How is diverticulosis treated?
If you have diverticulosis, you likely don’t have symptoms and don’t need treatment. However, since diverticulosis could lead to diverticulitis, you should eat a diet high in fiber as a preventive measure. This means eating more fruits, vegetables, grains, nuts, seeds, beans, legumes and less red meat.
How is diverticulitis treated?
If your diverticulitis is mild, your healthcare provider will prescribe an oral antibiotic, such as metronidazole (Flagyl®), trimethoprim-sulfamethoxazole (Bactrim®), ciprofloxacin (Cipro®) or amoxicillin and clavulanic acid (Augmentin®). Rest, taking over-the-counter medications for pain and following a low-fiber diet or a liquid diet may be recommended until your symptoms improve. Once your symptoms improve, you can slowly return to soft foods, then a more normal diet, which should be one that includes many high-fiber foods. You and your healthcare provider will discuss the specifics of your treatment plan.
If your diverticulitis is severe, you have rectal bleeding or are having a repeat bout of diverticulitis, you may be admitted to the hospital to receive intravenous (IV) antibiotics, IV fluids or possibly be considered for surgery.
When is surgery for diverticulitis considered?
Surgery for diverticulitis is considered if you have:
- Abscesses: An abscess is a contained or “walled-off” infection in the abdomen. If the fluid in an abscess (a collection of bacteria and white blood cells) is not successfully drained with a needle or catheter, surgery is needed. In surgery, the abscess is cleaned up and the affected part of the colon is removed.
- Perforation/peritonitis: A tear (perforation) in your colon allows pus or stool to leak into your abdominal cavity, resulting in peritonitis. This is a life-threatening infection that requires emergency surgery to clean the cavity and remove the damaged part of the colon.
- Blockages or strictures: Previous infections in your colon can cause scars to form, which can result in a partial or complete blockage or strictures (narrowing of sections of the colon). A complete blockage requires surgery (partial blockage does not).
- Fistulas: A fistula is an abnormal passageway or tunnel that forms and connects with another organ. An abscess that erodes into the surrounding tissue creates these passageways. A fistula in the colon can connect to the skin, bladder, vagina, uterus or another part of the colon. Most fistulas don’t close on their own so surgery is needed.
- Continued rectal bleeding (also called diverticular bleeding): Diverticular bleeding occurs when a small blood vessel near the diverticula bursts. Mild bleeding usually stops on its own, but about 20% of cases require treatment. Surgery may be needed if other attempts to stop the bleeding fail, such as clipping, drug infusion or cauterizing the bleeding artery. If bleeding is heavy and rapid, emergency surgery is a needed.
- Severe diverticulitis that has not responded to other treatment methods.
- Multiple attacks despite following a high-fiber diet. You and your surgeon may decide surgery to remove the diseased part of the colon is the best method to prevent future attacks.
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 (tradition surgery performed through a large incision) or by a minimally invasive laparoscopic procedure (surgery performed through small holes in your abdomen). 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 (at which time the colostomy bag is removed).
You and your surgeon will discuss the details of your specific surgery including risks, complications and what to expect after surgery.