How Is Diverticulitis Treated? Traditional, Alternative, and Surgical Options to Consider
Everyone experiences tummy issues at one point or another. Whether caused by gas, constipation, the stomach flu, or milk a few days past its expiration date, sudden stomach pain can knock you to your knees and leave you begging for mercy.
The good news is that most stomach cramps pass and don’t require medical attention. But when the problem is caused by diverticulitis, the pain can differ from other aches you’ve had before.
To understand diverticulitis, you must first understand what’s going on inside your colon — not the most comforting thought but a necessary one.
Sometimes — for reasons not exactly understood — small pouches or saclike protrusions, called diverticula, develop in the colon, most often in the lower part. This is called diverticulosis.
Doctors aren’t entirely sure what causes these pouches to form, but it’s likely a combination of genetic and environmental factors, such as a low-fiber diet, lack of exercise, consuming high amounts of red meat, and even changes in your gut bacteria.
But because diverticula may not cause symptoms, it’s possible to have one or more without knowing — until something goes wrong, that is.
“Diverticulitis means that a saclike protrusion has become inflamed and generally infected. In other words, diverticulitis means inflamed diverticulosis,” says Will Bulsiewicz, MD, a gastroenterologist and gut health expert in Mount Pleasant, South Carolina. “People who develop diverticulitis may have pain in the lower abdomen, and many will also have nausea with vomiting, fever, and a change in bowel habits.”
While this condition can affect anyone, the risk is higher if you’re older, overweight, eat a low-fiber diet, smoke, don’t exercise, or take steroids, opioids, or over-the-counter pain medications like ibuprofen (Advil, Motrin) and naproxen (Aleve).
Diverticulitis can be a painful shock to the system, but an attack can also be brief and improve with treatment. Keep in mind that there isn’t a one-size-fits-all treatment for this condition. Rather, your treatment depends on whether you have complicated or uncomplicated diverticulitis, as well as the severity and frequency of your symptoms.
A sudden attack can be frightening, and if you’ve never felt pain like this in your abdominal area, you may imagine the worst. But if a CT scan diagnoses diverticulitis with no other problems, you may be able to complete your recovery at home.
Treatments for uncomplicated diverticulitis include:
1. Liquid Diet
“In the setting of acute diverticulitis, patients are typically placed on bowel rest and a clear liquid diet,” says Daniel Motola, MD, PhD, a gastroenterologist in New York City. “This is typically advanced as their symptoms improve over the course of two to three days.”
During a diverticulitis flare, your colon needs rest, and the less irritation it endures, the better. Your doctor will likely advise a liquid diet for a few days so your digestive tract can begin healing, and then you can gradually reintroduce low-fiber solid foods back into your diet, such as eggs, fish, green beans, carrots, white rice, refined white bread, and poultry.
Foods and drinks to consume might include:
Clear broths
Clear sodas
Clear soups
Coffee without milk or cream
Plain gelatin
Sports drinks
Tea without milk
Juice and water
2. Pain Medication
As with any condition causing inflammation and an infection, pain doesn’t disappear overnight.
It can take a few days for uncomplicated diverticulitis pain to improve. But this doesn’t mean that you have to live in agony. Taking acetaminophen (Tylenol) as directed can take the edge off your pain and help you feel better.
Other pain relievers might be your preferred drugs of choice. But when it comes to diverticulitis, acetaminophen is your best bet. This is because nonsteroidal anti-inflammatory medicines like ibuprofen may irritate the stomach and make an already upset stomach feel worse.
3. Oral Antibiotics
Although oral antibiotics were previously the first line of therapy for uncomplicated diverticulitis, new guidance states that certain cases can be treated without the use of this medication.
For simple, uncomplicated cases of diverticulitis, bowel rest and a liquid diet promoting hydration should be enough to manage the condition.
However, the guidance states that doctors may still prescribe antibiotics for some patients, including those who are immunocompromised or medically frail.
For these individuals, one of the following antibiotics may be prescribed for 7 to 10 days:
metronidazole (Flagyl)
sulfamethoxazole and trimethoprim (Bactrim)
ciprofloxacin (Cipro)
amoxicillin (Amoxil)
clavulanate (Augmentin)
4. Alternative Therapies
Some natural and alternative therapies may improve symptoms, but as Dr. Bulsiewicz notes, there isn’t a lot of science-backed information available on the effectiveness of alternative medicine for the treatment of diverticulitis.
“Some examples that have been purported include slippery elm, cat’s claw, marshmallow, and licorice root,” he says. “Acupuncture has been used to aid in pain control, but the concern with opting for these supplements is that there is inherent risk with each and an inadequate amount of data to demonstrate efficacy at this point.”
That’s not to say you can’t try one of the above options — just make sure you do so under the guidance of your gastroenterologist.
