Diverticulitis is a gastrointestinal condition characterized by the inflammation or infection of small, bulging pouches called diverticula that form in the lining of the large intestine. When these pouches become inflamed, it typically causes sudden lower abdominal pain, often accompanied by changes in bowel habits, nausea, or fever. Whether diverticulitis can heal without formal medical intervention depends on the severity of the flare-up. While many mild cases may resolve with conservative home management, ignoring symptoms can lead to severe and potentially life-threatening complications.
The Difference Between Uncomplicated and Complicated Diverticulitis
The ability of diverticulitis to resolve on its own is directly tied to its classification: uncomplicated or complicated. Uncomplicated diverticulitis is the more common form, accounting for approximately 75% to 80% of all cases. This diagnosis involves localized inflammation confined to the colon wall without structural damage or spread of infection. For a mild, uncomplicated episode, about 95% of cases resolve within a week, though medical consultation is still highly recommended.
Complicated diverticulitis requires more aggressive treatment. This severe form involves complications such as an abscess (a localized collection of pus), a perforation (a tear in the colon wall), fistulas (abnormal connections between organs), or bowel obstruction. About 12% to 25% of patients present with complicated disease, and these cases rarely resolve without formal medical intervention.
Strategies for Managing Mild Diverticulitis at Home
For cases diagnosed as mild and uncomplicated, a doctor may recommend resting the digestive system. This typically begins with a temporary clear liquid diet, including items like broth, gelatin, pulp-free juices, and water. The purpose of this diet is to reduce the work the colon must do, allowing the inflammation to subside.
As symptoms improve, the diet is gradually advanced to include low-fiber foods. Low-fiber options, such as cooked vegetables without skins, eggs, white rice, and refined white bread, are gentle on the healing colon. For pain relief, acetaminophen is the preferred over-the-counter medication; Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are generally avoided due to the risk of bleeding.
Oral antibiotics are sometimes prescribed to manage any underlying infection, though some mild cases may not require them. Patients must complete the full course of antibiotics even if they feel better quickly. After the flare-up resolves, individuals are encouraged to slowly reintroduce a high-fiber diet and adequate hydration to help prevent future episodes.
Critical Symptoms Requiring Immediate Medical Care
Patients must remain vigilant for warning signs that indicate a worsening condition or the development of a complication. Persistent or rapidly escalating abdominal pain, especially if it is intense and continuous, is a primary concern. Pain accompanied by a high fever, typically over 100°F, or chills suggests that the infection is spreading beyond the colon wall.
Other signs requiring immediate medical attention include persistent nausea, excessive vomiting, or the inability to tolerate any liquids by mouth. These symptoms can lead to dehydration and may signal a bowel obstruction. Blood in the stool or signs of peritonitis, such as a hard and tense abdomen, indicate that a perforation may have occurred.
Clinical Treatments for Severe or Persistent Diverticulitis
When diverticulitis does not respond to outpatient care or is diagnosed as complicated, professional medical intervention is necessary. Treatment often begins with hospitalization to provide complete bowel rest and administer intravenous (IV) fluids to correct dehydration. Patients receive broad-spectrum IV antibiotics to treat the severe infection, targeting specific bacteria.
If a CT scan reveals a contained abscess, a radiologist may perform a percutaneous drainage procedure. This involves inserting a needle through the skin, guided by imaging, to drain the pus. Surgical intervention is reserved for severe complications, such as generalized peritonitis from a large perforation, or for cases that fail to improve after several days of medical management.
The most common surgical procedure is a partial colectomy, which removes the diseased section of the colon. In emergency situations, this may involve a temporary colostomy, diverting the colon through an opening in the abdomen to allow the bowel to heal. The colostomy is typically reversed in a subsequent operation. Elective surgery may also be considered for patients who experience frequent, recurrent attacks.