In 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.
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 add high-fiber foods, such as whole grains, fruits and vegetables, to 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 antibiotic-resistant bacteria.
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.
If you have a more severe attack that includes or puts you at risk of bowel obstruction or peritonitis, or you have developed a complication of diverticulitis, such as an abscess, you may need to be hospitalized to receive intravenous antibiotics.
If you develop an abscess, it 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.
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:
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- 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. With 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. Several months later — once the inflammation has healed — your surgeon may be able to perform a second operation to reconnect your colon and rectum.
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- Diverticulitis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/print/sec02/ch019/ch019c.html. Accessed March 24, 2011.
- Narula N, et al. Role of probiotics in management of diverticular disease. Journal of Gastroenterology and Hepatology. 2010;25:1827.