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Treatments and drugs
By Mayo Clinic staffIn general, treatment depends on the severity of your signs and symptoms and whether this is your first attack of diverticulitis. If your symptoms are mild, a liquid or low-fiber diet and antibiotics may be all you need. But if you're at risk of complications or have recurrent attacks of diverticulitis, you may need more advanced care.
Home care
If your condition calls for home treatment, expect to rest and consume a liquid diet for a few days so that your infection can heal. Once your symptoms improve — usually within three days — you can gradually start increasing the amount of high-fiber foods, such as whole grains, fruits and vegetables, in your diet.
In addition, your doctor will likely prescribe antibiotics to help kill the bacteria causing your infection. Even if you start feeling better, be sure to finish your entire course of medication. Stopping too soon could cause your infection to come back or could contribute to creating strains of bacteria that are resistant to antibiotics.
If you have moderate or severe pain, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others). Your doctor may also prescribe a more potent pain medication, although these medications tend to be constipating and may aggravate the problem.
Hospitalization
If you have a more severe attack that includes or puts you at risk of bowel obstruction or peritonitis, you may require hospitalization and intravenous antibiotics.
Surgery
If you have a perforation, abscess, fistula or recurring diverticulitis, your doctor may recommend surgery to remove the diseased part of your colon. There are two types of surgery:
- Primary bowel resection. In this procedure, your surgeon removes the diseased part of your intestine and then reconnects the healthy segments of your colon (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open (traditional) surgery or laparoscopic surgery. In open surgery, your surgeon makes one long incision in your abdomen, while laparoscopic surgery is performed through three or four small incisions. Recovery is generally faster and quicker with laparoscopic surgery.
- Bowel resection with colostomy. This surgery may be necessary if you have so much inflammation in your colon that it's not possible to rejoin your colon and rectum. During a colostomy, your surgeon makes an opening (stoma) in your abdominal wall. The unaffected part of your colon is then connected to the stoma, and waste passes through the opening into a bag. A colostomy may be temporary or permanent. Several months later — once the inflammation has healed — your surgeon may be able to perform a second operation to reconnect your colon and rectum.
- Abscess drainage. Diverticulitis may be complicated by the formation of an abscess, which may need to be drained. This can be done by inserting a needle through the skin which is guided by ultrasound or CT. A catheter is then placed to drain the abscess. This catheter may need to remain in place while you're being treated with antibiotics. Once you have recovered, a bowel resection may be needed.
- Diverticulosis and diverticulitis. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis. Accessed March 30, 2009.
- McQuaid KR, Gastrointestinal disorders. In: McPhee SJ, et al. Current Medical Diagnosis & Treatment 2009. 48th ed. Los Altos, Calif.: Lange Medical Publications; 2009. http://www.accessmedicine.com/content.aspx?aID=6395. Accessed March 30, 2009.
- Diverticulitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec02/ch019/ch019c.html. Accessed March 30, 2009.
- Young-Fadok T, et al. Epidemiology and pathophysiology of colonic diverticular disease. http://www.uptodate.com/home/index.html. Accessed March 30, 2009.
- Jacobs DO. Clinical practice: Diverticulitis. New England Journal of Medicine. 2007;357:2057.
- Strate LL, et al. Nut, corn, and popcorn consumption and the incidence of diverticular disease. Journal of the American Medical Association. 2008;300:907.
- Fox JM, et al. Diverticular disease of the colon: Epidemiology. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/128818258-3/0/1389/861.html?tocnode=51643533&fromURL=861.html#4-u1.0-B1-4160-0245-6..50119-0_5426. Accessed March 30, 2009.
- Fox JM, et al. Diverticular disease of the colon: Etiology. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/128818258-3/0/1389/863.html?tocnode=51643536&fromURL=863.html#4-u1.0-B1-4160-0245-6..50119-0--cesec3_5429. Accessed March 30, 2009.
- Picco MF (expert review). Mayo Clinic, Jacksonville, Fla. March 31, 2009.
