Diverticulitis occurs when small pouches, known as diverticula, form in the lining of the digestive tract and become inflamed or infected. While many cases are managed with diet and antibiotics, surgery becomes an option for severe or recurrent cases, or when complications like perforation, abscess, or fistula develop. Surgery, often a colectomy or bowel resection, aims to eliminate symptoms, prevent recurrence, or treat these complications, ultimately improving a person’s quality of life.
The Recovery Journey
Following diverticulitis surgery, patients spend several days in the hospital, where medical staff monitor healing and manage pain. Initial pain is expected, and medication, including opioids or non-steroidal anti-inflammatory drugs (NSAIDs), is provided for pain management. Patients begin with a clear liquid diet, gradually advancing to solid foods as their digestive system recovers.
During the hospital stay, a nasogastric (NG) tube might be used to keep the stomach empty for a few days, especially if postoperative ileus occurs. Movement is encouraged soon after surgery to help prevent complications like blood clots and pneumonia. Light activities, such as walking, begin within the first week, with discharge occurring within four to seven days.
Physical healing and regaining strength extend over several weeks. Patients should avoid heavy lifting and strenuous activities for at least six to eight weeks post-surgery to allow for proper incision healing. A follow-up appointment is scheduled within the second week to assess recovery.
Managing Diet and Lifestyle Post-Surgery
Dietary adjustments are key to post-surgical recovery and long-term well-being. Initially, a clear liquid diet such as broth, clear juices without pulp, and gelatin is recommended to allow the colon to rest and heal. After a few days, patients transition to a low-fiber diet, including easily digestible foods like white bread, white rice, potatoes without skin, and cooked or canned fruits and vegetables without skins or seeds. This diet helps avoid irritating the healing colon and facilitates recovery.
Within four to eight weeks, a gradual reintroduction of fiber into the diet is encouraged, aiming for 25 to 30 grams of fiber daily. These include high-fiber foods like beans, legumes, whole grains, fruits like apples and bananas, and vegetables like broccoli and carrots. Adequate hydration, with at least eight cups of fluid daily, is also important to soften stool and promote regular bowel movements. While nuts, seeds, and popcorn were historically restricted, current recommendations suggest reintroducing them as tolerated once the colon is no longer inflamed.
Beyond diet, lifestyle adjustments are important. Regular physical activity, starting with light walks and gradually increasing intensity, support bowel function and overall health. Managing stress and attending regular follow-up appointments with healthcare providers are also important for monitoring recovery and addressing any concerns.
Bowel Function and Physical Well-being
Changes in bowel habits are expected after diverticulitis surgery, particularly following a colon resection. Patients may experience variations in stool frequency, consistency, and urgency. Diarrhea is common, as the shortened colon may lead to faster stool transit. While these changes improve over six to eight weeks as the colon adapts, faster transit can be a permanent effect, especially if a long section of the colon was removed.
Conversely, some individuals experience constipation post-surgery, which can be influenced by pain medications that slow bowel movement. Stool softeners or prune juice may be recommended to help manage this. Gas and bloating can also be temporary side effects as the digestive system adjusts. Despite these initial adjustments, many patients report improvement in their physical comfort and energy levels once the acute and chronic pain associated with diverticulitis is resolved.
Patients with significant bowel issues before surgery, such as frequent diarrhea or constipation, often see substantial improvement after elective resection. This reduction in pre-existing discomfort improves physical well-being and daily experience.
Addressing Long-Term Challenges
While many patients experience improved quality of life after diverticulitis surgery, some face long-term challenges. Persistent abdominal discomfort, similar to symptoms of irritable bowel syndrome, can occur in 5% to 25% of individuals after surgery. These symptoms can include painful constipation, abdominal distension, cramps, or frequent painful diarrhea.
A temporary ostomy, such as a colostomy or ileostomy, may be created during initial surgery. This involves rerouting the bowel to an opening in the abdomen, allowing waste to collect in an external pouch. This measure is temporary, especially in emergency surgeries, and can be reversed in a subsequent procedure once the colon has healed, after a few months. However, a permanent ostomy may be necessary in cases of extensive colon removal or other complicating health conditions.
Recurrence of diverticulitis in the remaining colon is possible, although less common after surgery, with a recurrence risk around 16% over 15 years. Patients who continue to experience abdominal pain after surgery may have a higher risk of recurrence. It is important to seek medical attention for any new or worsening symptoms, such as severe abdominal pain, fever, or persistent changes in bowel habits, as these could indicate a recurrence or other complication.