Diagnosing and treating diverticulitis

Once at a consultation, a doctor will conduct a short medical interview in order to gain perspective regarding the nature of the visit, as well as acquire a medical history overview.

A doctor will likely ask questions which may include:

• When did symptoms first begin?
• How severe are the symptoms being experienced?
• Are symptoms experienced on a continuous or occasional basis?
• Has a fever occurred?
• Are any medications (over-the-counter or prescription) been taken to alleviate symptoms?
• Are any medications or pain relievers, unrelated to symptoms, currently being taken?
• Have any measures been taken to alleviate symptoms? If so, what?
• Have these measures improved or worsened symptoms?
• Has any pain while urinating been experienced?
• Has any air been passed while urinating?
• Has a screening for colon cancer (such as a colonoscopy) ever taken place?

From there, a doctor will request a physical examination and assess the level and location of pain in the abdomen. A doctor may recommend a pelvic exam for all females to rule out any potentially related conditions or diseases. A doctor may also request a digital rectal exam (which involves the insertion of a lubricated, gloved finger in the rectum) to assess possible rectal tenderness and signs of inflammation, or a mass or growth in the lower pelvic area.

Diagnosis and tests

Tests may be recommended to both diagnose and rule out various medical problems or gastrointestinal concerns. Tests will be done as needed and depend entirely on the nature of symptoms, taking severity into account too. One or more of the following may be recommended:

• Stool sample (faecal occult blood test): This is to determine the pressure of blood in stool (faeces).
• Urinalysis: This test may be used to determine a urinary tract infection (UTI).
• Blood test: Diagnostic indicators for infection are usually determined in the analysis of a blood sample which will show a higher than normal white blood cell count and few red blood cells (this is known as a complete blood count or CBC test). Blood tests can also assess any signs of blood loss, as well as check liver and kidney function.
• Computerised tomography (CT scan): This is to determine whether diverticula which may be infected are present with the use of computer-guided X-ray visuals. A doctor will look for pockets of infection, such as abscesses or a burst diverticulum.
• Abdominal X-ray: This can help to determine the source of abdominal pain or other related symptoms by checking organs in the abdomen.
• Barium enema X-ray: This is usually done after a diverticulitis attack due to the risk of peritonitis. This test looks for possible causes of gastrointestinal issues which can help to diagnose symptoms. A substance similar to barium but can be dissolved in water (a water-soluble contract) may be used if diverticulitis is suspected.
• Colonoscopy or sigmoidoscopy (flexible) screening: If bleeding is one of the symptoms being experienced, this diagnostic test may be able to assess for growths in the intestine or find narrow and weakened spots in the wall lining, using a narrow, flexible tube with a tiny camera attached (inserted through the rectum and passed further up into the colon). The procedure can also help to either diagnose or rule out conditions such as cancer or ulcerative colitis. The procedure is normally not recommended while a person is experiencing a diverticulitis attack due to the risk of causing perforation in the lining of the colon. Symptoms will be carefully assessed before recommending this examination.

In some instances, a pregnancy test may be recommended for women in the reproductive years to check for rule out this as a possible cause of abdominal discomfort or pain.

Initial treatment for diverticulitis

Next steps, once diverticulitis has been diagnosed, will depend on the nature of symptoms and their severity. Many may be sent home with care instructions. Others may need to be admitted to hospital overnight (or for a few days) for monitoring and treatment.

