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DIVERTICULITIS

Overview

Diverticulitis occurs when diverticula—small, bulging pouches that form in the lining of the colon—become inflamed or infected. The condition ranges from mild inflammation to severe complications such as abscesses, bowel obstruction, perforation, or fistula formation. Diverticulitis is part of the diverticular disease spectrum and is more common after age 40, although younger cases are increasingly seen due to lifestyle factors.

Symptoms

Symptoms typically localize to the left lower abdomen but can vary based on severity and complications.

Common symptoms:

  • Persistent LLQ (left lower quadrant) abdominal pain
  • Fever or chills
  • Nausea or vomiting
  • Diarrhea or constipation (may alternate)
  • Abdominal bloating or fullness
  • Localized tenderness to touch
  • Reduced appetite
  • Change in bowel habits
  • Fatigue or low energy during flare-ups

Emergency symptoms (seek immediate care):

  • Severe, worsening abdominal pain
  • High fever
  • Persistent vomiting
  • Blood in stool
  • Signs of dehydration
  • Rigid or hard abdomen
  • Inability to pass gas or stool
  • Dizziness or fainting

Risk Factors

Factors that increase the likelihood of developing diverticula and subsequent inflammation include:

  • Low-fiber diet (chronic constipation increases pressure in the colon)
  • Age (risk rises significantly after 40)
  • Obesity or central weight gain
  • Smoking
  • Sedentary lifestyle or lack of physical activity
  • Chronic constipation or straining
  • High consumption of red meat
  • Certain medications (NSAIDs, steroids, opioids)
  • Genetic predisposition

Diagnosis

Diagnosis is based on clinical symptoms, history, and imaging.

  • CT scan with contrast – Gold standard
    Identifies inflammation, abscesses, free air, fistulas, or obstruction.
  • Blood tests
    Elevated WBC count, CRP, dehydration markers.
  • Stool tests
    Used when infection is suspected or symptoms overlap with colitis.
  • Physical exam
    LLQ tenderness, guarding, reduced bowel sounds.

Treatment

Treatment varies by severity.

Mild / Uncomplicated Diverticulitis

  • Clear-liquid diet for 24–48 hours → gradual shift to low-fiber as symptoms improve
  • Oral antibiotics (if bacterial infection suspected or standard in certain regions)
    • Common: amoxicillin-clavulanate, ciprofloxacin + metronidazole
  • Pain management (acetaminophen preferred; avoid NSAIDs)
  • Rest and hydration

Moderate / Severe Diverticulitis

  • Hospitalization for IV antibiotics, fluids, monitoring
  • Nil per os (NPO) in severe cases until inflammation stabilizes
  • CT-guided drainage for abscesses
  • Surgery may be required for:
    • Recurrent episodes
    • Perforation
    • Obstruction
    • Fistula
    • Uncontrolled infection

Diet During a Flare

Stage 1: Clear liquids (24–48 hours):

  • Broth
  • Gelatin
  • Ice pops
  • Clear juice
  • Tea or electrolyte drinks

Stage 2: Low-fiber / Low-residue (a few days):

  • White bread, white rice, pasta
  • Eggs, fish, tender poultry
  • Cooked, skinless vegetables
  • Canned fruits without skins or seeds
  • Potatoes without skin

Stage 3: Gradual fiber re-introduction after recovery:

  • Oats, barley
  • Beans and lentils (slowly)
  • Whole fruits
  • Leafy greens
  • Whole grains

Complications

If untreated or severe, diverticulitis may lead to:

  • Abscess formation
  • Perforation and peritonitis
  • Bowel obstruction
  • Bleeding
  • Fistulas (commonly to bladder)
  • Strictures

Complicated diverticulitis requires urgent evaluation and often surgical management.

Self-Management & Prevention

Daily tracking inside the Gut Wellness App helps identify patterns that contribute to flare-ups. Helpful habits include:

Track in the App:

  • Meals and ingredients
  • Fiber intake
  • Stool patterns (Bristol scale)
  • Hydration
  • Bloating, pain, and bathroom urgency
  • Stress levels
  • Sleep quality

Prevention Strategies:

  • Adopt a high-fiber diet once recovered (20–35g/day).
  • Increase water intake to keep stool soft.
  • Exercise regularly (walking, cycling, resistance training).
  • Avoid smoking.
  • Limit red meat, processed foods, and fried foods.
  • Manage constipation early with hydration, fiber, or safe stool softeners.
  • Avoid heavy straining during bowel movements.

When to Use the Gut Wellness App

  • To track flare triggers
  • To monitor recovery from mild attacks
  • To document bowel habits for your doctor
  • To understand which foods worsen symptoms
  • To monitor patterns that may predict a flare
  • To access diet lists and daily guidance during a flare
  • To identify high-risk symptoms requiring prompt care
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