Overview of Diverticulitis

Diverticulitis is a condition that refers to the inflammation or infection of small pouches, known as diverticula, that can form in the walls of the digestive tract, most often in the colon [1]. These pouches are quite common, especially in people after the age of 50. If you have them, your physician will refer to them as with diverticulosis which in itself is not necessarily a problem. However, when these pouches become inflamed or infected, it leads to diverticulitis ("-itis means "inflammation of the..."), which can cause severe abdominal pain, fever, nausea, and changes in bowel habits - enough to go to the ER. 

Diverticulitis can be classified as either uncomplicated or complicated. Uncomplicated diverticulitis involves inflammation without any associated complications, while complicated diverticulitis can involve abscesses, perforations, fistulas, or obstructions [2]. Even when you have acute diverticulitis surgery is not always necessary except abscesses (where pus gathers). If they don’t respond to treatment with antibiotics, surgery might be the only option. Understanding the nature of diverticulitis and its potential complications is crucial for effective management and treatment.

Common Causes of Diverticulitis

Like with other GI tract diseases such as IBS, the exact cause of diverticulitis is not entirely understood, however, experts believe that the factors below make its development more likely:

• Major stress - The #1 cause of diverticulitis I see in clinic is a major stressor - the big stuff - a death of a loved one, divorce, etc. This happens and within a few weeks, the patient has an attack. It's unpredictable and of course very hard to prevent at first, but also a good once treated. That a patient might be susceptible to diverticulitis after a major stressor, enables us to try and prevent it from happening after the next one.
• Aging - your risk of developing diverticulitis increases with age, particularly after the age of 50;
• A diet that’s low in fiber - if you don’t eat enough fiber this can lead to constipation and increased pressure in the colon, which may contribute to the formation of diverticula;
• Genetics - it’s likely that genetic predisposition plays a role in developing diverticulitis;
• Obesity - being overweight or obese puts you at a higher risk of diverticulitis;
• Sedentary Lifestyle - if you don’t exercise enough or don’t incorporate enough physical in your daily routine, you increase your chance of developing diverticulitis.
• Smoking - there is a strong link between smoking and the increased risk of diverticulitis.

Other potential risk factors include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and opioids, which can increase the risk of diverticulitis by affecting the integrity of the colon wall.

Conventional Treatment Options for Diverticulitis

Most of the diverticulitis seen in our clinic is after an attack - that is, it was enough to send patients to the emergency room (and you should!) and conventional treatments are thus most commonly employed. 

After the first time, patients generally understand when a flare is brewing (see "mild" below") and can put the fire out quickly before it really gets going - and that's where jumping in with naturopathic assistance as the most efficacy. 

The treatment for diverticulitis depends on the severity of the condition, the complications with which it presents, and the overall health and physical condition of the patient. Conventional treatment options include:

Mild Diverticulitis

• Dietary changes: A clear liquid diet - or "NPO" or "nothing by mouth" - may be recommended initially to allow the colon to rest. Solid food will be reintroduced gradually as symptoms improve, starting with low-fiber foods since too much fiber can exacerbate the condition.
• Antibiotics: Antibiotics may be prescribed to treat the infection, typically Cirpo (ciprofloxacin) and Metronidazole (an anti-parasitic) but these are more aggressive/prophylactic. Antibiotics are falling from favor as doctors are now simply monitoring in hospital and allowing the body to heal on its own, except in the most severe cases.[3]
• Pain Management: Over-the-counter pain relievers such as acetaminophen can help manage pain.

Severe Diverticulitis

• Hospitalization: Severe cases may require hospitalization for intravenous antibiotics and fluids.
• Surgery: Surgery may be necessary if there are complications such as abscesses, perforations, or recurrent episodes of diverticulitis. Surgical options include removing the affected portion of the colon or, in more extreme cases, performing a colostomy. In some cases, minimally invasive procedures such as percutaneous drainage may be used to treat abscesses. For patients with recurrent diverticulitis, elective surgery may be considered to prevent future episodes (see below).

Recurrent diverticulitis:

• "Three strikes" - what I often see clinically and in working with gastroenterologists is "three strikes and your out" with diverticulitis. The disease tends to attack the same areas with each flare, causing a little more damage each time. And by the third attack doctors will recommend surgery to resect the colon (snip out the offending or damaged section). It can be effective but it is surgery. In my opinion, one attack is plenty! What we strive to help patients with is preventing future attacks and to avoid surgery in the first place. 

What are the Natural Treatment Options for Diverticulitis?

