Diverticulitis - Symptoms, causes and treatment

Diverticulitis is an inflammation or infection that occurs in diverticula, which are sacs that form along the digestive tract, especially in the large intestine (colon).

Diverticula are not organ tissues that are present from birth. Diverticula generally form in people aged 40 years and over because the intestinal wall has weakened, and in people who rarely eat fibrous foods, such as vegetables and fruit.

The condition where diverticula form on the walls of the large intestine is called diverticulosis. Diverticulosis is not a dangerous condition and in most cases is asymptomatic.

In contrast to diverticulosis, diverticulitis is usually accompanied by symptoms such as severe abdominal pain, nausea, fever, and changes in bowel habits.  

Causes of Diverticulitis

The cause of the formation of diverticula sac is not clearly known. However, a low-fiber diet, constipation, and obesity are thought to be associated with the formation of diverticula in the large intestine.

Not only diverticula, the cause of diverticulitis is also not known with certainty. However, this condition is thought to occur due to feces or undigested food being trapped in the diverticula and clogging the diverticula.

The blockage makes the diverticula swell and causes small tears in the colon wall that allow bacteria from the colon to enter the diverticula. This is what is then suspected to be the cause of inflammation or infection in the diverticula.  

Apart from that, there are several factors that can increase a person's risk of suffering from diverticulitis, namely:

  • Age

    The risk of developing diverticulitis increases with age.

  • genetic factors

    Genetics is believed to be related to the occurrence of diverticulitis, as evidenced by the diverticulitis experienced by Asians is more dominant on the right side, while diverticulitis experienced by Americans is more common on the left side of the abdomen.

  • Use of certain drugs

    Regular use of aspirin and nonsteroidal anti-inflammatory drugs can increase the risk of diverticulitis.

  • Obesity

    Compared with people who have an ideal body weight, the risk of diverculitis is higher in people who are overweight.

  • Low fiber diet

    In addition to increasing the risk of diverticula formation, eating too little fiber also increases the risk of causing inflammation of the diverticula that form.

  • Smoke

    Smoking can increase the risk and complications of diverticulitis.

  • Lack of exercise

    Infrequent exercise can also increase a person's risk of developing diverticulitis.

Symptoms of Diverticulitis

The large intestine (colon) is a tube-shaped organ measuring about 1.8 meters that functions to absorb fluids and process food waste from digestion in the small intestine.

When diverticula form on the wall of the colon, patients generally do not experience any symptoms. Only in certain cases, this condition can cause symptoms such as:

  • Pain in the stomach, which gets worse immediately after eating or when moving
  • Constipation, diarrhea, or both
  • Stomach bloating or feeling filled with gas
  • Stool contains blood

If the diverticula are already inflamed or infected, sufferers may experience symptoms of diverticulitis, such as:

  • Fever
  • Abdominal pain that is getting worse and continues
  • Nausea and vomiting
  • Stool contains blood and mucus
  • Bleeding in the rectum

These symptoms can appear suddenly or gradually over a few days.  

When to go to the doctor

Immediately consult a doctor if you experience symptoms of diverticulosis or diverticulitis. Symptoms of both conditions can resemble those of other, more serious conditions. Therefore, it is advisable to immediately conduct an examination as early as possible to confirm the diagnosis.  

Diagnosis of Diverticulitis

The first step taken by the doctor to diagnose diverticulitis is to check your medical history, symptoms experienced, and medications that are being consumed.

After that, the doctor will perform a physical examination, especially by examining the patient's abdomen to detect the location of inflammation or infection in the abdominal cavity. The location of the inflammation can be detected by the appearance of pain when the stomach is pressed.

The doctor will also perform a digital rectal examination, to see whether there is bleeding, pain, clots, or other disorders in the rectum.

In order to make the diagnosis more accurate, the doctor may perform additional investigations, such as:

  • blood test

    Blood tests are performed to detect infection or bleeding in the patient's large intestine, as well as liver function tests to find out whether the abdominal pain is caused by a liver disorder or not.

