Diverticulitis is usually diagnosed during an acute attack. Because abdominal pain can indicate a number of problems, your doctor will need to rule out other causes for your symptoms.
Your doctor will likely start with a physical examination, which will include checking your abdomen for tenderness. Women generally have a pelvic examination as well to rule out pelvic disease.
After that, the following tests are likely:
- Blood and urine tests, to check for signs of infection.
- A pregnancy test for women of childbearing age, to rule out pregnancy as a cause of abdominal pain.
- A liver enzyme test, to rule out liver-related causes of abdominal pain.
- A stool test, to rule out infection in people who have diarrhea.
- A CT scan, which can identify inflamed or infected pouches and confirm a diagnosis of diverticulitis. CT can also indicate the severity of diverticulitis and guide treatment.
Treatment depends on the severity of your signs and symptoms.
If your symptoms are mild, you may be treated at home. Your doctor is likely to recommend:
- Antibiotics to treat infection, although new guidelines state that in very mild cases, they may not be needed.
- A liquid diet for a few days while your bowel heals. Once your symptoms improve, you can gradually add solid food to your diet.
- An over-the-counter pain reliever, such as acetaminophen (Tylenol, others).
This treatment is successful in most people with uncomplicated diverticulitis.
If you have a severe attack or have other health problems, you'll likely need to be hospitalized. Treatment generally involves:
- Intravenous antibiotics
- Insertion of a tube to drain an abdominal abscess, if one has formed
You'll likely need surgery to treat diverticulitis if:
- You have a complication, such as a bowel abscess, fistula or obstruction, or a puncture (perforation) in the bowel wall
- You have had multiple episodes of uncomplicated diverticulitis
- You have a weakened immune system
There are two main types of surgery:
- Primary bowel resection. The surgeon removes diseased segments of your intestine and then reconnects the healthy segments (anastomosis). This allows you to have normal bowel movements. Depending on the amount of inflammation, you may have open surgery or a minimally invasive (laparoscopic) procedure.
- Bowel resection with colostomy. If you have so much inflammation that it's not possible to rejoin your colon and rectum, the surgeon will perform a colostomy. An opening (stoma) in your abdominal wall is connected to the healthy part of your colon. Waste passes through the opening into a bag. Once the inflammation has eased, the colostomy may be reversed and the bowel reconnected.
Your doctor may recommend colonoscopy six weeks after you recover from diverticulitis, especially if you haven't had the test in the previous year. There doesn't appear to be a direct link between diverticular disease and colon or rectal cancer. But colonoscopy — which isn't possible during a diverticulitis attack — can exclude colon cancer as a cause of your symptoms.
After successful treatment, your doctor may recommend surgery to prevent future episodes of diverticulitis. The decision on surgery is an individual one and is often based on the frequency of attacks and whether complications have occurred.
Some experts suspect that people who develop diverticulitis may not have enough good bacteria in their colons. Probiotics — foods or supplements that contain beneficial bacteria — are sometimes suggested as a way to prevent diverticulitis. But that advice hasn't been scientifically validated.
Preparing for your appointment
You may be referred to a doctor who specializes in disorders of the digestive system (gastroenterologist).
What you can do
- Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
- Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
- Make a list of all your medications, vitamins and supplements.
- Write down your key medical information, including other conditions.
- Write down key personal information, including any recent changes or stressors in your life.
- Ask a relative or friend to accompany you, to help you remember what the doctor says.
- Write down questions to ask your doctor.
Questions to ask your doctor
- What's the most likely cause of my symptoms?
- What kinds of tests do I need? Do these tests require any special preparation?
- What treatments are available?
- Will the diverticulitis come back?
- Should I remove or add any foods in my diet?
- I have other health conditions. How can I best manage these conditions together?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:
- When did you first begin experiencing symptoms, and how severe are they?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve or worsen your symptoms?
- Have you had a fever?
- What medications and pain relievers do you take?
- Have you had any pain with urination?
- Have you ever had a screening test for colon cancer (colonoscopy)?