Being Well: Let’s Talk About Diverticulitis

Being Well is a regular feature at LGBTSr highlighting health and wellness.

It started with sharp recurring pain in my abdomen and ended with a three-hour visit to the emergency room at 2:00 a.m. I waited four days for it to go away, thinking it was related to the acid reflux (GERD) I’ve been treating with medication the past three years. I’d had a virtual visit with my gastroenterologist on Monday to set up my next colonoscopy. He asked how my acid problem was doing and I said fine, because I hadn’t yet experienced any problems. Then, because life works this way, it hit me on Tuesday. Bloating, pain, and the bowel problems usually associated with those symptoms. Was it food poisoning? I wondered. I kept thinking back on what I’d eaten the past couple days. And then it went away … only to return every few hours.

Finally, on Saturday morning just after midnight, I woke up in excruciating pain. Was my esophagus rupturing? Was I having a heart attack? I called the 24-hour nurse line provided by my insurance company, spoke to a very helpful nurse, and it was decided I should go to the emergency room.

Three hours after arriving, and an hour after a CT scan, I was diagnosed with acute diverticulitis. Course of treatment: antibiotics, clear liquids only for two days, and a list of mitigating measures provided in the paperwork they gave me when I left. As it turned out, the doctor was the daughter of our forester, who takes care of our annual filing to keep our property designated as a tree farm. It’s a small world.

I found out later that day, when most people are normally awake, that this illness is very common. Two of my sisters have experienced it, and quite a few friends who weighed in after I let everyone know what happened. This is a serious medical condition that is generally not life-threatening. 95 out of 100 people who get it recover with treatment within a week. A small percentage develop serious issues that can require surgery and stays in the hospital. It’s only my second day on the antibiotic, but my prognosis is excellent. And once again the experience teaches us: knowledge is strength. Not knowing leads to imagining the worst, as most of us do. Knowing what the problem is means we can get on with healing and preventing a recurrence. Keep reading for information about diverticulitis, its causes and treatments, and be well. – Mark

What is Diverticulitis?

Diverticulosis and diverticulitis are two conditions that occur in your large intestine (also called your colon). Together they are known as diverticular disease. Both share the common feature of diverticula. Diverticula are one or more pockets or bulges that form in the wall of your colon.

Diverticula are like expanded areas or bubbles that form when you fill the inner tube of a bike tire with too much air. The increase in pressure from too much air being pumped into the inner tube causes the bubble to form where the rubber is the weakest. Similarly, an increase in pressure inside the colon causes pockets or bulges (diverticula) to form in weakened areas of your colon’s walls.

Diverticula can range from pea-size to much larger. Although they can form anywhere in the inner lining of your colon, they are most commonly found in your lower left-side, in the S-shaped segment of your colon called the sigmoid colon.

Diverticulosis is very common in Western populations and occurs in 10% of people over age 40 and in 50% of people over age 60. The rate of diverticulosis increases with age, and it affects almost everyone over age 80. (Cleveland Clinic)

What are the Symptoms?

Diverticulitis may cause acute symptoms such as

• abdominal pain, most often in the lower left side of your abdomen
• constipation or diarrhea
• fevers and chills
• nausea or vomiting

The pain caused by diverticulitis is typically severe and comes on suddenly, although the pain may also be mild and worsen over several days. The intensity of the pain may change over time. (NIH)

What are the Causes?

Diverticular disease develops when pouches form along your digestive tract, typically in your colon (large intestine). These pouches (diverticula) can become inflamed and infected, which may occur when feces or partially digested food blocks the opening of the diverticula.

Although there’s no single known cause of diverticular disease, several factors can increase the risk of developing diverticulitis, including:

• genetics
• diet
• decreased immune function
• having obesity
• physical inactivity
• smoking
• changes in the gut microbiome
• certain medications, such as steroids (Healthline)

Contributing factors may include:

• Being overweight
• Smoking cigarettes
• Not getting enough exercise
• Eating lots of fat and red meat but not much fiber
• Taking certain kinds of drugs, including steroids, opioids, and nonsteroidal anti-inflammatories like ibuprofen or naproxen

What are the Treatments?

Mild cases of diverticulitis can generally be treated by the individual. However, a doctor may prescribe antibiotics, as well as acetaminophen for the pain.

It is important to complete the whole course of antibiotics, even if symptoms get better.

Some people may experience drowsiness, nausea, diarrhea, and vomiting while they are taking their antibiotics.

Antibiotics include ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex) and doxycycline (Vibramycin).

For those on the contraceptive pill, it is important to remember that antibiotics can interfere with its effectiveness. This effect on the contraceptive pill continues for about 7 days after stopping the antibiotic, so another form of contraception should overlap with this time.

Hospital treatment may be necessary if any of the following apply:

• Normal painkillers do not alleviate the pain, or the pain is severe.
• The individual cannot consume enough liquids to keep hydrated.
• The person with diverticulitis cannot take oral antibiotics.
• They have a poor state of health.
• The doctor suspects complications, often if the immune system is weak.
• Treatment at home is ineffective after 2 days.

Hospital patients are generally given antibiotics intravenously (IV), as well as fluids if they are dehydrated.

Surgery

People who have at least two diverticulitis episodes may benefit from surgery. Studies indicate that such patients are significantly more likely to have further episodes and complications if they do not have surgery. (Medical News Today)

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Mark McNeases, Editor