Diverticulitis is a common digestive condition that affects the large intestine. It occurs when small pouches called diverticula become inflamed or infected. Symptoms of diverticulitis include abdominal pain, fever, nausea, vomiting, chills, cramping, and constipation. In most cases, diverticulitis can be treated with antibiotics and a liquid diet to give the colon a chance to heal. However, in more serious cases, or if diverticulitis keeps coming back, you may need to see a gastroenterologist. Here is a quick overview of when you should see a specialist for diverticulitis:
See a gastroenterologist if:
– You have severe, persistent symptoms that don’t improve with treatment at home
– You have recurring episodes of acute diverticulitis
– You develop complications like fistulas, obstructions, perforations, or abscesses
– You need surgery to remove part of your colon
– You want to discuss preventative treatment options
You likely don’t need a gastroenterologist if:
– You have mild, occasional diverticulitis that improves with rest and antibiotics
– You only have one or two episodes of acute diverticulitis
– Your symptoms are well controlled with diet changes and over-the-counter medications
– You don’t have any complications or other concerning symptoms
So in summary, seeing a specialist is often recommended if you have ongoing issues with diverticulitis that are not resolving with basic treatment. Read on for more details.
What is Diverticulitis?
Diverticula are small pouches or sacs that can form in the wall of the colon. It is very common to have diverticula as you get older, affecting more than half of all people over age 60. Having diverticula alone is called diverticulosis. This condition usually doesn’t cause any problems.
However, in some cases the diverticula become inflamed, known as diverticulitis. This causes pain and discomfort in the lower abdomen.
Diverticulitis happens when stool or bacteria become trapped in the diverticula. This leads to infection and swelling. The diverticula can then rupture and cause abdominal abscesses, which are pockets of pus.
Mild diverticulitis can often be treated at home with rest, a liquid diet, and antibiotics. But some people go on to develop complications like fistulas, bowel obstructions, bleeding, or recurrent infections. These complications usually require a gastroenterologist’s care.
Risk Factors for Diverticulitis
Several factors can increase your risk of developing diverticulitis:
– Age – The risk rises after age 40. About 10-25% of people over 50 have diverticulosis.
– Diet low in fiber – A low fiber diet can lead to constipation and straining during bowel movements. This increases pressure in the colon.
– Obesity
– Smoking
– Lack of exercise
– Medications like steroids and NSAIDs
– Family history – There may be a genetic component in some cases.
When to See a Gastroenterologist for Diverticulitis
In straightforward cases, you can manage diverticulitis at home with rest, liquids, and antibiotics prescribed by your primary care provider. But in other situations, it’s important to have a specialist take a look. Reasons to see a gastroenterologist include:
You Have Severe or Persistent Symptoms
Mild diverticulitis normally starts to improve within a few days on antibiotics and a liquid diet. Severe, worsening pain that doesn’t get better with treatment at home needs quick evaluation. Other concerning symptoms include:
– High fever over 101°F
– Inability to keep down fluids due to vomiting
– Dizziness or rapid heart rate
– Severe cramps or abdominal tenderness
– Rectal bleeding
These could be signs of a complication like a perforation or abscess. A gastroenterologist can help diagnose the cause and start the right treatment, which might include hospitalization, IV antibiotics, pain medications, or emergency surgery.
You Have Recurrent Episodes of Diverticulitis
For many people, a single case of diverticulitis will resolve and not return. But up to 30% of patients end up with repeated episodes. This is known as recurrent or chronic diverticulitis.
After two bouts of diverticulitis, your doctor will likely recommend seeing a specialist. Recurrent diverticulitis needs evaluation to rule out any underlying problems. The gastroenterologist can also help find ways to prevent further attacks.
You Develop Complications
Serious complications can arise from diverticulitis, requiring urgent specialty care. These include:
– **Abscesses** – Pockets of pus form near affected diverticula. You may need antibiotics and drainage.
– **Fistulas** – Abnormal openings develop between the colon and other structures like the bladder, vagina, or skin. Surgery is usually needed.
– **Bowel obstruction** – Severe inflammation blocks the colon. This requires hospitalization.
– **Perforation** – Diverticula can rupture, spilling bacteria into the abdomen. Emergency surgery is needed.
