What is the best medication for diverticulitis?

What is diverticulitis?

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Diverticulitis is a condition in which small pouches in the colon become inflamed. The small pouches, called diverticula, push outward through weak spots in the wall of the colon.

Doctors call the condition diverticulosis when a person has pouches or sacs in the colon without inflammation.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diverticulosis is relatively common. It affects more than 30% of adults in the United States between the ages of 50–59 and more than 70% of those older than 80.

However, less than 5% of people with diverticulosis develop diverticulitis.

Symptoms of diverticulitis

Diverticulitis can cause the following symptoms:

• pain, usually in the lower left side of the abdomen
• diarrhea or constipation
• nausea or vomiting
• fever and chills

Typically, diverticulitis pain comes on suddenly and is severe. However, pain can also be mild and worsen over several days. The intensity of the pain may also change.

Causes of diverticulitis

The NIDDK notes that doctors are not sure what causes diverticular disease. However, experts think the following factors may play a role:

• genes — around 50% of the risk for diverticulitis is due to genetic factors
• diets low in fiber and high in red meat
• lack of physical activity
• obesity
• certain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids
• smoking

Additionally, the NIDDK explains that scientists are studying other aspects that may play a role in diverticular disease development. These include:

• problems with the immune system, connective tissue, muscles, or nerves in the colon
• changes in the gut bacteria in the intestines
• bacteria or stool getting caught in a pouch in the colon

Complications of diverticulitis

Sometimes diverticulitis may lead to complications, which doctors may need to treat in the hospital. Complications include:

• bleeding from the rectum
• intestinal obstruction, which is a partial or total blockage of the movement of food, fluids, air, or stool through the intestines
• perforation of the colon
• a fistula, which is an abnormal tunnel between the colon and another part of the body, such as the bladder or vagina
• an abscess, which is a swollen, pus-filled area that occurs due to infection
• peritonitis, an infection of the lining of the stomach wall

One study also indicates that the risk of colon cancer may be higher in people with complicated diverticulitis (7.9%) compared with uncomplicated diverticulitis (1.3%).

Medications for diverticulitis

Antibiotics are the typical medication for diverticulitis. Sometimes a doctor may also prescribe painkillers or tricyclic antidepressants.

Antibiotics

The American College of Gastroenterology (ACG) advises that doctors typically use antibiotics and a liquid or low residue diet to treat diverticulitis. People with mild symptoms may be able to take their medication at home, but those with signs of infection or complications usually need to receive treatment in the hospital.

According to the American Gastroenterological Association (AGA), doctors may use a combination of oral fluoroquinolone and metronidazole antibiotics to treat mild cases in the outpatient setting. Alternatively, they may use monotherapy with oral amoxicillin/clavulanate potassium.

Additionally, the AGA advises that the duration of treatment is typically 4–7 days but can be longer.

However, people with mild symptoms and no complications may not need antibiotics. A 2019 review suggests that antibiotics have no proven benefit in reducing the duration of uncomplicated diverticulitis or preventing recurrence.

Acetaminophen

Research suggests that acetaminophen is suitable for diverticulitis pain relief.

NSAIDs may lead to diverticulitis complications, and people should avoid using them unless instructed otherwise by their doctor.

A doctor may prescribe other types of pain relief medications for someone to use at home or, in more severe cases, administer them intravenously in the hospital.

Tricyclic antidepressants

The AGA advises that ongoing gastrointestinal symptoms are common after an episode of acute diverticulitis. Therefore, a doctor may prescribe a low to modest dose of a tricyclic antidepressant after a full assessment.

Other treatments for diverticulitis 

Doctors can investigate diverticulitis symptoms or complications with a colonoscopy. This involves inserting a tube with a camera into a person’s rectum to examine the intestines.

People who have complications of diverticulitis may require treatment in a hospital. Additionally, doctors may recommend that someone with diverticulitis changes their diet and lifestyle.

Surgery

The ACG explains that doctors may use radiologic guided drainage for someone with a large abscess. This procedure involves a doctor placing a tube into the abdomen to drain the abscess.

In rare cases, a person may need surgery to remove a part of the colon that is bleeding.

Dietary modifications

Some people believe that a low residue diet can help with symptoms of diverticulitis.

However, the ACG advises that a large study found people who frequently ate nuts or popcorn were no more likely to experience diverticulitis than those who did not eat these foods. Therefore, the ACG no longer recommends that people with diverticulitis avoid these foods.

Similarly, the AGA notes that there is no association between consuming fruits with small seeds, such as strawberries, and diverticulitis risk.

However, a doctor may recommend a clear liquid diet to make a person more comfortable in the acute phase of uncomplicated diverticulitis.

The ACG also recommends including fiber and reducing the amount of red meat in the diet as studies suggest this helps decrease the risk of developing diverticulitis.

Lifestyle modifications

According to the ACG, people who maintain a moderate weight and exercise regularly are less likely to develop diverticulitis and diverticular bleeding. Additionally, avoiding smoking helps to prevent diverticulitis, especially the type with perforations.

Avoiding NSAIDs

The AGA explains that regular use of NSAIDs can increase the risk of diverticulitis. Therefore, doctors may advise a person with a history of diverticulitis to avoid using NSAIDs twice or more in a week. However, there may be exceptions for people with cardiovascular disease.

Frequently asked questions 

Below are answers to some common questions about diverticulitis.

What is the best medication for diverticulitis pain?

Acetaminophen may be suitable for diverticulitis pain. However, a doctor may advise a person to take something different.

People should speak with a doctor before taking any medications for diverticulitis pain.

What can trigger diverticulitis?

Contrary to past opinion, experts suggest that eating foods such as nuts or popcorn does not trigger diverticulitis. However, people who eat a low fiber diet may be more at risk of developing the condition.

Learn more about the best foods for diverticulitis here.

What are the early signs of diverticulitis?

Abdominal pain that comes on suddenly may be a sign of diverticulitis. A person may also experience altered bowel movements, nausea, or vomiting.

Summary

Doctors may prescribe antibiotics to treat diverticulitis. They may also recommend acetaminophen or tricyclic antidepressants to manage ongoing abdominal pain.

Experts do not advise people to take NSAIDs for diverticulitis as they may cause further complications. However, doctors may advise people with cardiovascular disease differently. A person should always follow a doctor’s advice.

Someone with symptoms of diverticulitis should contact a doctor for an assessment and to discuss treatment options.