Recurrent Diverticulitis Often Requires Surgery

December 17, 2010 Dear Mayo Clinic: I am 60 and I've had several episodes of diverticulitis. I usually take medicine to get better, but the last time I had to have surgery and they removed some of my colon. Do doctors know why some people get diverticulitis and others don't? Answer: Diverticulitis is common in people 40 and older. In fact, age is the most significant risk factor for developing diverticulitis. For people who have one bout of diverticulitis, antibiotics and other conservative treatment options may be all that are needed to effectively resolve this disorder. But, as in your situation, recurrent diverticulitis often requires surgery. Diverticula are small, bulging pouches that form in the colon wall. They can occur anywhere in the digestive tract, but they are most common in the colon. Diverticulitis develops when these pouches become inflamed or infected. The cause of the inflammation or infection isn't always clear. Symptoms of diverticulitis usually develop quickly, typically within several hours. The most common symptom is significant, persistent pain on the lower left side of the abdomen. The pain is often so severe that people with diverticulitis frequently seek emergency medical care. Abdominal tenderness, fever, a change in bowel habits, nausea and vomiting may also accompany diverticulitis. As mentioned earlier, age is a major risk factor for diverticulitis. As we get older, pressure imbalances in the colon wall become more significant, and the colon wall muscle becomes thinner. Both make diverticula formation more likely. The other significant risk factor is having a previous history of the disorder. Once a person has had diverticulitis, as in your situation, the risk of another episode increases substantially. Age and previous history are the two key risk factors. Diet may also play a role, but its influence isn't as clear-cut as the other two. That said, consistently eating a diet low in fiber for years seems to increase the risk of forming diverticula and developing diverticulitis. Lack of exercise and obesity can also increase your odds of developing diverticulitis. A first bout of diverticulitis often can be effectively treated with antibiotics, along with several days of increased fluid intake, reduced food intake and rest. If pain is severe or if there's a risk of a significant tear (perforation) in the colon wall, hospitalization may be necessary for close monitoring and intravenous antibiotics. About 30 to 40 percent of people who have diverticulitis once will never develop it again. For those who have subsequent episodes, particularly two or more, surgery is often required to remove the affected portion of the colon. You may be at an even greater risk of having a second or third episode if your first attack of diverticulitis was at age 50 or younger. Surgical resection generally prevents any additional episodes of diverticulitis. Following treatment of diverticulitis, we used to recommend avoiding hard-particle foods, such as nuts, seeds or popcorn. It was thought that these foods might become caught in diverticula and cause inflammation. But research has shown that isn't the case. People who consume a moderate amount of hard-particle foods are no more likely to have recurrent diverticulitis than people who avoid those foods. We still recommend that people with a history of diverticulitis monitor their fiber intake to ensure they are getting adequate amounts of daily fiber. Fiber and plenty of fluids soften stool and help it pass more quickly through the colon. That reduces pressure within the colon, especially on the left side where pressure otherwise can be exaggerated and increase the risk of diverticula formation. — Mark Larson, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

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