Diverticulitis occurs when small pouches form in the lining of the intestines and become inflamed. In some cases, these inflamed areas can rupture, leading to serious complications. Treatment varies depending on the type and severity of diverticulitis and may involve rest, antibiotics, or surgery.

People can experience multiple diverticulitis episodes, and the risk of complications increases with each recurrence. Potential complications include abscesses, strictures, fistulas, and intestinal bleeding.

When determining your treatment plan, your healthcare provider will evaluate your general health, the severity of the episode, and your symptoms. The primary goals of treatment are to eliminate infection, support recovery, and reduce the chance of serious complications.

Treatments by Condition Type

Treatment strategies depend on whether you are dealing with uncomplicated or complicated diverticulitis. Your medical history and any coexisting health conditions will also influence the decision. In many cases, a gastroenterologist may be consulted for specialized care.

hospitalization criteria
Hospital care is typically required if you:

  • Cannot eat or drink

  • Are vomiting

  • Show signs of peritonitis (inflammation of the abdominal lining)

  • Have a weakened immune system

  • Are an older adult

Treatment for Uncomplicated Diverticulitis

Uncomplicated diverticulitis refers to inflammation that has not led to additional complications. Most people with this form can be treated at home.

treatment options may include:

  • Bowel rest: A clear liquid diet may be advised initially to allow the intestines to recover. Solid foods can gradually be reintroduced as symptoms improve.

  • Pain relief: Acetaminophen (Tylenol) is often recommended for pain. NSAIDs such as ibuprofen should be avoided as they may increase the risk of complications.

  • Antibiotics: These are prescribed based on individual need. People with compromised immunity or other medical conditions may benefit from antibiotics, while others may not require them.

  • Colonoscopy: After recovery, a colonoscopy may be scheduled (typically four to eight weeks later) to rule out other causes of abdominal pain, such as colorectal cancer.

  • Surgery: Most uncomplicated cases do not require surgery. However, it may be considered if you have had multiple episodes, severe symptoms, or your quality of life is impacted. Your preferences should also be part of the decision-making process.

Treatment for Complicated Diverticulitis

Complicated diverticulitis requires more aggressive treatment and generally necessitates hospitalization. Certain cases may demand urgent surgical intervention.

treatment options include:

  • Bowel rest: Similar to uncomplicated cases, a clear liquid diet is used to help the colon heal.

  • Intravenous antibiotics: IV antibiotics are typically used when small abscesses are present.

  • Percutaneous abscess drainage: For larger abscesses, a catheter is inserted through the skin to drain fluid. This is usually done under imaging guidance and may take a few days to complete.

  • Surgery: In the event of a perforation and leakage of stool into the abdominal cavity (causing peritonitis), emergency surgery is often required to prevent life-threatening complications.

Surgery for Diverticulitis

Surgical intervention is no longer the default treatment for diverticulitis, thanks to advancements in imaging and a better understanding of the disease. However, surgery may still be necessary under specific conditions.

when surgery may be necessary:

  • Perforation of the bowel with leakage of stool

  • Abscess that does not respond to drainage

  • Failure of antibiotics and supportive care

  • A weakened immune system

  • Development of a stricture or fistula

  • Multiple recurring episodes

types of surgery:

  • Colectomy: Involves removing the diseased section of the colon. If possible, the two healthy ends of the colon are reconnected (anastomosis).

  • Colostomy: If inflammation or infection is too severe, a temporary colostomy may be performed. This diverts waste to an external bag. Once healing occurs, the ends of the colon may be surgically rejoined later.

Lifestyle Modifications

Lifestyle adjustments can help prevent diverticulitis or reduce the risk of recurrence.

recommended strategies include:

  • Avoiding smoking

  • Engaging in regular physical activity

  • Limiting intake of red meat

  • Eating more fiber-rich foods

  • Staying well-hydrated

  • Reviewing medications with your doctor to avoid drugs that increase risk

Living With and Managing Diverticulitis

Diverticulitis leads to complications in about 12% of cases, with abscesses being the most common. Those who develop complications face a higher risk of mortality compared to individuals with uncomplicated disease.

Approximately 8% of people will experience a recurrence within one year of their first episode. The likelihood of recurrence increases with each subsequent episode. Outcomes vary depending on age at diagnosis, overall health, and episode severity.

While diverticulitis was once seen as a progressively worsening condition, it is now viewed more as an inflammatory disease. This shift has allowed for more conservative treatment approaches. Improved diagnostic tools like imaging and endoscopy have also enhanced treatment accuracy.

A Quick Review

Diverticulitis treatment is tailored to the type and severity of the condition. While uncomplicated cases are often managed at home with diet modifications and rest, complicated cases usually require hospital care and possibly surgery.

Factors such as your overall health and the number of past episodes will influence your care plan. Surgery is generally reserved for severe or recurrent cases. Working with your healthcare provider can help you manage symptoms effectively and prevent future complications.