Diverticulitis Treatment Options - Home or Away?

Diverticulitis treatment varies depending on the severity of the symptoms and whether there are any complications present.

When the diverticula (pouches) which are found in the large intestine when you have diverticulosis become inflamed and sometimes infected this is called diverticulitis and then the management focus has to change from prevention to treatment.

Can I Be Treated At Home?

If your diverticulitis is considered to be uncomplicated and you do not have other illnesses then the aim is always to try and treat your condition in your own home.

If you are managing the pain, you are drinking and keeping fluids down and your flare up is responding to treatment then you will not need to go to hospital.

Which Diet Should I Follow During a Flare Up?

The first line of diverticulitis treatment is to alter the diet during a flare up to give the bowel a chance to rest and recover. For the first two days your doctor will probably recommend a clear liquid only diet. This means:

• Clear broth, like consomme
• Clear juice like apple, grape and cranberry, not juices with pulp like orange juice
• Jell-o (jelly)
• Popsicles (ice lollies)
• Tea with no milk
• Herbal tea - slippery elm is particularly recommended for diverticulitis
  

Solid food can gradually be re-introduced but until things have settled a low fiber diet should be followed.

This means food like:

• White rice
• White pasta
• Cooked fruit with no seeds like applesauce
• Melon
• White bread
• Butter, mayonnaise
  
• Well cooked vegetables with no seeds or skin
• Well cooked tender meat and fish
• Eggs
• Milk, yogurt and cheese

Basically you are aiming for a bland diet and you should introduce solid foods gradually. 

Once you have recovered from your bout of diverticulitis and your doctor is happy with your progress you can return to a higher fiber preventative diet.

Recently it has been found that people with symptomatic diverticulosis are more likely to have an imbalance of their intestinal flora or friendly bacteria than people without the disease; so when your acute diverticulitis has died down it may be a good idea to supplement your diet with high quality probiotics and include prebiotic foods.

Which Medication Is Useful For Diverticulitis Treatment?

The aim of diverticulitis treatment with medication is to reduce pain and inflammation, clear up any infection and prevent complications. 

Acetaminophen (Tylenol, Paracetamol) is recommended to control pain.

Simple diverticulitis may just be treated with diet and pain killers but antibiotics may be prescribed depending how bad the symptoms are. These would be broad spectrum antibiotics, so in other words they would treat a wide range of different bacteria.

Mesalazine is a drug which specifically reduces inflammation in the bowel and reduces the symptoms of diverticulitis. It has been shown that when used in conjunction with antibiotics diverticulitis is less likely to reoccur.

Will I Have to Go to Hospital?

In certain cases diverticulitis treatment will require a hospital stay. If you are an 'at risk person' then admission is more likely. This means for example that you are elderly or frail, you have another illness like diabetes or heart disease or you have a suppressed immune system.

Other reasons for being admitted to hospital include:

• Needing stronger pain relief
• Being dehydrated and needing intravenous fluid replacement
• Oral antibiotics are not staying down and IV antibiotics are needed
• After 48 hours your diverticulitis is not responding to treatment
• You develop complications like an abscess, fistula, perforation, peritonitis or obstruction
  

Will I Need Surgery?

It used to be the case that surgery would be a recommended treatment for diverticulitis to prevent diverticulitis complications after two or more episodes. This is no longer the case as it has been found that the risks of surgery outweigh the benefits in these circumstances. However, there are instances in which surgery would be necessary.

• If you are immunosuppressed 
• If you have already suffered complications in the past
• If you first had diverticular disease when you were young e.g under forty as you are at a greater risk of complications
• In an emergency situation following a complication
  

Between six and twenty percent of people with diverticulitis will go on to develop a complication.

A fistula is an abnormal passage between two areas of the body like the bowel and the bladder for example. This would have to be surgically closed.

A large abscess would need to be surgically drained usually under x-ray guidance.

Sometimes a part of the large intestine will need to be removed if you have an obstruction caused by a stricture (narrowing of the bowel) or if the bowel is very diseased leading to perforation, peritonitis or sepsis. This is called a partial colectomy or a bowel ressection.

Depending how bad the situation is the two ends of the remaining bowel may be reconnected (primary anastomosis) or a colostomy may be formed which can either be temporary or permanent. This is a hole (stoma) which is formed on the surface of the abdomen where your feces would be collected in a bag.

As the forming of a colostomy is very upsetting for most people and if it needs to be reversed a second operation would be required, these days a one stage procedure is preferred, especially as it has been found that this reduces post-operative complications.

Diverticular bleeding or hemorrhage and diverticulitis do not usually happen at the same time but in the rare cases where this occurs and the hemorrhage does not stop spontaneously surgery may also be required. 

Diverticulitis Treatment - Conclusion

The vast majority of people with diverticular disease do not have any symptoms and do not go on to develop diverticulitis but if you are one of the unlucky ones who need diverticulitis treatment then it is important that you seek help quickly and follow the instructions you are given about diet and medication carefully to try and prevent any complications happening.

DiarrheaNurse hopes that you have found this article useful and that you recover quickly. For more information about diverticular disease, diverticular bleeding and symptoms of diverticulitis please see below.

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