While uncomplicated diverticulitis may require only a brief doctor’s visit, complicated diverticulitis is a completely different ball game, and treatment isn’t as simple as a few days on a liquid diet.
“Complicated diverticulitis is defined by the presence of a more advanced disease, such as perforation, abscess, fistula, intestinal obstruction, or bleeding,” Bulsiewicz says. “Generally, those with complicated diverticulitis will be hospitalized, and there’s a much higher likelihood of requiring surgery to fix the issue, although not always.”
Here’s what you can expect treatment-wise if you’re diagnosed with a more serious case of diverticulitis.
1. Intravenous Antibiotic
If you can’t keep fluids down or if you have a weak immune system, your doctor may recommend being admitted to the hospital.
You’ll receive antibiotics intravenously while in the hospital, which involves connecting a tube to your vein. Intravenous therapy is effective because medication gets into your bloodstream and begins working faster.
2. Surgery
If diverticulitis progresses, your doctor may start discussing the possibility of surgery.
“There are two scenarios when surgery is considered as treatment for diverticulitis. First, if there’s a perforation, abscess, fistula, or intestinal blockage, it may be necessary to perform surgery in order to correct the problem,” Bulsiewicz warns. “In this setting, diverticulitis is usually so severe that there is little choice but to proceed with surgery.”
The purpose of surgery is to remove sections of the colon affected by the condition. One option is a primary bowel resection, which removes the diseased section of the colon and reconnects healthy sections so that you can retain normal bowel function. Your surgeon can perform this procedure with open surgery or a laparoscopic procedure.
If your surgeon can’t remove a diseased section and reconnect healthy sections, you may need a bowel resection with colostomy. This procedure involves the creation of a hole or opening for the large intestines through the abdominal wall. Your surgeon attaches a bag to the end of this opening, which collects waste.
The good news is that a colostomy isn’t always permanent, so you may need to wear the bag only temporarily. You’ll follow up with your doctor once your diverticulitis heals to discuss possibly reversing the colostomy and reconnecting your colon.
If you develop an abscess, which is a pocket of pus, it may heal on its own with antibiotics, or your doctor may recommend a drainage procedure via a needle in the skin or during surgery.
While surgery is usually for complicated attacks, there’s also the option of elective surgery if you have recurrent uncomplicated attacks. “In some cases, diverticulitis just doesn’t go away, or it just keeps coming back,” Bulsiewicz says. “If this is the case, at some point surgery needs to be considered because other therapies have failed.”
Diet can play a role in treating and preventing attacks. So to keep your bowels functioning properly, you may need to drink more fluids and add more fiber.
“In one study, there was a 42 percent reduced risk of developing diverticulitis among high-fiber consumers compared to low-fiber consumers,” says Bulsiewicz. “On the flip side, red meat consumption is strongly associated with diverticulitis. In fact, those eating red meat once per day have 25 times the risk of developing diverticulitis compared with those who eat it once per week or less.”
As far as foods to avoid, some people believe they must avoid nuts or seeds to prevent diverticulitis. Dr. Motola explains that contrary to popular belief, ingesting nuts, corn, popcorn, and presumably seeds is not associated with an increased risk of diverticular disease.
Bulsiewicz agrees: “Having done thousands of colonoscopies, I can honestly say that I’ve never seen anything inside the colon to suggest to me that nuts and seeds are clogging up diverticula.”
Diverticulitis can be painful and scary, and may require a hospital stay, but with appropriate treatment, the colon can heal.
Diverticulitis still may recur, but there are plenty of ways to stop this from happening:
Move. Find activities that you enjoy and get moving. Adults should aim for 150 minutes of moderate-intensity exercise (such as brisk walking) per week or 75 minutes of vigorous-intensity aerobic activity (such as running, biking, or swimming) per week.
Fuel up with fiber. After your body has healed from diverticulitis, reach for fiber-rich fruits and vegetables to help prevent the disease from recurring.
Be wary of using just any supplement. When it comes to supplements, there are a number of ideas but unfortunately an insufficient amount of research to validate or invalidate the ideas, warns Bulsiewicz.
Diverticulitis occurs when small saclike protrusions (diverticula) form in the colon. These can become inflamed or infected, which can cause several symptoms, such as vomiting, constipation, fever, and chills.
Treatment for diverticulitis depends on the severity. Antibiotics, pain medications, and a liquid diet are treatments for milder cases.
In more severe instances, surgery is sometimes required to remove affected areas of the colon.
There is limited evidence supporting alternative treatments, such as acupuncture for pain and licorice root or cat's claw.
It's always a good idea to discuss your symptoms and treatment options with a doctor or healthcare provider, especially if you have severe symptoms suggesting complicated diverticulitis.
