Defend Yourself From Diverticulitis

Overview

Diverticulitis (say: dy-ver-tik-yoo-LY-tis) is when small pouches that have formed in the wall of your bowel become inflamed or infected. These pouches are called diverticula. Many people have them without ever knowing — that harmless situation is called diverticulosis. Diverticulitis is the painful flare-up that happens when one of those pouches gets irritated or infected. It usually affects the lower part of the large bowel, most often on the left side.

Yes, it is common. Diverticula are found in a large share of people over 60, and only a small fraction of those people ever develop diverticulitis. It is one of the more frequent reasons adults go to their doctor with sudden belly pain.

It is most common in adults over 50, and the chance rises with age. It can happen in younger adults too, and it is rare in children. It affects people of all backgrounds, though it is less common in parts of the world where people eat a lot of fibre-rich food.

Symptoms

Common symptoms

• Steady pain, often in the lower left side of the belly, that may come on over a day or two
• Tenderness when you press on the belly
• Fever and feeling generally unwell
• Feeling sick, or actually being sick
• Constipation or diarrhoea
• Bloating and passing more gas than usual
• Losing your appetite

Symptoms in children

• Diverticulitis is rare in children, so belly pain in a child usually has other causes.
• If it does happen, children may show vague belly pain, vomiting, fever, or poor feeding rather than the classic left-sided pain.
• Any child with lasting belly pain, fever or vomiting should be checked by a doctor the same day.

Symptoms in older adults

• Older adults may have milder or less obvious pain, or pain that is hard to pinpoint.
• Confusion or sudden sleepiness can sometimes be a sign of serious illness in an older person, even without much pain.
• Fever may be low or missing, so a change in eating, drinking or alertness matters just as much as pain.

Causes

Main causes

• Diverticulitis happens when a pouch in the bowel wall becomes inflamed, and sometimes infected, often because a small piece of stool gets trapped in it.
• It is usually the result of long-standing pressure inside the bowel, which is linked to how the bowel wall changes with age.
• A low-fibre diet over many years is thought to play a part in forming the pouches in the first place.

Risk factors

• Getting older — the chance rises steadily after age 50
• A diet low in fibre and low in fruit and vegetables
• Not being very physically active
• Carrying extra weight, especially around the middle
• Smoking
• Regular use of some pain-relief medicines — ask your pharmacist or doctor whether yours is one of them
• A family history of diverticular disease

When to see a doctor

See a doctor urgently if:

• New belly pain with a fever
• Pain that keeps getting worse over a day
• Being unable to eat or drink without feeling very sick
• Blood in your stool or on the toilet paper
• Pain on the left side of your belly that comes back after a recent flare-up

Book a routine appointment if:

• You have had bouts of belly pain, bloating or changes in your bowel habits that keep coming back
• Your bowel habits have changed for more than a few weeks
• You want advice on diet and fibre because of a past flare-up
• You have a family history of diverticular disease and want to know what to watch for

Diagnosis

Your doctor will usually start by asking about your symptoms and feeling your belly. They may check your temperature, blood pressure and pulse, and ask about your usual bowel habits. If your symptoms are mild and clear, tests may not be needed at all. If your symptoms are strong or unclear, they may refer you for a scan or blood tests.

Tests that may be done

• A physical examination, including pressing gently on your belly
• Blood tests to look for signs of infection or inflammation
• A urine test, to rule out a urine infection
• A CT scan of the abdomen — a type of imaging that gives clear pictures of the bowel
• An ultrasound scan in some situations
• A colonoscopy or similar bowel test, but usually only later, after the flare-up has settled

What to expect at your appointment

You may be seen the same day by a doctor, and sometimes in a hospital assessment unit if the pain is strong. A scan is quick and painless. Once the diagnosis is clear, most people are given advice and treated at home, with a follow-up plan if things do not settle.

Treatment

Most people with diverticulitis are treated at home and get better without any surgery. Treatment focuses on letting the bowel rest and settle, treating infection when one is present, and preventing future flare-ups. Your doctor will tailor the plan to how severe your symptoms are.

