Diverticula are small, bulging pouches that form in the lining of the large intestine, a condition known as diverticulosis. While often harmless, these pouches can become inflamed or infected, leading to diverticulitis. This inflammation causes acute episodes of pain and other symptoms. Diverticulitis has a notable tendency to return, making it important to understand its causes and prevention strategies.
The Likelihood and Timing of Recurrence
Recurrence rates are estimated to be between 20% and 35% of patients following a first attack. Approximately one-third of people treated for diverticulitis will face a second inflammatory event.
The highest risk period for a subsequent episode is immediately following the initial recovery. Readmission risk is notably higher within the first year after the acute attack has resolved. The majority of recurrences, up to 90%, tend to occur within five years of the first diagnosis. While the risk of a simple recurrence remains, the risk of a complicated event, such as a perforation, is generally highest during the first episode and decreases with later attacks.
Factors That Increase the Risk of Future Episodes
Several patient and disease characteristics elevate the probability of experiencing another acute episode. A primary factor is the severity of the initial attack; patients who experienced complicated diverticulitis, particularly with abscess formation, have an increased risk of recurrence. The extent of the disease in the colon, such as an inflamed segment longer than five centimeters, may also contribute to future episodes.
Lifestyle and chronic health conditions play a major role in repeat events. Obesity, often measured by a high body mass index (BMI), is consistently identified as a risk factor due to its association with chronic inflammation. Smoking status is another modifiable behavior that increases recurrence rates.
The chronic use of certain medications can also increase susceptibility to inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and opioid pain medications are associated with a higher likelihood of recurrent diverticulitis. Genetics may also be involved, as a family history of the condition increases an individual’s risk.
Proactive Strategies for Prevention
The most effective strategy for reducing recurrence involves long-term modifications to diet and lifestyle. Promoting healthy bowel movements is central to prevention, achieved through a high-fiber diet. Adults should aim for a daily fiber intake of 25 to 35 grams, focusing on sources like whole grains, fruits, vegetables, and legumes.
Fiber must be introduced gradually to avoid side effects like bloating and gas, and it requires sufficient water to function correctly. A general guideline is to drink at least eight cups of fluid daily. Regular physical activity also helps by promoting normal bowel function and reducing pressure within the colon.
Maintaining a healthy weight is another actionable step, as it directly addresses the chronic inflammation associated with obesity. Patients should discuss alternatives to NSAIDs with their healthcare provider for pain relief, as NSAIDs can irritate the digestive tract. Acetaminophen is often recommended instead. Furthermore, the once-common advice to avoid popcorn, nuts, and seeds is now largely considered a myth, as research indicates these foods do not increase the risk of a flare-up.
Recognizing Acute Symptoms and Treatment
Recognizing the early signs of an acute flare-up is crucial for minimizing complications and ensuring prompt treatment. The hallmark symptom is persistent abdominal pain, which is most often felt in the lower left side of the abdomen. This pain may be sudden and intense, or it may start mildly and worsen over several days.
Other symptoms that signal a potential acute episode include:
- A fever and chills.
- Nausea.
- Changes in bowel habits, such as new-onset constipation or diarrhea.
If any of these symptoms appear, particularly in combination, a healthcare provider should be consulted immediately.
Treatment for an acute episode typically involves resting the colon, often achieved through a temporary clear liquid diet. If an infection is present, antibiotics may be prescribed, although they are not necessary for all mild, uncomplicated cases. Severe cases, or those that present with complications like an abscess or perforation, often require hospitalization for intravenous antibiotics and fluids, and sometimes surgery.