– **Bleeding** – Oozing from inflamed diverticula causes rectal bleeding. It often resolves on its own but can occasionally be severe.
– **Sepsis** – A severe, life-threatening blood infection that requires intensive treatment.
If you have any of these complications, a gastroenterologist can provide the procedures or surgery needed. Early intervention gives you the best chance of recovery.
You Need Surgery
Most cases of diverticulitis will not require surgery. But it may be recommended if:
– You have frequent recurrences that impact quality of life
– You develop severe or recurrent complications
– You have a fistula, obstruction, or perforation
– You have uncontrolled bleeding
There are two main types of surgery:
– **Diverticulectomy** – Just the affected portion with the diverticula is removed
– **Colectomy** – A larger portion or all of the colon may be taken out
A gastroenterologist can determine if surgery is appropriate and perform the procedure. Recovery may require a hospital stay. The specialist can also oversee your long-term care after surgery.
You Want to Discuss Preventative Treatment
Some medications and supplements may help prevent future diverticulitis episodes. A gastroenterologist can determine if these options are recommended for you. This may include:
– **Probiotics** – Live bacteria to improve gut health. Some studies show probiotics may reduce diverticulitis recurrences.
– **Mesalamine** – An anti-inflammatory drug used to treat inflammatory bowel disease. Research indicates it may decrease flare-ups.
– **Rifaximin** – An antibiotic that targets bacteria in the gut and may help prevent infection.
– **Fiber supplements** – Adding fiber improves stool consistency and eases straining.
– **Vitamin D** – Some research links vitamin D deficiency with development of diverticulitis. Supplements may help.
Talk with a specialist to see if these or other preventive therapies are right for you.
When You Likely Don’t Need a Gastroenterologist
Seeing a gastroenterologist probably isn’t necessary if:
You Only Have Mild, Occasional Diverticulitis
For a first episode or infrequent recurrences of mild diverticulitis, your regular doctor can likely manage treatment. With rest and a course of oral antibiotics, you can often recover at home without needing a specialist.
Call your physician if symptoms persist more than 2-3 days on antibiotics. But otherwise a gastroenterologist’s input is not usually needed for an uncomplicated case.
You Have One or Two Episodes
Experiencing diverticulitis once or twice generally doesn’t require specialty referral. Again, your primary care provider can oversee treatment, which is often successful.
Only if you have multiple recurrences or a severe initial case might a gastroenterologist be recommended for aggressive diagnosis and management.
Symptoms Are Controlled with Diet Changes
Adjusting your diet to get more fiber and avoid foods that aggravate diverticula can ease symptoms. Adding fiber supplements or over-the-counter medications may also provide relief.
If these at-home measures keep your diverticulitis well controlled, you likely don’t need to see a gastroenterologist. But if diet and lifestyle changes aren’t helping, a specialist’s guidance could be beneficial.
You Don’t Have Complications
Uncomplicated diverticulitis often resolves with general treatment. It’s the development of serious complications like fistulas, perforations, obstructions, or abscesses that typically necessitates a gastroenterologist’s involvement.
If your diverticulitis responds well without complications, you can typically avoid referral to a specialist. But see a doctor promptly if concerning new symptoms develop.
When to Seek Emergency Care
Most cases of diverticulitis are not emergencies. You’ll start with home treatment and antibiotics from your regular physician. If symptoms are severe at the onset or don’t improve in 2-3 days, seeing a gastroenterologist on an urgent basis is recommended.
However, you should go to an emergency room or call 911 if you experience:
– Sudden, severe abdominal pain along with vomiting, fever, or weakness
– Bleeding from the rectum that does not stop
– Inability to have a bowel movement or pass gas
– Signs of shock like rapid heart rate, confusion, sweating, or fainting
These may indicate a perforation or dangerous infection requiring immediate treatment. Prompt medical care can help prevent life-threatening complications.
How a Gastroenterologist Diagnosis and Treats Diverticulitis
If you see a gastroenterologist for diverticulitis, here is how they will typically evaluate and manage your condition:
Medical History and Physical Exam
The gastroenterologist will ask about your symptoms, including when they started and what makes them better or worse. They will want to know if you have had diverticulitis before.
On exam, they will press on specific areas of your abdomen to check for tenderness, swelling, or masses.