  • urine test

    A urine test is done to rule out possible causes of abdominal pain caused by an infection in the urinary tract.

  • Pregnancy test

    Pregnancy tests are done to ensure that the abdominal pain experienced by female sufferers is not caused by pregnancy.

  • Occult blood test on stool sample

    This test is done to check whether the patient's stool contains blood.

  • CT scan

    A CT scan is done to find out in detail the inflamed or infected sacs and confirm the diagnosis. This test can also show the severity of the diverticulitis.

Colonoscopy is not recommended when the diverticula are inflamed because of the risk of tearing or rupturing the diverticula. Colonoscopy is done when the doctor wants to evaluate the diverticula when they are not inflamed, or the doctor suspects a tumor in the colon.

Diverticulitis Treatment

The treatment given is adjusted to the severity of the diverticulitis experienced by the patient. If the patient has mild symptoms and there are no signs of complications, the treatment may include:

  • Drugs

    The doctor can give painkillers, such as paracetamol, and if needed, the doctor can also prescribe antibiotics to treat the infection.

  • Diet high in fluids and avoid solid food

    This diet is carried out until the pain disappears. When the pain is gone, slowly add solid foods to the diet.

If the symptoms are getting worse or diverticulitis has caused complications, then the patient needs to get medical treatment at the hospital. Handling that can be done include:

1. Infusion of fluids and nutrition

Nutrients and fluids will be given through an IV to rest the intestines.

2. Injectable antibiotics

To treat infection, doctors can give injection antibiotics. Several types of antibiotics are often used to treat diverticulitis, namely amoxicillin and metronidazole.

3. Insertion of a tube to the stomach (NGT)

The insertion of a tube into the stomach aims to empty the stomach contents.

4. Drainage with needle

If an abscess has formed in the diverticula, a special needle will be inserted into the abdomen with the help of a CT scan or endoscope to drain the pus (abscess).    

5. Operation

Surgical procedures are performed by surgeons on patients who have compromised immune systems, have recurrent diverticulitis, or have complications. There are 2 types of surgical procedures to treat diverticulitis, namely:

  • Bowel resection and anastomosis

    A surgical procedure performed by removing the inflamed part of the intestine and reattaching it to a healthy part of the intestine (anastomosis).

  • Bowel resection with colostomy

    If the area of ​​inflammation is large enough, the colon and rectum will be difficult to attach, then the doctor will perform a colostomy procedure. After removing the inflamed intestine, a hole is made in the abdominal wall to temporarily pass stool, so that the person does not pass stool through the anus.  

Complications of Diverticulitis

Diverticulitis can cause serious and even potentially life-threatening complications. Several types of complications that may arise, including:

  • Abscess, which is when a collection of pus forms in the diverticula
  • Fistula, which is when an abnormal channel forms between the large intestine and the bladder, vagina, or small intestine
  • Intestinal obstruction, which is a narrowing of the large intestine
  • Perforation and peritonitis, which is an inflammatory or infectious condition in the abdominal cavity (peritonitis)
  • Continuous rectal bleeding due to small blood vessels bursting near the diverticula

Prevention of Diverticulitis

There is no known way to completely prevent diverculitis. However, there are several ways that can be done to reduce the risk of developing this condition, namely:

  • Consumption of high-fiber foods

    High-fiber foods are useful for softening food waste from the small intestine so that the colon does not have to work as hard to process it. Several types of high-fiber foods, including whole grains, oatmeal, vegetables and fruits.

  • Drink more water

    Fiber works by absorbing water. If the consumption of fluids to replace what has been absorbed by the body is not enough, then constipation can occur.

  • Do exercise regularly

    Exercise can help maintain bowel function and reduce pressure in the colon. Exercise regularly at least 30 minutes every day.

  • Do not smoke

    Smoking can increase the risk of diverticulitis and various other health problems.