How Is Diverticulitis Treated?
Medically reviewed by Robert Burakoff, MD
Diverticulitis is a disease that happens when pouches develop in the lining of the intestines and become inflamed. These inflamed patches can burst and create complications. Treatment will depend on what type of diverticulitis you have but can include bowel rest, antibiotics, and sometimes surgery.
It's possible to have multiple attacks of diverticulitis. The more episodes you have, the more likely you will have another attack and complications. Diverticulitis complications include abscesses, strictures, fistulas, and bleeding.
When deciding on treatment, your healthcare provider will also consider your overall health, how severe your diverticulitis episode is, and how intense your symptoms are. The treatment goal is to control the infection, help you regain good health, and minimize your risk of serious complications.
Treatments by Condition Type
Treating diverticulitis will depend on whether you have uncomplicated or complicated diverticulitis. Your healthcare provider will also consider your overall health status and other conditions before implementing a treatment plan. They may refer you to a gastroenterologist, or a doctor who specializes in conditions affecting the digestive system.
Some people can be treated at home, while others may require hospitalization. People who cannot tolerate anything by mouth, are vomiting, show signs of abdominal lining inflammation called peritonitis, are immunosuppressed, or are older are usually hospitalized.
Treatment for Uncomplicated Diverticulitis
Most people who have diverticulitis don't experience complications, which is known as having uncomplicated diverticulitis. Treatment can usually occur at home when there aren't any complications. If you have severe symptoms, or complications, or are at high risk for developing complications, you will most likely require treatment in the hospital.
Treatments can include:
Bowel rest: Allowing the bowel to rest includes consuming a clear liquid diet. This rest means your bowels do not have to work by digesting foods and can start to heal. As your symptoms improve, you can typically start adding solid food again.
Pain medications: To help with abdominal pain, your healthcare provider may recommend trying Tylenol (acetaminophen). You should not use nonsteroidal anti-inflammatory drugs (NSAID) like Advil (ibuprofen) because they can increase the chance of complications. Medications that help with gastrointestinal tract spasms may also help with abdominal pain.
Antibiotics: Antibiotics are not necessary for everyone and are given based on each person's situation. You may need antibiotics if you are immunocompromised or have other serious conditions.
Surgery: You may not need surgery for uncomplicated diverticulitis. Your healthcare provider will review your situation and discuss your options. For example, they will look at the number of attacks you've had, your operative risks, intensity of attacks, quality of life, and concerns for recurrence. They should also take your preference for having surgery into consideration.
Colonoscopy: Once the diverticulitis episode has stopped, your healthcare provider may decide to do a colonoscopy to view the inside of your intestines. A colonoscopy can help detect other causes of abdominal pain, like colorectal cancer. It is usually recommended that you have a colonoscopy four to eight weeks after a diverticulitis attack.
Treatment for Complicated Diverticulitis
Treating diverticulitis with complications—known as complicated diverticulitis—requires a more intensive treatment plan and will usually happen in the hospital. Some complications are more serious than others and may require emergency surgery.
Bowel rest: Even with complicated diverticulitis, bowel rest is usually part of the treatment plan. Bowel rest allows the intestines time to heal.
Antibiotics: Small abscesses can benefit from using intravenous (IV) antibiotics. Intravenous means through the vein of an arm.
Percutaneous abscess drainage: Larger abscesses usually require percutaneous drainage. During this procedure, your healthcare provider will position you, administer medications to help you relax, apply numbing medications, and then insert a catheter or needle into the abscess area. A drainage bag is attached to the catheter to collect the fluid. It may take a few days for all the drainage to come out of the abscess.
Surgery: When the pouches perforate and leaks stool into the abdomen, it can create inflammation of the abdominal lining, known as peritonitis. Surgery is typically needed when peritonitis occurs because this condition can be life-threatening.
Surgery for Diverticulitis
Surgery used to be the recommended treatment for diverticulitis. As researchers better understand the condition, less aggressive options are available. The need for surgery will depend on vital signs like your blood pressure and pulse, lab values, and abdominal symptoms.
Situations that might require surgery include:
Leaking of stool in the abdomen
An abscess that will not go away with drainage
Diverticulitis does not go away with antibiotics and hospitalization
People who have a weakened immune system
Developing a stricture (narrowing of the colon) or fistula (an abnormal connection of two of your organs)
Having multiple attacks of diverticulitis
Surgery for diverticulitis is called a colectomy. In a colectomy, a surgeon (likely a proctologist) will remove the part of the intestine that has the disease. Surgeons can attach the two ends back together, known as anastomosis, after removing the portion of the colon. Healthy people who don't have perforation or abscesses or don't have a lot of inflammation can usually have the ends anastomosed.
Others will have a temporary colostomy. A colostomy is when a surgeon creates an opening between the intestine and the outer part of the abdomen. Once the intestines heal and there is improvement in your condition, the two ends can be surgically placed back together by your surgeon.
Lifestyle
There are measures that you can try to prevent diverticulitis attacks. These measures can also help avoid diverticulitis from coming back.
Avoid smoking
Try to stay active and exercise
Decrease your intake of red meats
Increase your daily intake of fiber and water
Discuss medications you take to ensure they don't increase the chances of developing diverticulitis
Living With and Managing Diverticulitis
Diverticulitis leads to complications in about 12% of people. The most common complication is an abscess. People who develop complications risk death more than those with uncomplicated diverticulitis.
About 8% of people will have a recurrence of diverticulitis in the first year after they have the first episode. The risk of recurrence goes up with each episode experienced. Certain factors like your age at diagnosis, other conditions you have, and how severe your case is will impact your outcomes.
Researchers once thought diverticulitis was a disease that progresses or worsens but have discovered it is more of an inflammatory disease. This discovery means treatment can be less aggressive. Imaging and endoscopies allow diagnoses to be more accurate.
A Quick Review
Treating diverticulitis will vary depending on what type you have. Uncomplicated diverticulitis can be managed at home, while complicated diverticulitis usually needs treatment in the hospital. Several factors play a part in determining your treatment plan, such as your overall health status and any other medical conditions. Surgery is usually only needed for severe complications. Surgery might be beneficial if you suffer from frequent attacks that affect your quality of life.
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