What Does a Diverticulitis Attack Feel Like?

Diverticula are small, bulging pouches that are formed in the lower part of the large intestine. They are found in only some individuals and are mostly asymptomatic. The presence of diverticula is known as diverticulosis. They are usually seen in individuals aged above 40 years. When one diverticulum or diverticula becomes inflamed or infected due to the accumulation of waste products and bacteria, the condition is called diverticulitis. Diverticulitis can cause fever, severe abdominal pain, nausea, and changes in bowel habits. Diverticulitis may be mild and treated conservatively with diet, medication, and rest; it may be severe and recurring requiring surgery.

Certain factors that may increase the risk of diverticulitis are as follows:

• Genetics: Genetics may play an important role. Having family members who have diverticulitis increases the risk of this condition.
• Age: The risk of diverticulitis increases with age, usually over 40 years. 
• Smoking: Nicotine and other chemicals in cigarettes and tobacco products can weaken the lining of the colon, causing diverticulosis and in turn diverticulitis.
• Dehydration: Dehydration affects digestion causing the accumulation of waste products and harmful bacteria in the colon. 
• Medications: Some medications such as long-term painkillers or steroids can cause weakening or irritation of the colon. 
• Sedentary lifestyle: Regular exercise may reduce the risk of diverticulitis. 
• Obesity: Being overweight exerts increased pressure on the colon, increasing the risk of diverticulosis and diverticulitis. 
• Constipation: Chronic straining while passing stools increases the pressure on the wall of the colon.

Although complications are not common, around 25% of individuals with acute diverticulitis tend to develop the following:

• Abscess: It is the accumulation of pus in the out-pouching.
• Scarring: Inflammation of the swelling may heal with scarring, causing obstruction of the bowel. 
• Fistula: Fistula is an abnormal connection between different sections of the bowel and or the bowel to other organs.
• Peritonitis: Peritonitis may occur if the pouch gets infected, inflamed, and ruptured, causing the intestinal contents to spill into the abdominal cavity. This is a medical emergency and requires immediate attention.

Treatment depends on the severity of the signs and symptoms.

Mild or uncomplicated diverticulitis: If the symptoms are mild, diverticulitis may be treated conservatively on an outpatient basis at home. Treatment may include:

• Antibiotics to treat the infection
• A liquid diet until the symptoms improve, after which solid food can be slowly started
• Plenty of rest 

Severe or complicated diverticulitis: A severe attack of diverticulitis may even require hospitalization. Treatment may include:

• Intravenous (IV) antibiotics
• Painkillers
• Drainage of abscess
• Liquid diet 

Surgery: Surgery may be indicated in the following cases:

• Having complications such as abscess, fistula, bowel obstruction, or perforation of the bowel wall
• Having multiple, recurring episodes of uncomplicated diverticulitis
• A weak immune system due to other conditions such as human immunodeficiency virus (HIV) or diabetes

There are two main types of surgery:

• Primary bowel resection: Diseased segments of the intestine are removed (resection), and ends of the healthy segments are reconnected (anastomosis). This is also called bowel resection and anastomosis. It may be performed as an open surgery or a laparoscopic (a minimally invasive) procedure.
• Bowel resection with colostomy: If the inflammation is severe, it may not be possible to reconnect the colon and rectum; in such cases, a colostomy may be performed. A colostomy is a stoma (an opening) made in the abdominal wall, which is connected to the healthy part of the colon. Stools (bowel waste) pass through the opening and into the colostomy bag. Once the inflammation resolves, the colostomy may be reversed, and the healthy segments of the bowel may be reconnected.

The following may help prevent diverticulitis by promoting healthy bowel function:

• Regular exercise
• A healthy, balanced diet that is rich in fiber 
• Drink plenty of fluids and remain hydrated 
• Avoid smoking and other tobacco products