Diverticulitis is a common digestive condition where small pouches, known as diverticula, form in the large intestine and become inflamed or infected. While an acute episode typically resolves, the pain can persist for extended periods, sometimes lasting months. This chronic discomfort warrants medical attention, as it may indicate underlying issues or complications.
Understanding Diverticulitis
Diverticula are small, bulging pouches that form in the lining of the large intestine, also known as the colon. The presence of these pouches is called diverticulosis, which often causes no symptoms and is quite common, especially after age 50. Diverticulitis occurs when one or more of these diverticula become inflamed or infected.
Typical acute symptoms of diverticulitis include abdominal pain, most often in the lower left side. This pain can be severe and constant, though it may also be mild and worsen over several days. Other common symptoms include fever, nausea, vomiting, and changes in bowel habits such as constipation or, less commonly, diarrhea.
Factors Contributing to Prolonged Pain
Pain from diverticulitis can last for months due to several factors. One significant reason is post-diverticulitis syndrome (PDS), involving lingering symptoms like abdominal pain, bloating, and altered bowel habits after acute inflammation subsides. This persistent discomfort may be linked to low-grade inflammation or changes in the gut microbiome and nerve sensitivity.
Another contributing factor is chronic diverticular disease, where individuals experience ongoing low-grade inflammation in the colon. This chronic inflammation may not always present with severe acute symptoms but can cause persistent pain and other gastrointestinal disturbances. Research suggests that chronic low-grade inflammation might be linked to factors like a low-fiber diet, high red meat consumption, obesity, and physical inactivity.
Complications arising from an initial diverticulitis episode can also lead to prolonged pain. These include strictures, which are narrowings of the colon caused by scarring from repeated inflammation. Fistulas, abnormal connections between the colon and other organs, can also develop and cause ongoing pain. Unresolved abscesses, pockets of pus caused by infection, can cause persistent pain if not fully drained or treated.
Overlapping gastrointestinal conditions can further complicate prolonged pain. Irritable Bowel Syndrome (IBS), for instance, shares many symptoms with diverticular disease, such as abdominal pain and changes in bowel habits. IBS can coexist with diverticulosis, making it challenging to differentiate the source of chronic pain and potentially contributing to persistent symptoms after a diverticulitis episode.
Diagnosing and Managing Persistent Pain
When experiencing prolonged abdominal pain following a diverticulitis episode, consulting a healthcare professional is important. A medical evaluation can help determine the underlying cause and rule out more serious complications.
Diagnostic tools include imaging tests such as a CT scan, which provides detailed images of the colon to detect inflammation, abscesses, strictures, or fistulas. A colonoscopy may also be performed to visualize the colon lining, assess the extent of diverticular disease, and rule out other conditions. Blood tests help check for signs of ongoing infection or inflammation.
Management strategies for chronic diverticulitis pain often involve a combination of approaches. Dietary modifications are commonly recommended, including gradually increasing fiber intake through fruits, vegetables, and whole grains once acute symptoms have subsided. Adequate hydration is also crucial, especially when increasing fiber, to help soften stool and promote regular bowel movements.
Lifestyle changes, such as maintaining regular physical activity and a healthy weight, can contribute to overall bowel wellness and may reduce the risk of flare-ups. Pain management may involve over-the-counter pain relievers like acetaminophen, as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may increase the risk of complications.
Signs Requiring Immediate Medical Attention
Recognizing specific symptoms that signal a serious complication is important for individuals with diverticulitis. Severe, sudden, or worsening abdominal pain that does not subside warrants immediate medical evaluation. This type of pain can indicate a perforation (a hole in the colon) or an abscess rupture, which are medical emergencies.
A high fever, typically above 100.4°F (38°C), accompanied by chills, can be a sign of a spreading infection or abscess. Persistent nausea, vomiting, or an inability to keep fluids down may lead to dehydration and indicate a more serious condition, such as a bowel obstruction. Rectal bleeding, especially if it is heavy or accompanied by dizziness or weakness, requires prompt attention. Significant changes in bowel habits, such as a complete inability to pass stool or gas, suggest a possible intestinal obstruction. Abdominal tenderness, swelling, or rigidity also indicate a need for urgent medical care.