Lab Tests
Blood tests look for signs of infection like elevated white blood cells. A stool test checks for blood from possible colon bleeding. Urinalysis assesses kidney function.
CT Scan
This provides detailed images that confirm diverticulitis and help detect complications like abscesses, perforations, or fistulas. Oral and IV contrast are used.
Ultrasound
Soundwaves create abdominal images. Ultrasound can identify cysts, abscesses and assess nearby organs without radiation exposure. It is not as detailed as CT but may be used for follow-up.
Colonoscopy
This may be done after the acute infection resolves to evaluate the colon. It can detect bleeds, rule out cancer, or assess fistulas. Colonoscopy is usually avoided during an active flare.
Prescribing Antibiotics
Antibiotics treat infection causing diverticulitis. They may be given by IV in the hospital or orally at home. Common choices are ciprofloxacin and metronidazole.
Advising on Diet
A clear liquid diet eases inflammation during acute attacks. The gastroenterologist will advise slowly resuming solid foods as tolerated. They may recommend a high fiber diet.
Ordering Additional Treatment
For severe infection, the specialist may prescribe IV fluids and pain medication. Surgery may be needed for some complications. Procedures like draining abscesses are options.
Coordinating Follow-up Care
The gastroenterologist will specify when to have follow-up visits to assess recovery. They can counsel you on preventing recurrent diverticulitis based on risk factors.
When to See a Gastroenterologist for Follow-Up
Schedule follow-up gastroenterology visits if:
– Your symptoms don’t fully resolve after treatment
– You want guidance on adjusting your diet and lifestyle
– You need ongoing prescriptions to prevent future diverticulitis recurrences
– You need monitoring for complications or disease progression
– You need colonoscopy surveillance at regular intervals
Routine follow-up is especially important if:
– You required hospitalization for diverticulitis
– You have recurrent episodes
– You have other colon issues like inflammatory bowel disease
– You underwent surgery on your colon
The gastroenterologist will tailor an ongoing care plan based on your specific condition and risks. Follow-up visits allow them to monitor your status and adjust management as needed.
Preparing for Your Gastroenterologist Appointment
To make the most of your diverticulitis evaluation, be sure to:
– List your symptoms and when they began
– Note any past episodes of diverticulitis
– Write down your medications, supplements, and dosage information
– Gather your medical records, test results, and colonoscopy reports
– Ask close contacts about their observations of your symptoms
– Make a list of questions you want to ask the gastroenterologist
– Inform them of any pain, nausea, or prior reactions to procedures
– Arrange for a ride home, since sedation is used with some tests
– Follow directions for bowel prep if having a colonoscopy
Thorough preparation and open communication sets you up for an effective gastroenterologist visit. Don’t hesitate to speak up about all your concerns and problems.
Questions to Ask Your Gastroenterologist
Important questions for your gastroenterologist include:
– What caused my diverticulitis?
– Do I need any additional testing to confirm the diagnosis?
– How severe is my condition? Do I show any concerning complications?
– Do I need to be hospitalized for treatment?
– What antibiotics do you recommend?
– What can I eat during acute episodes? What dietary changes do you advise?
– Are probiotics or other supplements recommended?
– How much activity can I do? When can I return to work?
– How often should I schedule follow-up visits?
– Will I need surgery or repeat colonoscopies in the future?
– What steps can I take to prevent this from happening again?
– When should I go to the ER if symptoms return?
Don’t leave your appointment until all your questions have been answered. Full understanding of your diverticulitis helps ensure proper care.
Conclusion
In many uncomplicated cases of diverticulitis, home treatment will be sufficient. But seeing a gastroenterologist is often advised for severe or recurring episodes, or if complications develop. The specialist has the expertise to thoroughly evaluate your condition and provide appropriate management.
Visit a gastroenterologist if you have concerning symptoms that don’t resolve with rest and antibiotics. Seek urgent care if you experience sudden, severe pain, bleeding, vomiting, fever, or trouble passing stools. Follow up regularly with your gastroenterologist to monitor your health and prevent future flare-ups.
With the right care from a specialist when indicated, most people with diverticulitis recover well and can go on to live a healthy life. Monitoring symptoms closely and getting gastroenterology care when appropriate allows you to optimally manage this common digestive disease.