Reminder: acute diverticulitis is generally an emergency. One should use extreme caution and in milder cases, only perform under the care of a licensed physician. The natural treatment options below for mild diverticulitis focus on dietary and lifestyle changes to prevent flare-ups [4] [5]. These include:

Dietary Changes

• High-Fiber Diet: Increasing fiber intake through fruits, vegetables, and whole grains can help prevent constipation and reduce pressure in the colon. Fiber supplements, such as psyllium, may also be beneficial.
• Probiotics: Probiotics can help maintain a healthy gut microbiota and reduce inflammation. Strains such as Lactobacillus and Bifidobacterium are effective in managing digestive health. They can be taken as supplements or found in foods such as yogurt, kefir, kombucha, sauerkraut, tempeh, miso, and other fermented foods.
• Hydration: Drinking plenty of water is essential for your overall health and to keep the digestive system functioning properly. Adequate hydration helps soften stool and prevent constipation.

Lifestyle Changes

• Regular Exercise - physical activity can help maintain healthy bowel function and reduce the risk of diverticulitis. Exercise promotes regular bowel movements and reduces pressure in the colon, not to mention that it helps your overall health and well-being.
• Stress Management practicing yoga, meditation, and deep breathing exercises can help manage stress, which may contribute to digestive issues. Reducing stress can improve overall gut health and prevent flare-ups of diverticulitis and other conditions such as IBS, gastritis, etc.

Natural Remedies

• Castor oil packs: A warm castor oil pack over the site of irritation can help to soothe pain and reduce inflammation. Larrea (chaparral) oil can be added as an anti-inflammatory. 
• Mucilagenous herbs like flaxseed (linnum) and comfrey (symphytum) can be helpful for diverticulosis and can also be anti-inflammatory for very mild diverticulitis. 

Possible Complications for Patients with Diverticulitis

While more often than anything cases of diverticulitis are uncomplicated and resolve with treatment and lifestyle changes, there are potential complications that can arise. These include:

• Abscess: A pocket of pus that forms in the abdomen, which may require drainage. Abscesses can cause severe pain and may lead to further complications if not treated promptly.
• Perforation: A hole in the colon that can lead to peritonitis, a serious infection of the abdominal cavity. Perforations are medical emergencies and require immediate surgical intervention.
• Fistula: An abnormal connection between the colon and another organ, such as the bladder. Fistulas can cause significant complications and may require surgical repair.
• Bowel Obstruction: A blockage in the colon that prevents the passage of stool. Obstructions can cause severe pain, and vomiting, and require surgical intervention.
• Bleeding: Although less common, diverticulitis can cause bleeding in the digestive tract. Bleeding may be mild or severe and may require medical attention.

How can you prevent Diverticulitis?

In some respects - like major stress above - one cannot prevent how the body may react, be we can always mitigate it. After a flare, I believe we can always strive to prevent one from happening again. 

Preventing diverticulitis, as with any other condition, is preferred to having to treat it once it occurs. It involves making dietary and lifestyle changes to reduce the risk of developing diverticulitis and prevent inflammation. Here are the most commonly recommended preventive measures:

• High-Fiber Diet: Consuming a diet rich in fiber can help prevent constipation and reduce pressure in the colon. Foods high in fiber include fruits, vegetables, whole grains, and legumes.
• Stay Hydrated: Drinking plenty of water helps keep the digestive system functioning smoothly. Adequate hydration is essential for preventing constipation and maintaining overall gut health.
• Regular Exercise: Engaging in regular physical activity can promote healthy bowel function. Exercise helps maintain a healthy weight and reduces the risk of diverticulitis.
• Avoid Smoking: Quitting smoking can reduce the risk of diverticulitis. Smoking has been linked to an increased risk of diverticulitis and other gastrointestinal conditions.
• Maintain a Healthy Weight: Achieving and maintaining a healthy weight can lower the risk of diverticulitis. Obesity is a known risk factor for diverticulitis, and weight management is crucial for prevention.

The Bottom Line

Diverticulitis is a condition characterized by the inflammation or infection of small pouches in the colon. It can cause severe abdominal pain, fever, and changes in bowel habits. Understanding the common causes, conventional and natural treatment options, and potential complications is crucial for managing the condition effectively. Preventive measures, such as a high-fiber diet, regular exercise, and staying hydrated, can help reduce the risk of diverticulitis. If you experience symptoms of diverticulitis, it is important to seek medical attention promptly to prevent complications and receive appropriate treatment.