Diverticulitis Treatment

As some people age, their large intestinal walls may weaken and bulge out to form small pockets. These pockets are called diverticula. When they become infected, it's called diverticulitis. Diverticulitis treatment ranges from short-term diets to medications, hospitalization, and even surgery.

Treatment for diverticulitis will depend on individual factors, such as the severity and location of the infection, any complications, and other medical history.

In this article, learn more about diverticulitis treatment options.

Uncomplicated or Complicated Diverticulitis?

If you have diverticulitis, it will be categorized as either uncomplicated (without issues) or complicated (one or more issues are present).

Diverticulitis complications include:

• Abscesses: A confined collection of pus due to infection
• Fistula: An abnormal connection between two body cavities (in diverticulitis, the most common fistula is from the colon to the bladder, and fistulas from the colon to the skin, vagina, uterus, or other parts of the bowel can also occur)
• Colonic stricture: A narrowing of the part of the colon that restricts the passage of stool
• Peritonitis: Inflammation of the inner lining of the abdomen

How Is Diverticulitis Diagnosed?

The American Gastroenterological Association advises diagnosis of diverticulitis via a computed tomography (CT) scan. This test delivers a 3D image of your inner abdomen and helps your healthcare provider see if you have infected intestinal pockets (diverticula).

For people with a history of diverticulitis or continuous symptoms, other health conditions must also be ruled out. This can take place via blood tests, lower endoscopy, and other imaging methods.

Antibiotics for Diverticulitis

The recommendations for antibiotic use with diverticulitis have changed over the years as healthcare providers have become more aware of the dangers of antibiotic resistance.

Currently, healthcare providers may prescribe antibiotics for some people with diverticulitis (but not all).

Antibiotics are no longer usually prescribed for cases of uncomplicated diverticulitis. However, they may be recommended for immunocompromised people and those with high blood pressure, allergies, or chronic kidney disease.

Antibiotics are most often prescribed for people with complicated diverticulitis and the presence of abscesses. Antibiotics may be delivered intravenously (IV) (in the vein) to help treat the infection in the abscess and diverticula.

Diet and Diverticulitis

Your healthcare provider may recommend a specific diet if you have diverticulitis. Diet changes can help treat acute diverticulitis (the sudden onset of active infection) and prevent future diverticulitis flare-ups.

However, the diet recommendations for diverticulitis treatment and prevention differ significantly.

Liquid Diets

A liquid diet of soups and non-solid foods may be recommended during an episode of acute diverticulitis (active infection). The theory behind this is that avoiding solid foods gives your colon a period of rest to recover from the infection.

Fiber

Fiber intake is essential when it comes to diverticulitis treatment and prevention.

High-Fiber Diet for Diverticulitis Prevention

Eating a diet high in fiber is often recommended for people diagnosed with diverticulosis (uninfected intestinal pockets).

Fiber helps bulk up stool and maintain regular bowel movements; with regular bowel movements, you're less likely to get stool stuck in the pockets, which may lead to a diverticulitis infection.

However, there is conflicting evidence to support high-fiber diets for diverticulitis prevention. Some studies support high-fiber diets, some say there is no effect, and some even associate high-fiber diets with diverticulitis. Though controversial, health providers still generally recommend high-fiber diets to prevent diverticulitis.

Low-Fiber Diet for Acute Diverticulitis

Healthcare providers may recommend following a low-fiber diet during a diverticulitis flare-up. Similar to a liquid diet, this gives your colon a period of rest.

There is not much research yet to support one diet recommendation over another with acute diverticulitis.

Do Probiotics Help Diverticulitis?

Probiotics are consumable living microorganisms (yeast and/or bacteria) that change the microbiome of the intestine to increase "good" bacteria, therefore potentially helping treat infected intestinal pockets (diverticulitis).

One 2016 systematic review found insufficient evidence to conclude whether probiotics are effective at reducing diverticulitis symptoms or recurrence.

Since then, there has been ongoing research on the subject. One 2019 study found that a probiotic mix of Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, and Lactobacillus acidophilus LA 201, in combination with antibiotics, significantly reduced diverticulitis-associated pain and inflammation, compared to antibiotic use alone. Another 2022 study found that probiotics effectively prevented diverticulitis in rats.

There isn't currently enough evidence to determine whether probiotics help with diverticulitis. The answer probably depends on the type of probiotic and infection you have. However, it's worth discussing this potential treatment with your gastroenterologist.

