Is diverticulitis pain constant or does it come and go in a patient with diverticulitis?

Diverticulitis Pain Pattern

Diverticulitis pain is typically constant and persistent for several days, not intermittent or coming and going. 1

Characteristic Pain Presentation

The pain associated with acute diverticulitis presents with specific features that distinguish it from other abdominal conditions:

• The pain is described as constant and persistent, lasting for several days rather than waxing and waning 1
• Left lower quadrant pain that progressively worsens over days is the classic presentation, as demonstrated in clinical case series 2
• The pain can be characterized as cramping in quality but remains continuous throughout the acute episode 1
• Patients typically present after 3 days of progressively worsening pain, indicating a sustained rather than episodic pattern 2

Clinical Context and Associated Symptoms

The constant nature of diverticulitis pain is accompanied by other persistent features:

• Fever and leukocytosis accompany the constant abdominal pain, forming the classic triad of diverticulitis 2, 3
• Additional symptoms include anorexia, nausea, changes in bowel habits, and abdominal distention, all of which persist during the acute inflammatory episode 4, 5
• Abdominal tenderness on examination is typically localized and constant, not intermittent 6, 4

Important Clinical Distinction

If abdominal pain is truly intermittent or comes and goes, alternative diagnoses should be strongly considered, as this pattern is inconsistent with acute diverticulitis 3, 6. The inflammatory process in diverticulitis creates sustained symptoms that require several days to resolve with appropriate treatment 1, 4.

Duration and Resolution

• Symptoms typically persist for several days without treatment and require 4-7 days of therapy (when antibiotics are indicated) for resolution 2, 7
• If pain does not improve after 3-5 days of appropriate management, repeat imaging is warranted to assess for complications 2, 7
• Approximately 45% of patients report periodic abdominal pain at 1-year follow-up, but this represents post-inflammatory visceral hypersensitivity rather than active diverticulitis 2, 6