Diverticulitis develops when bacteria become trapped in pouches, also called diverticula that have formed along the wall of the large intestine, which leads to an infection. The bacteria grow and cause inflammation and pressure that may lead to a small perforation or tear in the wall of the intestine. An infection of the lining of the abdominal wall, called peritonitis, may develop if infection spills into the abdominal cavity. Diverticula form in the wall of the large intestine, but this reason is not known by doctors. Most people have in their colons small pouches the bulge outward through weak spots, like an inner tube the pokes through weak spots. About half of all Americans ages 60 to 80, and almost everyone over age 80 have diverticulosis.
A diet that has adequate fiber will produce a stool that is bulky and can move easily through the colon. If a diet is low in fiber, the colon must exert more pressure than usual to move the small hard stool. Medications to stop infection and to control symptoms are often used to treat attacks of diverticulitis. Antibiotics, such as metronidazole and ciprofloxacin, are given to treat the infection that caused the attack. Prescription pain relievers are also sometimes needed if nonprescription pain relievers are unable to control the pain. Medications are not used to prevent future attacks of diverticulitis. Prevention depends on increasing the amount of fiber in your diet and practicing healthy bowel habits.
Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early. To help the colon rest, the doctor may recommend bed rest and a liquid diet, along with a pain reliever to control muscle spasms in the colon. An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein. Surgery is required, however, in some cases.
If attacks are severe or frequent, the doctor may advise surgery. The surgeon opens the abdomen and removes the affected part of the colon. The remaining sections of the colon are rejoined. This type of surgery is called colon resection helps to keep attacks from coming back and to prevent complications. The doctor may also recommend surgery for complications of a fistula or intestinal obstruction. If antibiotics do not correct the attack, emergency surgery may be required. Other reasons for emergency surgery include a large abscess, peritonitis, perforation, or continued bleeding. Emergency surgery usually requires two operations. The first surgery will clear the infected abdominal cavity and remove part of the colon. The surgeon creates a temporary hole, called a colostomy, to allow normal eating and bowel movement. The stool goes into a bag attached to the opening in the abdomen. In the second surgery, the surgeon rejoins the ends of the colon.