• Home treatment: For mild cases, a doctor may recommend bed rest for a few days (up to a week), a liquid diet (to allow for diverticula healing and rest for strained bowels) until solid foods (initially a bland diet that is low in fibre and gradually increased) can be tolerated, and the administration of pain medications and antibiotics to help clear the infection. A liquid diet can include water, ice chips or pops, frozen fruit puree, broth or stock, tea or coffee (without sweeteners, milk or cream) and gelatine. Warm / hot compresses can also be used (as required) to alleviate cramping and abdominal pain.
• Hospital treatment: Severe cases with signs of complications, such as bowel blockages or an abscess, may require a short stay in hospital (at least one to two days). A doctor will administer intravenous (IV) antibiotics through a vein in the arm and no food or liquids will be given until the infection clears (up to a week). An abscess will be drained using a needle. The stomach may also be drained or emptied by sucking out contents through a tube (nasogastric / NG tube), which is passed through the nose and down the throat into the stomach. Once satisfied that the remainder of treatment can take place at home, a doctor will arrange that the affected person be discharged. Home treatment may take as long as a few weeks (and in some cases months if recurrent attacks occur).
• Surgery (partial colectomy, bowel resection or colostomy): Recurrent attacks may occur when antibiotic treatment is no longer effective. Surgery may be an option in this instance, when all other treatment measures have failed, as well as when a person has had two or more attacks, or is under the age of 40 and has an impaired immune system, or has developed a complication. Surgery will involve the removal of part of the intestine affected by diverticulitis and reconnecting the remaining parts. A colostomy (wherein the upper intestine is sewn to an opening, called a stoma, that is made in the skin of the abdomen for stool to pass out from and into a disposable bag) may be performed if multiple surgeries are required. Later on, when inflammation has cleared, the intestine is reconnected to healthier portions in a separate surgery, reversing the colostomy. Initial recovery may require a stay of between a few days or a week (sometimes longer) in hospital. A full recovery following surgery may take several months, depending on how well necessary lifestyle changes (such as diet) are implemented. Surgical procedures are rarely required (as many as 6% of all cases).

In the majority of instances diverticulitis treatment shows signs of improvement within 2 to 3 days. Antibiotics should be taken as directed, and a full course completed in order to be effective, even if symptoms reduce significantly before the final dose.

Ongoing treatment

Since diverticulitis can recur (diverticula tend to remain in the system permanently), treatment extends beyond the clearing of infection. Treatment beyond an attack is aimed at reducing the occurrence of another down the line.

A doctor may recommend the following preventive measures:

• Gradually increasing quantities of fibre into the diet – fresh fruits and vegetables, wheat bran, whole grain breads and cereals, and a fibre supplement.
• Practice healthy habits – eating at regular times, regular exercise (this helps to reduce pressure in the colon), being mindful of trying to prevent straining during bowel movements and getting plenty of fluids daily (to aid fibre in the absorption of water, thus softening waste in the colon) can all contribute towards healthy bowel function. It is also a good idea to get in the habit of using the toilet whenever the need arises to avoid stool hardening and bouts of constipation.
• Do not use laxatives to alleviate bowel strain or constipation unless advised and recommended by a doctor directly. Regular use of laxatives can make the bowel ‘lazy’ and encourage function to become dependent on them. Laxatives and enemas can result in more pain and discomfort, and are not generally recommended.
• Regular check-ups - after an attack and the commencement of treatment, the first follow-up may be requested within 2 days, and thereafter at 6 weeks (these may involve a colonoscopy or barium enema X-ray) and then every so often once symptoms are under control.

What to eat

Great sources of fibre to include in a diet are:

• Fruit: apples, pears, bananas, oranges, raspberries and mangoes
• Vegetables: broccoli, carrots, beets, collard greens, cabbage, squash, spinach and sweet potatoes (with the skin), as well as vegetable juices
• Beans ad legumes: black beans and kidney beans, as well as peas and lentils
• Whole grains and cereals: brown rice, bulgur wheat, quinoa, and oatmeal

Once the body is clear of infection and a person begins to feel well again following an attack, introducing low-fibre foods into the diet may be recommended. These include:

• Canned or cooked fruits (without skins or seeds) and vegetables
• Fruit or vegetable juices (no pulp content)
• Refined white bread
• Pasta or noodles and white rice
• Low-fibre cereals
• Eggs
• Fish and poultry
• Milk, yoghurt and cheese

There are no known trigger foods which specifically cause a diverticulitis attack. Previously nuts, seeds and popcorn were often avoided, but no direct link has been proved through research. It is not advisable to remain on a liquid diet for longer than a handful of days as the body requires more nutrients to function than this will provide. Remaining on a liquid diet for longer can lead to body weakness and will not promote inflammatory healing.