What are the treatment options for diverticulitis (inflammation of the diverticula) pain?

From the Guidelines

To treat diverticulitis pain, start with acetaminophen (Tylenol) at 650-1000mg every 6 hours as needed, not exceeding 4000mg daily, as recommended by recent guidelines 1. For more severe pain, your doctor may prescribe antibiotics like ciprofloxacin (500mg twice daily) with metronidazole (500mg three times daily) for 7-10 days, but this should be done selectively, considering the patient's overall health and risk factors 1. Some key points to consider when treating diverticulitis pain include:

• Resting your bowel by following a clear liquid diet for 2-3 days, then gradually transitioning to low-fiber foods before returning to your normal diet 1
• Applying a heating pad to your abdomen for 15-20 minutes several times daily to relieve discomfort
• Staying hydrated by drinking plenty of water, and avoiding foods that may aggravate symptoms, particularly nuts, seeds, and high-fiber items during an acute flare
• Considering the use of antibiotics only in patients with complicated diverticulitis, or those with uncomplicated diverticulitis who have comorbidities, are frail, or have refractory symptoms 1 Pain relief occurs because acetaminophen blocks pain signals in the brain, while antibiotics reduce inflammation by fighting the bacterial infection that develops when stool gets trapped in diverticula (small pouches in the colon) 1. If pain is severe or accompanied by fever above 100.4°F, persistent vomiting, or inability to keep liquids down, seek immediate medical attention as these may indicate complications requiring hospitalization 1.

It's also important to note that the American College of Physicians recommends using abdominal CT imaging when there is diagnostic uncertainty in a patient with suspected acute left-sided colonic diverticulitis, and managing most patients with acute uncomplicated left-sided colonic diverticulitis in an outpatient setting 1. Additionally, the guidelines suggest initially managing select patients with acute uncomplicated left-sided colonic diverticulitis without antibiotics, considering the patient's individual circumstances and risk factors 1.

Overall, the treatment of diverticulitis pain should be individualized, taking into account the patient's overall health, risk factors, and severity of symptoms, and guided by recent clinical guidelines and evidence-based recommendations 1.

From the Research

Treatment Options for Diverticulitis Pain

• The management of diverticulitis is based on the classification of the disease as complicated or uncomplicated, which is determined by CT scan, severity of symptoms, and patient history 2.
• For patients with uncomplicated diverticulitis, outpatient treatment is recommended, and antibiotics have no proven benefit in reducing the duration of the disease or preventing recurrence, and should only be used selectively 2, 3.
• A systematic review found that the use of antibiotics for uncomplicated diverticulitis may have little or no difference in short-term complications, but the rate of emergency surgery within 30 days may be lower with no antibiotics compared to antibiotics 3.
• Medical management of acute diverticulitis often includes antibiotics and a clear liquid diet, with abdominal pain being the most common complaint in patients with acute diverticulitis 4.
• The treatment of diverticulitis is undergoing a paradigm shift, with care moving to the outpatient setting, and physicians forgoing antibiotics for uncomplicated disease 5.
• Evidence-based treatment strategies for acute diverticulitis have evolved over time, with data questioning the need for antibiotic therapy for certain types of diverticulitis, and clinical trials demonstrating the effectiveness of laparoscopic lavage and primary resection with anastomosis and defunctioning stoma in select cases 6.

Classification and Diagnosis

• Radiological evidence of inflammation, using computed tomography (CT), is needed to diagnose the first occurrence of diverticulitis 2.
• CT is also warranted when the severity of symptoms suggests that perforation or abscesses have occurred, and is used to classify diverticulitis as complicated or uncomplicated 2.

Surgical Intervention

• Surgical intervention, including Hartmann procedure or primary anastomosis, with or without diverting loop ileostomy, is indicated for peritonitis or in failure of non-operative management 2.
• Minimally invasive and robot-assisted techniques are being adopted for the surgical management of diverticulitis 5.
• Laparoscopic lavage is an appropriate option for select patients with certain types of diverticulitis, and primary resection with anastomosis and defunctioning stoma may be considered in some cases 6.