Anyone who has ever suffered the severe abdominal pain of an acute diverticulitis attack agrees it’s never something they want to experience again. However, the intense pain of a severe, acute diverticulitis episode is only one form of diverticulitis symptoms. Many more people suffer from a more chronic form of the disease that is characterized by less severe lower abdominal pain, bloating, constipation, and diarrhea.
Diverticulitis is widespread
Diverticulitis—a disease of the colon that causes lower abdominal pain—is becoming increasingly common in the United States in the over-50 population. As we age, become more sedentary, and eat Western-style diets devoid of fiber, many of us start to develop small, weak areas in the muscular wall of the colon. This allows the colon’s lining to protrude through, forming tiny pouches called diverticuli.
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It’s fortunate that diverticuli usually don’t cause any symptoms, given how common they are: 50% of people at age 50 years, 60% at age 60 years, and almost 70% of people in their 70s and 80s are estimated to have diverticulosis, which is how the condition is defined when the presence of diverticula causes no symptoms.
In up to 20% of people with diverticulosis, however, the diverticuli bleed or become inflamed or infected, leading to what is called diverticulitis. Abdominal pain, fever, and constipation are common diverticulitis symptoms, but, as you will soon see, medical researchers have recently discovered that the symptoms of diverticulitis are much more variable than traditionally thought.
Acute diverticulitis symptoms
Diverticulitis symptoms often include the following:
- Lower abdominal pain (occurs on left side in 70% of patients; often described as crampy)
- Change in bowel habits
- Nausea and vomiting
The symptoms of diverticulitis depend on many factors, including the location of the inflamed diverticula in the abdomen, the severity of the inflammatory process, and the presence of complications (see below).
Some people have a single, acute episode of diverticulitis, never to have the problem again. Other people may suffer from recurrent, distinct episodes. In these cases, the lower abdominal pain is often severe and comes on suddenly, but it can also be mild and become worse over several days. The intensity of the pain can fluctuate.
Symptoms caused by complicated diverticulitis may be severe and life-threatening
Occasionally, diverticulitis leads to bleeding; infections; small tears, called perforations; or blockages in the colon. Bleeding diverticula can lead to blood in the stool. Infected diverticula can form abscesses or can perforate and leak infected fluid into the abdominal cavity, which can lead to body-wide infection (sepsis), fever, chills, and severe abdominal pain.
Fistulas may form if infection spreads outside the colon and causes the colon’s tissue to stick to nearby tissues, such as the bladder. This may cause chronic, severe bladder infections with associated pelvic pain. Scarring caused by infection may lead to partial or total blockage of the intestine, called intestinal obstruction. When the intestine is blocked, severe constipation, bloating, and pain occurs. For these complicated cases of diverticulitis, hospitalization and surgery are often required.
Symptoms of chronic diverticulitis may resemble irritable bowel syndrome
Not all people with diverticulitis have distinct, acute episodes separated by symptom-free periods. In fact, what is becoming more and more obvious to medical experts in recent years is that a number of people have a chronic, low-grade form of diverticular disease that causes ongoing symptoms which mimic the symptoms of irritable bowel syndrome (IBS).[3-4]
Factors leading to symptoms in this chronic form of diverticular disease include low-grade inflammation, altered intestinal gut bacteria (microbiota), hypersensitivity of the gut tissue to pain, and abnormal gut motility.
For these people, symptoms often include more vague abdominal pain and discomfort, bloating, constipation, and diarrhea. The onset of the IBS-like abdominal pain is often associated with a change in frequency and/or form (appearance) of stool and is typically relieved with defecation.
What to do if you have diverticulitis
Whether you have an acute, severe attack of diverticulitis or a more chronic form of the disease, new treatment options are available that don’t involve strong antibiotics or invasive surgery. While antibiotics and surgery have traditionally been the conventional treatments of choice, new evidence shows that they are typically not helpful or necessary.
Not only that, but we now have enough research showing the benefits of natural treatments like probiotics and vitamin D that even conventional gastroenterologists are beginning to recommend them to their patients.
If you have diverticulitis symptoms, seek out a healthcare provider who is up-to-date on the latest research that shows the benefits of natural treatments like probiotics, vitamin D, and more.
Originally published in January 2016, this post has been updated.
 Dig Dis Sci. 2015 Oct 12. [Epub ahead of print]