Diverticulitis is a common digestive condition affecting the large intestine, particularly as individuals age. It involves the inflammation or infection of small, bulging pouches that can form in the colon wall. This article explores whether the condition can be truly “healed” or if it requires ongoing management.
Diverticulosis Versus Diverticulitis
To understand diverticulitis, it is important to distinguish it from diverticulosis. Diverticulosis refers to the presence of small, bulging pouches, known as diverticula, in the lining of the digestive tract. These pouches are common, especially after age 50, and often do not cause any symptoms. Their presence alone is not considered a disease.
Diverticulitis occurs when one or more of these diverticula become inflamed or infected. This inflammation can lead to symptoms such as abdominal pain, fever, nausea, and changes in bowel habits. While diverticulosis pouches generally do not disappear, acute diverticulitis involves inflammation that can resolve with treatment.
Managing Acute Diverticulitis
For acute diverticulitis, the goal of treatment is to alleviate symptoms and resolve inflammation. Mild, uncomplicated cases can often be managed on an outpatient basis with rest and dietary modifications. Initially, a clear liquid diet may be recommended for a few days to allow the digestive tract to rest. As symptoms improve, a gradual transition to low-fiber foods, then a regular diet, is advised.
Antibiotics are often prescribed, especially for suspected infection or individuals with certain risk factors. However, recent studies suggest that for mild, uncomplicated diverticulitis, antibiotics may not always be necessary, as supportive care alone can be effective. In more severe cases, or if symptoms do not improve, intravenous antibiotics and hospitalization may be required.
Strategies for Long-Term Prevention
After an acute episode subsides, long-term strategies help prevent future flare-ups. A high-fiber diet is recommended, which helps maintain soft stools and reduces pressure within the colon. Foods rich in fiber include fruits, vegetables, whole grains, beans, and lentils. Increase fiber intake gradually and consume plenty of fluids to aid its movement.
Regular physical activity also plays a role in prevention. Consistent exercise can reduce the risk of diverticulitis and its complications. Low-impact activities like walking, swimming, or yoga can improve digestive function and overall well-being. Contrary to past beliefs, current evidence suggests that nuts, seeds, and popcorn do not increase the risk of diverticulitis and can be part of a healthy diet.
When Diverticulitis Becomes Complex
While many diverticulitis cases resolve with conservative treatment, some individuals experience complications requiring more intensive intervention. Uncomplicated diverticulitis accounts for approximately 80% of cases, but severe or persistent inflammation can lead to problems. Complications include the formation of an abscess, a pocket of infected pus that may require drainage.
Another potential complication is a perforation, where a tear develops in the colon wall, allowing intestinal contents to leak into the abdominal cavity and potentially cause a severe infection called peritonitis. Fistulas, abnormal connections between the bowel and other organs like the bladder, can also form due to persistent inflammation. Chronic inflammation may also lead to scarring and stricture, causing a narrowing of the colon that can obstruct the passage of stool. In instances of recurrent severe episodes or serious complications, surgical intervention, such as removing the affected section of the colon (colectomy), may become necessary.