When To Go To The Er For Diverticulitis
When to Go to the ER
When youre experiencing symptoms caused by some unknown condition, you may instantly begin to panic. Whats causing the discomfort? Can you afford to get treatment? And, should you seek medical attention immediately or can you wait? It may take time and a doctors visit to answer some of the millions of questions swirling in your head. But, if youre experiencing symptoms of diverticulitis, your answers may come sooner than you expect. Thats because some signs of the condition shouldnt be ignored and require an immediate emergency room visit.
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Got a question about diverticulitis? Flares can happen at the most inopportune times, like when your doctor isnt available or when you cant get an appointment. Gasteroenterology.com is another place to find answers to your questions. Perhaps the best part? The service is free. Keep in mind that it might take a couple of days for a gastroenterologist to get back to you.
Do Oral Antibiotics Work For Diverticulitis
Oral antibiotics can be prescribed only in selected cases of mild diverticulitis. Also, patients who receive intravenous antibiotics often complete a 10-14 days course of oral antibiotics at home.
Oral antibiotics are helpful in many cases of diverticulitis when prescribed according to the needs. However, recent evidence suggests that oral antibiotics dont provide added benefits in mild, uncomplicated cases of diverticulitis.
So, let your doctor decide whether antibiotics are good or not for your case.
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Can Diverticulitis Come Back After Antibiotics
Diverticulitis may recur even after treatment with antibiotics. Following medical treatment with antibiotics for the first attack of diverticulitis, approximately one-third will have a second attack .
The good news is that the recurrent attacks after treatment with antibiotics are often milder and uncomplicated.
- Evidence-based
Understanding What Diverticulitis Is And The Factors That May Cause It
To understand diverticulitis, you must first understand whats going on inside your colon not the most comforting thought, but a necessary one.
Sometimes for reasons not exactly understood small pouches or sac-like protrusions, called diverticula, develop in the colon , most often in the lower part.
One theory behind why these pouches form is straining from constipation. But because diverticula may not cause symptoms, its possible to have one or more without knowing that is, of course, until one of these sacs tears and becomes inflamed or infected.
Diverticulitis means that a sac-like protrusion has become inflamed and generally infected. In other words, diverticulitis means inflamed diverticulosis, explains Will Bulsiewicz, MD, a gastroenterologist and gut health expert in Mount Pleasant, South Carolina. People who develop diverticulitis will have pain in the left lower abdomen, and many will also have nausea with vomiting, fever and a change in bowel habits.
While this condition can affect anyone, the risk is higher if youre older, overweight, eat a low-fiber diet, smoke, dont exercise, or take steroids, opioids, or over-the-counter pain medications like ibuprofen and naproxen.
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How To Treat Diverticulitis
During your trip to the emergency room, your doctor will administer a blood test to identify any infections. They may also conduct other tests to help diagnose diverticulitis including CT scans, ultrasounds of the abdomen, and x-rays of the abdomen.
In most cases, diverticulitis can be treated at home with oral antibiotics, but if your condition is severe, a hospital stay may be required. Your doctor will recommend getting plenty of rest, taking medication to control pain, and drinking mainly fluids for the first couple of days of your recovery. After the first few days, you should introduce a high-fiber diet into your daily routine to ensure your bowels move regularly. You should incorporate foods such as:
- Cooked vegetables
- Foods rich with probiotics
If your condition is extremely severe or other treatments have failed, your doctor may suggest surgery. There are many surgery options, so theyll be able to provide the most information about which choice is best for your condition. You should talk to your doctor about the benefits and risks before making any decisions.
How To Treat Uncomplicated Diverticulitis
A sudden attack can be frightening, and if youve never felt pain like this in your abdominal area, you may imagine the worst. But if a CT scan or a barium enema X-ray diagnoses diverticulitis with no other problems, you should be able to complete your recovery at home.
