What Is Diverticulitis?
Diverticula are small pockets in the colon that are present in up to 10% of people over age 45. About 25% of those people experience an inflammation of those pockets (otherwise known as diverticulitis). Do nuts, seeds, corn, and popcorn really cause this potentially serious condition? The House Call Doctor explains the latest research.
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Diagnosis of Diverticulitis
People who have a history of diverticulitis simply “know” when they are experiencing an acute attack. When symptoms are mild, imaging (meaning X-rays or CT scans) is not typically necessary. However, diverticulitis is most often diagnosed using an abdominal CT scan.
If you're a regular listener or reader of the House Call Doctor show, you know that I’m not a big fan of CT scans due to excessive exposure to ionizing radiation. I think CT scans are over-utilized in the U.S. and really should be reserved for when it’s absolutely necessary. In a patient with severe abdominal pain, especially with a fever and an elevated white blood cell count, it may be necessary depending on the severity of the symptoms. But if you have a history of diverticulitis that’s been documented on a prior CT, and your symptoms are mild and similar, you don’t need a CT scan every time you have abdominal pain or an attack.
An ultrasound is a good alternative to the CT for diagnosing diverticulitis. However, it may not be the best choice if we suspect certain complications from diverticulitis. Also, a colonoscopy may be recommended after an acute attack has resolved, typically about 4-6 weeks after.
Complications of Diverticulitis
If left untreated, diverticulitis can be very serious and cause some potentially life-threatning complications, including:
Abscess (a ball of pus surrounding the inflamed pocket)
Perforation (a hole that is created in the colon wall as a result of a inflammation)
Fistula (a “tunnel” that is created connecting the colon and the nearby organs, including the bladder or rectum)
Obstruction in the colon
Treatment of Diverticulitis
Most patients (over 90%) can be treated without hospitalization. Besides oral antibiotics, doctors recommend an initial clear liquid diet along with close monitoring by your doctor. Most patients see improvement in symptoms within 2-4 days of outpatient treatment.
Your doctor may decide to hospitalize you if your symptoms don’t improve with oral antibiotics (and in that case, would require IV antibiotics), if your fever doesn’t break, if your pain does not subside, or if you cannot tolerate any fluids or food.
Up to a third of those with one episode of acute diverticulitis have another attack sometime in their lifetime, and surgery is often recommended after the third attack that requires hospitalization (this varies depending on the patient, of course).
How to Prevent Diverticulitis
Unfortunately, we don’t know why some people are so prone to diverticulitis when there are so many others with diverticulosis who never get their diverticula inflamed. However, we do know that for some reason, patients who are obese and live rather sedentary lifestyles tend to have a higher risk of developing diverticulitis. There is evidence that the following recommendations are helpful in preventing diverticulitis attacks:
Increase your fiber intake
Lose weight if you're obese
Avoid anti-inflammatory drugs (like ibuprofen, naproxen, etc.)
Take Lactobaccillus Casei (a probiotic)
Two prescription drugs that may also aid in preventing future attacks are:
What about avoiding nuts, seeds, corn, or popcorn as it was advised to my friend Devin, you may be wondering? Perhaps you were also given the same advice at some point along the way? Well, there was a large research study done in 2008 that refuted this theory. It seems that small food particles are not the culprits in causing diverticulitis.