What are the symptoms of diverticulitis flare (Diverticulitis flare-up)?

From the Guidelines

Diverticulitis flare symptoms typically include persistent pain in the lower left abdomen, which may be severe and worsen with movement, and can be diagnosed using abdominal CT imaging when there is diagnostic uncertainty, as recommended by the American College of Physicians 1. Other common symptoms include fever, nausea, vomiting, constipation or diarrhea, bloating, and tenderness in the affected area. Some patients may also experience chills, cramping, or changes in bowel habits. In more severe cases, symptoms can include rectal bleeding, difficulty urinating, or signs of infection like increased heart rate. These symptoms occur when small pouches (diverticula) that form in the colon wall become inflamed or infected. During a flare, it's essential to contact a healthcare provider promptly, especially if pain is severe or accompanied by fever. Initial treatment often includes antibiotics, but recent evidence suggests that antibiotics may not be necessary for all patients with uncomplicated diverticulitis, and the decision to use antibiotics should be made on a case-by-case basis, considering factors such as the patient's overall health, symptoms, and risk of complications 1. For example, patients with uncomplicated diverticulitis who are immunocompetent and have no signs of systemic inflammation may not require antibiotics, while those with complicated diverticulitis or underlying health conditions may benefit from antibiotic treatment. Pain management with acetaminophen is typically recommended over NSAIDs, which may irritate the digestive tract. Severe cases may require hospitalization for intravenous antibiotics, pain management, and possibly surgical intervention if complications develop. In patients with immunosuppression, such as those with chronic kidney disease or on chronic steroid medication, elective sigmoidectomy may be considered after an episode of acute diverticulitis, given the high morbidity and mortality rate when emergency surgery is required 1. It's crucial to weigh the benefits and risks of different treatment approaches and consider individual patient factors, such as the presence of comorbidities, symptoms, and risk of complications, to provide the best possible care. Key considerations in managing diverticulitis include:

• Using abdominal CT imaging to diagnose diverticulitis when there is diagnostic uncertainty 1
• Selectively using antibiotics in patients with uncomplicated diverticulitis, considering factors such as the patient's overall health and risk of complications 1
• Managing pain with acetaminophen and avoiding NSAIDs, which may irritate the digestive tract
• Considering elective sigmoidectomy in patients with immunosuppression, such as those with chronic kidney disease or on chronic steroid medication, after an episode of acute diverticulitis 1
• Weighing the benefits and risks of different treatment approaches and considering individual patient factors to provide the best possible care.

From the Research

Diverticulitis Flare Symptoms

The symptoms of diverticulitis flare can vary, but common symptoms include:

• Left lower quadrant pain
• Abdominal distention or rigidity
• Fever
• Leukocytosis
• Anorexia
• Constipation
• Nausea
• Diarrhea
• Dysuria 2, 3, 4, 5

Diagnosis and Classification

Diverticulitis can be diagnosed using computed tomography (CT) scans, which can also help classify the disease as complicated or uncomplicated 2, 3, 4, 5.

• Uncomplicated diverticulitis is characterized by inflammation limited to the colonic wall and surrounding tissue
• Complicated diverticulitis is defined as diverticulitis associated with localized or generalized perforation, localized or distant abscess, fistula, stricture, or obstruction 3, 5

Treatment Options

Treatment options for diverticulitis flare depend on the severity of the disease and can include:

• Outpatient treatment with antibiotics for uncomplicated diverticulitis
• Hospitalization and intravenous antibiotics for complicated diverticulitis
• Percutaneous drainage for abscesses
• Surgery for severe cases or when other treatments fail 2, 3, 4, 6, 5

Prevention Measures

Prevention measures for diverticulitis flare include:

• Consuming a high-fiber diet
• Limiting red meat and sweets
• Achieving or maintaining a healthy body mass index
• Being physically active
• Avoiding tobacco and long-term nonsteroidal anti-inflammatory drugs 2, 5