Surgical Treatment for Diverticulitis

Surgery may be recommended for some people with diverticulitis. Each type of surgery varies in its level of invasiveness.

When Is Surgery for Diverticulitis Considered?

Not everyone with diverticulitis will require surgery. Surgery for diverticulitis is recommended in cases of:

• Peritonitis
• Colon rupture
• Colonic stricture
• Fistula
• An abscess that cannot be drained
• Irresponsiveness to intravenous antibiotics
• Immune system issues, such as chemotherapy or organ transplant

Additionally, if a person experiences multiple diverticulitis attacks, they may selectively choose to have surgery to reduce their chance of getting diverticulitis in the future.

Types of Surgery for Diverticulitis

Different types of surgery for diverticulitis depend on the location and severity of your infection and any complications.

Some types of diverticulitis surgery include:

• Abscess draining: If an abscess is around 3–5 centimeters (cm), it may be drained. This is a simple outpatient procedure performed by a radiologist, who inserts a needle into the abscess and removes the fluid. About 15% of people with complicated diverticulitis require this. This is the most conservative method of diverticulitis surgery.
• Colectomy: A colectomy is a broad term for surgery in which parts of the large intestine are removed. Complications like fistulas, intestinal blockage, peritonitis, and abscesses that cannot be drained require a colectomy. One colectomy surgery can look very different from another. The surgeon may perform an open (large incision) or laparoscopic (multiple small cuts) surgery.
• Colostomy: During a colostomy, your surgeon will connect part of your large intestine to an opening in the abdomen, which is then connected to a bag for stool to exit. This is typically to let the colon heal and is usually temporary. Another surgery will be required to reverse the colostomy.

After diverticulitis diagnosis and treatment, a colonoscopy may be recommended to check on recovery and investigate any other possible conditions.

Can I Still Get Diverticulitis After Partial Colon Removal?

It is still possible to get diverticulitis after partial colon removal, but this is rare. One study found that the recurrence of diverticulitis after colon resection was about 10%; however, more recent research is necessary to confirm this number.

Recovering from Surgery

Your surgeon should provide you with detailed instructions for any precautions you should take after diverticulitis surgery. They may prescribe you a course of antibiotics after the surgery to clear up any remaining infection. Additionally, you may have to spend a few days in the hospital as you recover and consult with a pain management or ostomy team during this time.

Home Remedies for Diverticulitis 

Many cases of uncomplicated diverticulitis can be treated at home. Your healthcare provider may recommend a liquid diet full of fluids like water, broth, and soups. They may also recommend a low-fiber diet or other methods for colonic rest.

However, if you experience severe abdominal pain or bleeding, it's essential to seek immediate medical care.

New Treatments for Diverticulitis 

There is a great deal of ongoing research on new treatments for diverticulitis, including a specific interest in the benefits of probiotics for diverticulitis.

Additionally, there have been some changes over the past two years in recommendations for managing diverticulitis. As of 2021, antibiotic treatment is now selective rather than recommended for all people with diverticulitis.

There is also less of an emphasis on surgery. Surgery was previously recommended based solely on the number of diverticulitis episodes someone had had, but this is no longer the case. Now, a more person-centered approach is recommended, in which the individual's symptoms, preferences, and values are also considered.

How Long Does It Take to Recover From Diverticulitis?

The length of time to recover from diverticulitis can vary significantly from person to person, depending on factors like complications, age, and other health conditions.

Fortunately, 95% of uncomplicated diverticulitis cases resolve in one week, and 80% of complicated diverticulitis cases resolve after several weeks of antibiotic therapy.

Managing Diverticulitis Pain

Abdominal pain is one of the most common symptoms of diverticulitis. However, you must be careful with your medications to manage diverticulitis pain.

Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided because they are associated with a higher risk of diverticulitis. Talk to your healthcare provider about safe options for pain management.

How to Prevent Diverticulitis

There are several ways to prevent a diverticulitis episode, including:

• Do not use NSAIDs
• Eat a high-quality, high-fiber diet
• Maintain an average body mass index (BMI)
• Exercise regularly
• Do not smoke
  

Summary

Diverticulitis can be painful and, in some cases, lead to life-threatening complications. Treatment for diverticulitis depends on many factors, such as the severity of the infection, medical history, and any complications.

Liquid diets, colonic rest, antibiotics, hospitalization with intravenous (IV) antibiotics and nourishment, abscess drainage, and surgery may all be recommended to treat diverticulitis.