Self-care at home

• Follow your doctor's advice about resting your bowel — some people are advised to have a short period of lighter, low-fibre food, then build fibre back up gradually.
• Drink plenty of fluids, especially water.
• Take acetaminophen-type pain relief only if your doctor or pharmacist confirms it is suitable for you.
• Use a hot water bottle or warm pack on your belly for comfort, if it feels soothing.
• Rest and avoid heavy lifting until you feel better.
• Once you are recovering, slowly increase fibre again over a few weeks rather than all at once.
• Keep a simple note of what you ate and how you felt, so you can spot patterns.

Medical treatments

Your doctor will decide what you need based on how unwell you are. Options include simple pain relief, a short period of lighter eating, and antibiotics if they think there is an infection — many mild cases now recover well without them. If you are dehydrated or in a lot of pain, you may be given fluids and stronger pain relief in hospital. Occasionally a small collection of pus (an abscess) needs to be drained by a specialist. Your doctor will explain the reasoning behind whatever they suggest, and you can always ask questions.

When is surgery considered?

Surgery is not needed for most people. It may be discussed if you have repeated, troublesome flare-ups, or if a serious complication happens, such as a hole in the bowel, a blockage, or an abscess that cannot be treated another way. In those situations the surgery is usually done as an urgent or planned procedure by a bowel specialist. Talking it through with your doctor can help you weigh the benefits and risks.

Living with this condition

Most of the time, living with diverticular disease just means paying attention to your diet, drinking enough, staying active, and knowing your own warning signs. Many people go months or years without any trouble. After a flare-up, give yourself time to build strength and appetite back up — recovery is usually steady rather than instant.

Lifestyle tips

• Build up fibre gradually instead of all at once, so your gut can adjust comfortably.
• Drink more fluids as you eat more fibre — the two work together.
• Stay physically active; regular walking and everyday movement help the bowel.
• If you smoke, ask your doctor or pharmacist for support to stop.
• Aim for a steady, healthy weight rather than quick diets.
• Go to the toilet when you feel the urge, and avoid straining.
• Ask your pharmacist before starting any new over-the-counter pain medicine.

Diet and exercise

A high-fibre diet is the mainstay: wholegrains, beans and lentils, fruit and vegetables, nuts and seeds — many people used to be told to avoid nuts and seeds, but that advice has changed and they are generally fine for most people. Add fibre slowly, over weeks, and drink enough water. Gentle, regular exercise such as walking most days supports bowel health, and so does keeping to a steady weight. If certain foods seem to trigger symptoms for you, note them down and discuss it with your doctor rather than cutting out whole food groups on your own.

Mental health and emotional wellbeing

Belly problems can be genuinely stressful. Fear of another flare-up, worry about eating out, or feeling embarrassed about bowel symptoms is very common and completely understandable. Stress does not cause diverticulitis, but it can make symptoms feel harder to cope with. If you feel anxious or low, or you are avoiding things you used to enjoy, tell your doctor — this is part of your health, not a side issue. If you ever feel overwhelmed or have thoughts of harming yourself, contact your local crisis line or emergency services straight away.

Prevention

You cannot guarantee you will never get diverticulitis, but you can lower the odds. The strongest steps are eating plenty of fibre, drinking enough fluids, staying active and keeping to a healthy weight. These habits also help your bowel in general.

Screening programmes

There is no routine screening test for diverticulitis itself. Bowel cancer screening programmes exist in many countries for a different reason, and you should take part when invited — it is one of the best ways to look after your bowel health as you get older. Ask your local health service about what is offered at your age.

Complications

If left untreated

• An abscess — a small collection of pus near the bowel, which may need draining
• A hole (perforation) in the bowel, which is serious and needs urgent hospital care
• A narrowing (stricture) of the bowel that causes blockages and constipation
• A fistula — an abnormal tunnel between the bowel and another organ or the skin
• Bleeding from the bowel, which can sometimes be heavy
• Scarring and repeated flare-ups that are harder to manage over time

Long-term outlook

The outlook is good for the great majority of people. Most flare-ups settle with simple treatment and never cause lasting trouble, and many people have only one episode in their lifetime. If you do have repeated problems, your doctor has several options to help, including specialist review and, in a small number of cases, surgery. Knowing the warning signs and getting help early is the single most useful thing you can do.

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