When to Go to the Hospital for Diverticulitis?

To understand when to go to the hospital for diverticulitis, you should first know the differences between different nomenclatures of diverticulitis.

The below table illustrates the differences between terms related to diverticular diseases (source):

Diverticula are tiny sacs protruding from the wall of the colon. Diverticulosis (presence of asymptomatic diverticula is very common.

The incidence of diverticulosis increases with age. For example, 60% of people over 60 have diverticulosis (reference).

Diverticulosis is an asymptomatic disease that doesn’t require you to go to the hospital. But, eventually, the diverticula become acutely inflamed (acute diverticulitis) or develop complications.

It would help if you went to the hospital when you suspect the presence of acute diverticulitis or the development of complicated diverticulitis.

Complications of diverticulitis include:

• A diverticular abscess (pus-filled diverticula with high fever and abdominal pain).
• Perforation (rupture) of the diverticula with subsequent leakage of the intestinal contents to the outside of the intestine.
• Intestinal obstruction.
• Fistula formation (a tubular tract between the colon and adjacent organs such as the urinary blood).
• Sepsis and septic shock due to the spread of the infection from acute diverticulitis, abscess, or perforation.
• Significant bleeding.

You should go to the hospital for diverticulitis when you have:

• Severe intolerable abdominal pain.
• Fever (especially when associated with abdominal pain).
• Nausea, anorexia, or vomiting.
• Bleeding (frank bleeding or blood in the stool).
• Signs of sepsis or septic shock.
• Signs of intestinal obstruction such as severe distension, absolute constipation, and persistent vomiting.

1. Severe intolerable abdominal pain.

Abdominal pain is the most common symptom denoting the development of acute diverticulitis.

The diverticular disease often affects the last portions of the colon (The sigmoid and descending colon). These portions of the colon lie on the left side of your abdomen.

So, acute onset of sharp left-sided abdominal pain should raise the concern about acute diverticulitis in people with diverticular disease.

However, diverticulitis can also affect other portions of the colon. So, acute diverticulitis pain can occur in any part of your abdomen.

Go to the hospital when the pain is severe and associated with tenderness or other symptoms of acute diverticulitis such as fever, bleeding per rectum, vomiting, etc.

The pain is often dull and constant (lower left or diffuse). It usually starts as mild pain and constantly increases and persists for days.

Mild transient pain without other warning signs doesn’t require going to the hospital unless you have other symptoms suggestive of acute diverticulitis.

2. Fever.

Fever is a meaningful sign of acute diverticulitis. Fever is significant when associated with other symptoms (such as abdominal pain).

The fever may indicate:

• Development of acute diverticulitis.
• Development of complications such as diverticular abscess, rupture of diverticula, or sepsis.

Fever can be either low grade or high grade. Any grade fever should raise the suspicion of acute diverticulitis when associated with abdominal pain.

However, Not every fever means diverticulitis. Fever alone without other abdominal symptoms (such as abdominal pain) is unlikely due to acute diverticulitis.

Search for the cause of fever first. Then, ask your doctor if you cannot spot the source of the fever.

3. Nausea and vomiting.

Nausea and vomiting are common with diverticulitis. They occur due to either severe inflammation or due to intestinal obstruction.

Nausea and vomiting are reported in 20-62% of patients with acute diverticulitis (reference).

Vomiting is a more serious indicator of the severity of acute diverticulitis. When you have recurrent or persistent vomiting with abdominal pain, go to the hospital.

4. Signs of intestinal obstruction.

Intestinal obstruction can occur with diverticulitis by different mechanisms. The intestinal obstruction prevents food from traveling through the digestive.

Causes of intestinal obstruction may include:

• Partial obstruction of the colon wall due to inflammation and edema of its walls.
• Compression of its walls by an abscess (diverticular abscess).
• Paralysis of the small intestine (paralytic ileus) due to inflammation and irritation.

The signs of intestinal obstruction include:

• Severe abdominal distension.
• Absolute constipation.
• Recurrent or persistent vomiting.
• Extreme nausea and anorexia.
• Abdominal pain.
• In extreme cases, vomiting of bile or even fecal matter may occur.

5. Bleeding in the stool.

Bleeding from the diverticula may occur with or without acute diverticulitis.

Bleeding from the diverticular can take several forms:

• Blood mixed with the stool.
• Frank bleeding per rectum.
• Blood mixed with mucus.
• Rarely, black stool or black spots on the stool.

Go to the hospital if you experience bleeding per rectum, even if you don’t have other symptoms and signs of acute diverticulitis.

The amount of bleeding is important; frank bleeding of a large amount of blood from the rectum requires urgent medical attention.

Also, if you experience slight bleeding per rectum for more extended periods may cause significant anemia in the long run.

If you see a small amount of bleed in your stool for several days or weeks, go to the hospital.

6. Signs of low blood pressure (shock).

Low blood pressure (shock) is a rare complication of acute diverticulitis. Different mechanisms may cause such a condition:

• Septic shock due to perforation or abscess from acute diverticulitis.
• Hypovolemic shock due to massive bleeding from the diverticula.

The symptoms of low blood pressure that require going to the hospital include:

• Severe dizziness and lightheadedness.
• Shortness of breath and rapid breathing.
• Fast heartbeats.
• Extreme fatigue, fainting.
• Bluish tinge to the lips and fingernails.
• Confusion or coma in late cases.

7. Recent change in bowel habits (diarrhea or constipation).

Although non-specific, changes in bowel habits are widespread with acute diverticulitis (reference):

• Diarrhea occurs in 35% of patients with acute diverticulitis.
• Loose stool is also very common (without frank diarrhea).
• Constipation occurs in 50% of the cases.

Simple bowel habit changes without abdominal pain or blood in stool are unlikely to be due to acute diverticulitis. Therefore, there is no need to go to the emergency room unless you have severe diarrhea, associated abdominal pain, or fever.

What to expect at the hospital ER?

Once you arrive at the ER, The doctor or nurse will take a medical history, perform a clinical examination, and check for your vital signs.

If your doctor suspects acute diverticulitis, He may order some investigations to confirm the condition and to detect complications such as:

• Full blood count.
• Abdominal imaging (CT, MRI, Ultrasonography, X-ray, or a combination).
• C-reactive protein (CRP).

For mild and non-complicated diverticulitis, Your doctor may decide to prescribe home treatments (with or without antibiotics according to your conditions).

For severe or complicated cases (as with diverticular abscess), Your doctor may admit you for intravenous antibiotics, drainage of an abscess, or even surgery in complicated cases.

MORE:

• Diverticulitis Stool: All You Need to know (Shape, Colors, mucus, & More).
• Diverticulitis Abscess: Causes, symptoms, & Treatments (including surgical drainage).

• Ciprofloxacin for Diverticulitis: Does, Side Effects, & Alternatives.