If you're dealing with cramping or pain in your lower left belly, you've likely scoured the Internet to identify the problem. One possibility that might have caught your eye: diverticulitis.
What exactly is diverticulitis? And, more importantly, if you do have the condition, how can you make the pain go away quickly?
Diverticulitis is a common gastrointestinal problem, especially with increasing age, and its symptoms can range from bothersome to downright debilitating.
Whether you're experiencing your first diverticulitis attack or you've previously had flare-ups, knowing how to recognize and respond to the pain is key.
"Diverticulosis is the actual clinical condition," says Dr. Christina Warner, a colorectal surgeon at Houston Methodist. "This is when sac-like protrusions develop in the wall of the colon. Diverticulitis is when one of these sacs becomes infected, leading to inflammation and, if it's bad enough, sometimes even perforations in the colon wall."
Why does diverticulosis happen?
Why do outpouchings form in the colon in the first place? The reason isn't entirely clear.
"Diverticuloses tend to occur in areas of natural weakness in the wall of the colon, usually where arteries connect," explains Dr. Warner. "We also know that while diverticulosis can develop anywhere in your GI tract, it occurs most frequently in the left portion of the colon, specifically the sigmoid colon."
This S-shaped part of the colon is also its narrowest portion. It's thought that colonic pressure might be highest here, contributing to the formation of outpouchings.
That said, Dr. Warner notes that diverticulosis isn't a problem for everyone, so there's more to the story.
The risk factors linked with diverticulosis include:
- Increasing age
- Being very overweight (obesity)
- Low fiber diet
- An imbalance in the gut microbiome
- Family history
(Related: Gut Health: Signs of an Unhealthy Gut & How to Improve It)
"We do also see diverticulosis occur more frequently in males than females," says Dr. Warner. "And while we don't have any specific genes identified, there may be some genetic component. For instance, if your parent or sibling has diverticulosis, you're more likely to develop it over the course of your lifetime — though that's not a guarantee."
What does a diverticulitis attack feel like?
These outpouchings that can form in the wall of the colon aren't themselves an issue, but pain and other symptoms can result if one becomes inflamed or infected.
"Imagine a hard piece of stool gets stuck in one of these diverticuloses, leading to infection, inflammation and maybe even a microperforation in the colon lining," says Dr. Warner. "The symptoms experienced by the patient will depend on how severe the inflammation or infection has become."
The typical mild case of diverticulitis may just feel like intermittent pain in the lower left abdomen. The pain comes and goes — it can range from sharp to crampy — often seeming to be the worst after eating. "A lot of people who've never seen a doctor for recurrent pain in this region may not even know they've had it," adds Dr. Warner.
More complicated cases can come with more intense, persistent pain. If inflammation is severe, even a simple movement like bending over may hurt. Other symptoms can include fever, nausea and vomiting.
A large perforation in the lining of the colon leads to even more complex diverticulitis. Stool and bacteria can leak out of the colon, leading to serious complications. "Abscess formation, for instance, which can cause really horrible pain that brings a person into the emergency room," Dr. Warner adds.
A perforation can also lead to a fistula, which is an abnormal connection between two structures. "As the body tries to wall off the infection, it can inadvertently connect areas of the body that shouldn't be connected," explains Dr. Warner. "In this case, a person may come into the emergency room with not just pain, but also because they are passing stool, pus or gas through their urine."
How long does diverticulitis last?
"It depends on how severe the infection is," says Dr. Warner. "The severity of diverticulitis also dictates the way it is treated."
Mild, uncomplicated diverticulitis typically resolves on its own at home. "Going from a solid, heavy diet to a softer, more liquid diet for a few days usually helps ease symptoms as the body naturally clears a mild infection," Dr Warner says.
More intense pain may warrant antibiotics. "If the pain is really bothersome but it's your only symptom, your doctor may just send you home with a two-week supply of oral antibiotics," says Dr. Warner. Symptoms should improve within a few days, though it's important to complete the full course of antibiotics.
When diverticulitis causes debilitating pain or complications like abscesses and fistulas, hospitalization is needed. Treatments range from IV antibiotics to having a drain put in for a few weeks or even emergency surgery.
When to go to the hospital
If you're unsure whether your pain warrants a trip to the emergency room, here's what to watch for:
- Worsening abdominal pain
- Fever and chills
- Nausea and vomiting
- Blood in the stool
- Inability to pass stool or gas
These symptoms may signal a serious infection or complication that requires prompt medical care.
What causes a diverticulitis flare-up?
Dr. Warner points out that a lot of confusion exists around what causes diverticulitis attacks.
"You'll often hear people say they're not eating nuts and seeds because of their diverticulitis, avoiding foods like tomatoes, cucumbers, corn and peanuts," says Dr. Warner. "There was an old thought that small food products — tiny seeds and hard fragments of nuts — getting stuck in these outpouchings is what caused diverticulitis, but, technically, there's been no data to prove that."
So, is there anything you can do to prevent a future attack?
"There's evidence that smoking is linked to a higher recurrence rate of diverticulitis, meaning smoking cessation can help reduce the likelihood of a future flare-up," explains Dr. Warner. "As does regular exercise, weight loss and living an overall healthy lifestyle."
Diet matters, too. "There are no miracle foods," says Dr. Warner, "but a high-fiber diet and high fluid intake can help keep things moving in the colon, reducing the risk of hard stool forming and getting stuck in any diverticuloses present. Limiting the consumption of red meat and processed meat can also help reduce diverticulitis flares."
(Related: High-Fiber Foods: How to Get More Fiber In Your Diet)
Lastly, the complexity of diverticulitis can sometimes determine how to think about future attacks.
"There's no data to predict when or if you will have diverticulitis again if you have experienced mild, uncomplicated diverticulitis once before, but we do see a consistency in the severity of diverticulitis upon recurrence," explains Dr. Warner. "For instance, if you had a case of complicated diverticulitis as your first presentation, you are more likely to experience the same severity should another episode occur at some point."
It's why a consultation with your gastroenterologist or colorectal surgeon to talk about potential treatment options like surgery is a good idea.
"I may have someone who experiences a mild episode every other year, and it's manageable with just antibiotics prescribed from their primary care provider — this person may not require surgery," says Dr. Warner. "But the patient who had severe diverticulitis and needed a drain placed to help clear an abscess, maybe we will think about a future surgery to help prevent recurrence in that case."
