonoscopy is contraindicated in acute diverticulitis but may be performed six weeks after discharge from hospital to exclude further complications.