Treatments for uncomplicated diverticulitis include:
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Causes And Symptoms Of Diverticulitis
Other than aging, consumption of low-fiber diet is another important reason for developing diverticula. Those, who eat foods less in fiber and high amount of processed and high-fat foods, are at the increased risk of getting diverticulitis. Also, obesity, inactive lifestyle and smoking can increase the risk of diverticulitis.
Abdominal pain is the most significant symptom of diverticulitis. Pain is often experienced in the lower left side of the abdomen. The sufferer may feel relief after bowel movements. It is accompanied by loss of appetite, nausea, sometimes vomiting, alteration in bowel habits like constipation or diarrhea and fever. In mild cases of diverticulitis, the sufferer may experience abdominal pain as well as bloating and flatulence.
Signs Your Diverticulitis Could Be In A Flare
For people who have felt the steady, sharp abdominal pain of a diverticulitis attack, another flare-up is not something that youd want to experience again, although it may happen: More than half of people who experience diverticulitis once are likely to have another flare-up.
Diverticulitis is the name for the condition caused by inflammation or infection of the diverticula, which are small, bulging pouches that sometimes develop in weak spots along the wall of someones colon or large intestines.
Diverticula may form as people get older, particularly if theyre overweight, dont exercise and eat a low-fiber diet, says Steven Koerner, D.O., FACOI, gastroenterologist at Hackensack Meridian Medical Group. In most people, these extra bulges along the colon wall dont cause health problems, and most people dont realize that they have them. But when diverticula becomes inflamed or infected, the resulting diverticulitis can be quite painful.
Symptoms of a diverticulitis flare-up
If you think that you may have diverticulitis, or if youve been diagnosed before and you think that youre having a flare-up, call or see your doctor. Common symptoms of diverticulitis include:
Constant abdominal pain that lasts for days, typically on the lower left side of the abdomen
Nausea and/or vomiting
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Hispanic Americans And Diverticulitis
The rate of hospitalization among Hispanic Americans with diverticulitis is similar to that of Black Americans, about 32 per 100,000 cases. However, Hispanic Americans are less likely to need surgery for recurrent diverticulitis, and theyre also less likely to have diverticular bleeding, according to research.
Signs Of A Diverticulitis Flare
Diverticula probably wont cause any symptoms. In some cases, however, diverticula will get inflamed and cause problems, which is called diverticulitis.
Some of the signs and symptoms of a diverticulitis flare-up are:
- Abdominal pain on the lower left side which feels achy or crampy
- Abdominal tenderness
- Pain or burning during urination
- Vomiting
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How Diverticulitis Can Affect The Sigmoid Colon
During the digestive process, the colon is responsible for absorbing liquid from food and breaking down any remaining material to move it to the rectum. The rectum acts as a storage space for this waste, and its muscles help your body remove stool through the anus, notes the ASCRS.
The sigmoid colon is the S-shaped lower section of your colon, which links the descending colon to your rectum. In Western countries, most diverticula develop in this area of the colon.
When diverticulosis becomes inflamed and progresses to diverticulitis, you may feel pain in the area of the sigmoid colon the lower left part of your abdomen and potentially develop fever and chills.
Scar tissue, an abscess, and peritonitis can also affect the sigmoid colon.
To keep your sigmoid colon healthy, take the same steps you would to prevent diverticulitis in the first place:
Mild Diverticulitis Home Treatment
Mild diverticulitis is usually treated with oral antibiotics and antispasmodics. However, these medications can cause certain adverse effects. Home treatment can effectively help you to manage the symptoms of mild diverticulitis. Home remedies are also effective in reducing the chances of recurrent attacks of diverticulitis. What you have to do is to simply follow certain changes in lifestyle and dietary habits.
Mild pain and cramps can be relieved by applying a heating pad to your abdomen. You can also try relaxation techniques like meditation, which can help reduce mild pain. A nonprescription pain reliever like acetaminophen can be used. When you are suffering from diverticulitis attack, you are advised to remain on clear liquid diet. This kind of diet includes plain water, clear broth, plain gelatin, ice pops, gelatin and fruit juices without pulp. The purpose is to relax the bowels for some time. When the symptoms are reduced, you can gradually start with low-fiber diet, which includes low-fiber cereals, white rice, cooked or canned vegetables, cooked or canned fruits without pulp or seeds, eggs, poultry, fish, low-fat milk and milk products like yogurt and cheese. Once the symptoms fade away, you can slowly switch to regular high fiber diet.
