Diverticulitis is a type of infection in your large intestine. It needs medical treatment along with diet changes. Some people might also need surgery for diverticulitis, especially if their condition causes complications.

Keep reading to learn more about diverticular disease, what causes it, and how to know if you need diverticulitis surgery.

What Is Diverticular Disease?

Diverticular disease includes diverticulosis and diverticulitis, conditions that affect your digestive tract.

Diverticulosis occurs when small pouches, called diverticula, form in the wall of your large intestine (colon). The pouches push outward in weak spots, usually in the lower part of your large intestine.

About one-third of adults over 50 have diverticula; by their 70s, most people have them. Diverticulosis rarely causes health problems, but you might have chronic symptoms like:

  • Abdominal discomfort, especially in your lower abdomen.
  • Bloating.
  • Constipation or diarrhea.

With diverticulitis, diverticula become infected or inflamed. Less than 5% of people with diverticulosis develop diverticulitis. If you do develop an infection, it can come on suddenly and cause these symptoms:

  • Abdominal pain, usually in the lower left side of your abdomen.
  • Constipation or diarrhea.
  • Fever.
  • Nausea or vomiting

These factors might increase your risk of developing diverticular disease or diverticulitis:

  • Diets low in fiber or high in red meats.
  • Chronic constipation.
  • Family history.
  • Lack of exercise or physical activity.
  • Medications like NSAID pain relievers or steroids.
  • Obesity.
  • Problems with the nerves or muscles in your intestines.
  • Smoking.

Doctors can diagnose diverticular disease with bloodwork to look for signs of an infection. They may also do imaging tests like a CT scan or a colonoscopy to examine your colon.

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Standard Treatments for Diverticulitis

Medications and diet can treat most cases of uncomplicated diverticulitis. Your doctor may prescribe an oral antibiotic to clear up the infection. They may also recommend over-the-counter pain medication if needed.

Following a clear liquid diet until your infection clears up (usually two to three days) is essential. It allows your bowel to rest and recover. Clear liquids include foods and beverages like:

  • Broth.
  • Coffee or tea without milk or cream.
  • Fruit juices like apple, grape, or cranberry (no orange or grapefruit because of the pulp).
  • Plain gelatin.
  • Popsicles.

Once you’re feeling better and your health care provider gives the OK, you can slowly advance your diet. Start with lower fiber, soft foods, and beverages like:

  • Bananas.
  • Canned fruit.
  • Cream soups.
  • Eggs.
  • Ice cream or sorbet.
  • Oatmeal.
  • Milk.
  • Peeled, cooked vegetables.
  • Pudding.
  • Shakes or smoothies.
  • Tuna or chicken salad.

After your infection clears, you should follow a high-fiber diet.

Treating Diverticulitis Complications

Sometimes, diverticulitis causes complications, or the infection doesn’t clear with oral antibiotics. If you have more severe diverticulitis, you may need hospital treatment with stronger IV medications.

One frequent complication is an abscess, a collection of pus that forms adjacent to the part of the colon affected by the infection. Your doctor may put you on IV antibiotics to help clear it.

They may also need to drain the abscess. To do so, they use image guidance to place a catheter through a small cut in your abdomen into the fluid collection, allowing pus to drain.

Some people have diverticular bleeding that usually stops on its own. But if needed, doctors can find and often stop the bleeding with a colonoscopy and a special tool on the scope. They can also stop the bleeding by injecting medication into the blood vessel with the help of an X-ray procedure.

If you notice rectal bleeding, it’s crucial to call your doctor because significant blood loss may require a transfusion.

Who Needs Surgery for Diverticulitis?

Most people don’t need surgery for diverticulitis. But if you have frequent attacks, it’s worth talking to your doctor. Ask these questions if you’re thinking about elective surgery:

  • Will surgery cure my diverticulitis? It may not unless you have your entire colon removed.
  • What are the risks of surgery?
  • How will surgery change how my digestive tract works? Will I need to wear a colostomy bag?
  • How long does diverticulitis surgery recovery take?
  • Can I make other lifestyle changes first to reduce my risk of a future infection?

You may need surgery if diverticulitis doesn’t improve with standard treatment or if you develop certain serious complications, like:

  • An abscess that hasn’t cleared with IV antibiotics or by draining it, or a very large abscess.
  • A bowel obstruction or narrowing in your large intestine that prevents food waste from moving through.
  • Fistula. This is an abnormal tunnel that forms in your colon and leads to another part of your body, such as the bladder or vagina.
  • Hemorrhage, if your doctor can’t stop diverticular bleeding.
  • Perforation. This is when a weakened part of your bowel wall ruptures, allowing your bowel contents to seep into your abdominal cavity. A perforation is a medical emergency that can lead to a life-threatening infection.

What Happens in Diverticulitis Surgery?

The most common diverticulitis surgery is a sigmoidectomy. Your sigmoid is the last part of your colon before it connects to your rectum at the end of your bowel. It’s also the most popular spot for diverticula to form in your colon.

During a sigmoidectomy, a surgeon removes your sigmoid colon. Then, they reconnect the healthy part of your colon to the top portion of your rectum.

Your surgeon may use a minimally invasive laparoscopic surgery or robotic surgery to remove and resect your sigmoid colon. They’ll make tiny cuts in your abdomen and insert instruments to perform the operation. Minimally invasive surgery leaves minimal scars after the surgery.

If laparoscopic surgery isn’t an option, you’ll need open surgery, requiring a larger incision.

Two-part surgery

If you need emergency surgery because the infection has spread into your abdominal cavity, you may need a two-part surgery. This can happen if the infection makes it unsafe to reconnect your colon during the initial surgery.

During the first surgery, the surgeon will remove the diseased part of your colon, seal off your rectum, and clean out any signs of infection. Then they’ll create an opening in your abdomen (a stoma) and connect your colon to the skin. You’ll use a colostomy bag to collect stool, which allows your colon to rest and heal.

The second surgery happens several months later, after your colon has healed. Your surgeon will then reverse the colostomy and connect the healthy part of your colon back to your rectum.

Your surgeon may do these surgeries laparoscopically, or you may need an open surgery, depending on your health.

Diverticulitis Surgery Recovery

Diverticulitis surgery recovery depends on the type of surgery you had and which method your surgeon used. Minimally invasive surgeries allow for a faster and easier recovery. Recovering from open surgery takes longer, and you may have more pain.

Also, you may need IV antibiotics and an extended hospital stay if you have emergency surgery. That allows your health care provider to monitor your health and ensure your infection is gone.

The best treatment for diverticulitis depends on many factors, including your age, colon health, overall health, and future risk of an infection. Your doctor can run tests and assess your risk to determine whether you need surgery.

National Institute of Diabetes and Digestive and Kidney Diseases. Diverticular Disease. LINK

Medscape. Diverticulitis. LINK

National Library of Medicine National Center for Biotechnology Information. Diverticular Disease and Diverticulitis: Surgery for Diverticulitis and Diverticular Disease. LINK

About Digestive Disorders

UPMC Digestive Health Care cares for a wide range of gastrointestinal (GI) conditions and diseases, from diagnosis to treatment. Whether your digestive condition is common or complicated, our experts can help. Upon referral from your physician, we coordinate your testing and treatment. If you have a complicated condition, we can refer you to one of UPMC’s digestive health centers of excellence. Find a GI doctor near you.