Most individuals who develop diverticula (small bulges in the intestinal lining) do not develop symptoms of the condition. However, around a quarter of people do get symptoms, at which point they are said to have diverticular disease. In cases where the diverticula become infected and inflamed, the condition is called diverticulitis.
Diverticular disease and diverticulitis can be treated in several ways, some of which are described below:
Mild diverticulitis may be treated with oral antibiotics and the patient is advised to stick to a fluid-only diet until symptoms improve. Solid foods can aggravate symptoms and should be introduced slowly over time as the patient recovers.
More severe illness may require hospitalization, which is indicated when one of the following applies:
- Pain is not controlled by paracetamol
- The patient cannot drink enough to hydrate themselves
- The patient has poor health or a weakened immune system
- Oral ingestion of antibiotics is not possible
In hospital, patients are provided with intravenous fluids and antibiotics snd usually start to improve after several days.
A patient is advised to follow a low fibre diet after discharge from hospital in order to allow the colon time to heal. Once a patient has recovered, a high fibre diet is advised to help stools stay soft and easy to pass.
For recurrent attacks of diverticulitis or complications such as abscess, peritonitis or fistula, surgery may be needed to remove the diseased section of the colon.
The two main types of surgery are primary bowel resection and bowel resection with colostomy.
In a primary bowel resection, the diseased portion of the intestine is removed and the healthy parts are then connected together in a process called anastomosis. The surgery may either be performed as an open procedure or a laparoscopic surgery, depending on the extent of the inflammation. Laparoscopy involves three or four small incisions being made in the abdomen while open surgery requires one long incision across the abdomen. Patients usually recover more quickly after a laparoscopy.
A bowel resection with colostomy is performed in cases where the inflammation is too severe for the rectum and colon to be reconnected. After the diseased segment has been removed, the remaining healthy portion is attached to an opening that the surgeon creates in the abdominal wall called a stoma. Instead of the intestinal waste moving into the rectum, it is passed out of the body via the stoma. Several months after the procedure, when the inflammation has healed, it may be possible for the surgeon to reconnect the colon and rectum in a follow-up procedure.
Patients who have experienced diverticulitis are usually advised to follow a high fibre diet and to quit smoking, maintain a healthy body weight and exercise regularly.
Reviewed by Sally Robertson, BSc