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The Many Shades Of Poop And What They Mean
Just keep in mind theres such a thing as too much fiber. Aim for 20 to 35 grams per day, research notes.
Another important note is that if you have diverticulosis, you can eat nuts, seeds, and popcorn. While doctors once thought these foods could increase the risk of diverticulitis, more recent research debunks that theory.
What Is A Diverticulitis Flare
Most diverticula cause no symptoms. However, in some cases the pouches may fill with feces and may become swollen and infected. This may cause an abscess and may even cause a tear or hole in the gut wall. Such episodes are called diverticulitis flares.
Such flares cause pain on the left side of the belly, blood in stools and abdominal cramps. In case of complicated diverticulitis, there may be abscess formation in the pouches causing fever and swelling or inflammation of the abdomen .
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When Are Antibiotics Needed For Diverticulitis
Antibiotics are needed for diverticulitis when:
- Complicated diverticulitis: abscess, fistula, perforation, intestinal obstruction, septic shock, etc.
- Uncomplicated severe diverticulitis .
- Patients with uncomplicated diverticulitis with fever or hypothermia .
- Patients with other signs of septicemia .
- White blood cell count > 12,000 or < 4,000).
- Selected patients with mild diverticulitis have significant diseases or a bad history of complicated diverticulitis.
Your doctor may or may not give antibiotics based on your unique condition and risk factors regarding mild diverticulitis. Recently, we no longer give antibiotics routinely for mild diverticulitis.
What Causes Diverticulosis And Diverticulitis
Scientists arent really sure what causes diverticulosis, but they think its caused by not eating enough fiber. Not eating enough fiber causes a buildup of waste in your colon. Constipation puts extra strain on the walls of the colon. This increased pressure causes the little pockets the diverticula to form in weak areas in your colon.
Again, scientists arent sure what causes diverticulitis, but they think the infection starts due to the bacteria in stool that gets pushed into the diverticula. Another theory is that the walls of the diverticula itself erode from the increased pressure on the colon walls.
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Causes Of Diverticular Disease And Diverticulitis
Diverticular disease is caused by small bulges in the large intestine developing and becoming inflamed. If any of the diverticula become infected, this leads to symptoms of diverticulitis.
The exact reason why diverticula develop is not known, but they are associated with not eating enough fibre.
Fibre makes your stools softer and larger, so less pressure is needed by your large intestine to push them out of your body.
The pressure of moving hard, small pieces of stools through your large intestine creates weak spots in the outside layer of muscle. This allows the inner layer to squeeze through these weak spots, creating the diverticula.
There is currently no clinical evidence to fully prove the link between fibre and diverticula. However, diverticular disease and diverticulitis are both much more common in Western countries, where many people do not eat enough fibre.
Can Diverticulitis Go Away On Its Own
Yes, an attack of uncomplicated diverticulitis can go away on its own. However, you must visit your doctor for a thorough evaluation of the episode. Most attacks of uncomplicated diverticulitisare not life-threatening and usually resolve within a week. Complicated diverticulitisneeds medical attention because it can cause serious complications.
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What Causes Diverticulitis
Although not proven, according to some researchers, chronic constipation creates pressure in the intestinal walls, weakening them and leading to the development of diverticular pouches.
Another speculated theory suggests that the lack of fiber in the diet is responsible for increased strain in the colon, leading to the formation of pouches in the weak parts of the colon wall.
This pressure, along with the undigested food that is caught in these pouches pushes against the diverticular wall, causing inflammation and propensity for bacterial infections, resulting in diverticulitis.
When To Get Medical Advice
Contact a GP as soon as possible if you have symptoms of diverticular disease or diverticulitis.
If you’ve already been diagnosed with diverticular disease, you usually do not need to contact a GP the symptoms can be treated at home.
