Most cases of diverticular disease can be treated at home. The over-the-counter (OTC) painkiller, paracetamol, is recommended to help relieve your symptoms.
The type of painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are not recommended because they may upset your stomach and increase your risk of internal bleeding.
Eating a high-fibre diet may initially help to control and resolve your symptoms of diverticular disease. Some people will notice an improvement after a few days, although it can take around a month for you to fully feel the benefits. See Diverticular disease and diverticulitis - prevention for more information and advice about diet.
If you are having symptoms of constipation, you may be given a bulk-forming laxative. These can cause flatulence (wind) and bloating. Drink plenty of fluid to prevent any obstruction in your digestive system.
Heavy or constant rectal bleeding occurs in about 1 in 3 cases of diverticular disease. This can happen if the blood vessels in your large intestine (colon) are weakened by the diverticula, making them vulnerable to damage. The bleeding is usually painless, but losing too much blood can be potentially serious.
If you have heavy rectal bleeding, you may need to be admitted to hospital so that you can be given a blood transfusion.
Treatment at home
If you have mild diverticulitis, the condition can often be treated at home. Your GP will prescribe antibiotics for the infection, and you should take paracetamol for the pain. If antibiotics are prescribed for you, it is important that you finish the complete course even if you are feeling better.
Some types of antibiotics that are used to treat diverticulitis can cause side effects in some people.
Possible side effects include:
- drowsiness (do not drive if you have this side effect)
Also, some antibiotics may react unpredictably if they are taken with alcohol. Therefore avoid drinking alcohol until you have finished taking your course of antibiotics.
Antibiotics have been known to cause the contraceptive pill and patch to fail. Therefore use an additional form of contraception, such as a condom, when taking antibiotics, and for seven days afterwards. Your GP can give you advice about the types of antibiotics that are likely to cause a problem.
Your GP may recommend that you stick to a fluid-only diet for a few days until your symptoms improve. This is because trying to digest solid foods may make your symptoms worse. You then gradually introduce solid foods over a two or three day period.
Treatment at hospital
If you have more severe diverticulitis, you may need to go to hospital. Hospital treatment is usually recommended if:
- your pain cannot be controlled using paracetamol
- you are unable to drink enough fluids to keep you hydrated
- you are unable to take oral antibiotics (tablets)
- your general state of health is poor
- you have a weakened immune system
- your GP suspects complications
- your symptoms fail to improve after two days (48 hours) of treatment at home
If you are admitted to hospital for treatment, you are likely to receive injections of antibiotics and be kept hydrated and nourished using an intravenous drip (a tube that is directly connected to your vein). Most people start to improve within two to three days.
In the past, surgery was usually recommended as a preventative measure for people who had two episodes of uncomplicated diverticulitis,. It was believed that this would reduce their risk of developing serious complications in the future, such as peritonitis.
But nowadays most surgeons do not recommend surgery. This is because research has found that the risks of complications associated with having two episodes of uncomplicated diverticulitis are lower than were previously thought. For example, one study estimated that it would take 18 operations to prevent just one case of serious complications.
The surgery itself is also not risk free. Complications that lead to death can occur in 1 in every 100 cases. As with any form of medical treatment, surgery is only recommended if it is felt that the benefits outweigh the risks.
The benefits and risks of surgery are currently determined on a case-by-case basis, as a 'one size fits all' type of recommendation is considered unhelpful. Factors that may cause surgery to be recommended include:
- having a history of serious complications arising from a previous episode of diverticulitis
- having symptoms of diverticular disease from at a young age (it is thought that the longer you live with diverticular disease, the greater your chances of having a serious complication)
- having a weakened immune system or other underlying factors that make you more vulnerable to the effects of infection
Surgery for diverticulitis involves removing the affected section of your colon. This is known as a colectomy. There are two ways that a colectomy can be performed:
- an open colectomy, where the surgeon makes a large incision (cut) in your abdomen and removes a section of your colon
- laparoscopic colectomy - a type of 'keyhole surgery' where the surgeon makes a number of small incisions in your abdomen and uses special instruments that are guided by a camera to remove a section of colon
Open colectomies and laparoscopic colectomies are thought to be equally effective in treating diverticulitis, and have a similar risk of complications. Laparoscopic colectomies have the advantage of having a faster recovery time, and they cause less post-operative pain.
Laparoscopic colectomies are a relatively new technique and may only be available at specialist surgical centres. There may also be a longer waiting time for this type of surgery.
In some cases, the surgeon may decide that your colon needs to heal before it can be reattached, or that too much of your colon has been removed to make reattachment possible.
In such cases, it is necessary to find a way of removing wasting materials from your body without using all of your colon. This is done using stoma surgery.
Stoma surgery involves the surgeon making a small hole in your abdomen that is known as a stoma. There are two ways that stoma surgery can be carried out. These are explained below.
- An ileostomy, where a stoma is made in the right-hand side of your abdomen (stomach). Your small intestine is separated from your colon and connected to the stoma, and the rest of the colon is sealed. You will need to wear a pouch that is connected to the stoma to collect waste material.
- A colostomy, where a stoma is made in your lower abdomen and a section of your colon is removed and connected to the stoma. As with an ileostomy, you will need to wear a pouch to collect waste material.
In most cases, the stoma will be temporary and can be removed once your colon has recovered from the effects of the surgery. This will usually take at least nine weeks.
If a large section of your colon is affected by diverticulitis and needs to removed, you may need to have a permanent ileostomy or colostomy.
Results of surgery
In general terms, surgery is usually successful, although it does not achieve a complete cure in all cases. Following surgery, an estimated 8% of people will have a recurrence of the symptoms of diverticular disease and diverticulitis.