But if you have any bleeding or severe pain, seek immediate medical advice.
Contact a GP or, if this is not possible, call NHS 111 or your local out-of-hours service.
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How Is Diverticulitis Diagnosed
If you have symptoms of diverticulitis, its important to be seen by your healthcare provider to get the correct diagnosis.
First, your healthcare provider will ask you about your medical history including your current symptoms, the types of foods you normally eat, how often you have bowel movements and other questions about your bowel movements, and will review any medications you are currently taking. Your healthcare provider will check your abdomen for pain and tenderness.
Other tests that may be performed or ordered to help diagnose your condition include:
Return To The Emergency Department If:
- You have bowel movement or foul-smelling discharge leaking from your vagina or in your urine.
- You have severe diarrhea.
- You urinate less than usual or not at all.
- You are not able to have a bowel movement.
- You cannot stop vomiting.
- You have severe abdominal pain, a fever, and your abdomen is larger than usual.
- You have new or increased blood in your bowel movements.
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Causes And Risk Factors Of Diverticulitis
Diverticula form when the inner soft-tissue layer of the intestine passes through the outer muscular layer, forming a pocket or pouchlike and marble-sized bulge. This happens most often where the muscles of the intestine are weakest, particularly in the sigmoid colon.
Its unclear why diverticula form, but the Mayo Clinic notes that theyre linked with these facors:
Being Obese Having a body mass index of 30 or over means youre obese.
Eating Too Much Red Meat Theres no rule about how much red meat is too much, but generally, dietitians recommend opting for leaner sources of meat when possible, according to Harvard Health Publishing.
Not Exercising Regularly Aim for 150 minutes of moderate-intensity aerobic exercise each week, per the Centers for Disease Control and Prevention.
What Does The Surgery For Diverticulitis Entail
Surgery usually involves removing part of the colon. During surgery, the diseased section of the colon is removed and the colon is reattached to the rectum.
Depending on the extent and severity of disease, surgery can be performed in a single surgery, in two surgeries, in an open procedure or by a minimally invasive laparoscopic procedure . You may or may not need a colostomy. A colostomy involves bringing the healthy end of your colon to the surface of your skin through a hole made in your abdominal wall. A colostomy bag attaches to the colon on the surface of your skin to collect colon waste. The colostomy bag may be needed for several months while your colon heals. Once healed, the colon is reattached to the rectum .
You and your surgeon will discuss the details of your specific surgery including risks, complications and what to expect after surgery.
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Symptoms Of Diverticular Disease And Diverticulitis
Symptoms of diverticular disease include:
- tummy pain, usually in your lower left side, that tends to come and go and gets worse during or shortly after eating
- occasionally, blood in your poo
If your diverticula become infected and inflamed , you may suddenly:
- get constant, more severe tummy pain
- have a high temperature
- get mucus or blood in your poo, or bleeding from your bottom
A New Approach To Diverticulitis
Evidence is fueling new guidelines suggesting internists treat most cases of uncomplicated diverticulitis in an outpatient setting, without antibiotics.
The old way of managing diverticulitisroutine antibiotics for allis officially on the way out, according to ACP’s first two clinical guidelines on the topic.
The College’s Clinical Guidelines Committee developed the guidelines on diagnosis and management of patients with diverticulitis, which were published in January by Annals of Internal Medicine.
ACP’s two clinical guidelines are based on the best available evidence on benefits and harms and taking into context costs, patient values, and preferences, and hopefully will help in improving the care of our patients, said Amir Qaseem, MD, PhD, MHA, FACP, lead author of the guidelines and the College’s Chief Science Officer.
In the first guideline, ACP suggested that clinicians initially manage most patients with acute uncomplicated left-sided colonic diverticulitis in an outpatient setting because of a lack of evidence suggesting a benefit of routine hospitalization. The guideline also suggested managing select patients without antibiotics at first, among other recommendations.
Experts explained the evidence behind the guidelines and offered tips for changing practice around antibiotics and communicating with patients.
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