10 Warning Signs and Symptoms of Diverticulitis You Should Know

Diverticulitis is a digestive condition that occurs when small pouches called diverticula, which form in the walls of the colon, become inflamed or infected. This condition affects millions of people worldwide, particularly those over the age of 40. While some people with diverticula experience no symptoms at all (a condition called diverticulosis), diverticulitis can cause significant discomfort and requires prompt medical attention.

Understanding the warning signs of diverticulitis is crucial for early detection and proper management. The symptoms can range from mild discomfort to severe complications that may require hospitalization. In this comprehensive guide, we’ll explore the ten most common symptoms of diverticulitis, helping you recognize when it’s time to consult with a healthcare professional.

1. Sudden and Severe Abdominal Pain

The most characteristic symptom of diverticulitis is sudden, severe pain in the lower left side of the abdomen. This is the hallmark sign that distinguishes diverticulitis from other digestive conditions. The pain occurs because the diverticula, small pouches in the colon wall, become inflamed or infected.

Key characteristics of diverticulitis pain include:

• Location: Typically felt in the lower left quadrant of the abdomen, though in Asian populations it may occur on the right side
• Intensity: Can range from constant mild discomfort to sharp, severe pain
• Duration: Usually persistent rather than coming and going
• Worsening pattern: May intensify when moving, coughing, or touching the affected area

The pain develops when bacteria become trapped in the diverticula, causing inflammation and sometimes infection. Unlike other types of abdominal pain that may shift or migrate, diverticulitis pain tends to remain localized to one area. Some patients describe it as a constant ache that suddenly worsens, while others experience immediate severe pain. The intensity can be significant enough to interfere with daily activities and sleep.

2. Fever and Chills

When diverticulitis progresses to infection, fever is a common response as your body fights off the bacterial invasion. A fever accompanying abdominal pain is a red flag that suggests the condition may be more serious than simple diverticulosis.

Temperature-related symptoms include:

• Low-grade fever: Usually ranging from 100°F to 102°F (37.8°C to 38.9°C)
• Chills or feeling cold despite warm surroundings
• Body aches and general malaise
• Night sweats in some cases

The presence of fever indicates that the inflammation has likely progressed to infection, a condition known as acute diverticulitis. This is your body’s immune system responding to bacteria that have breached the intestinal wall through the inflamed diverticula. A high fever (above 102°F or 38.9°C) or a fever that persists for more than a day or two requires immediate medical attention, as it may signal a more serious complication such as an abscess or perforation.

3. Nausea and Vomiting

Nausea and vomiting frequently accompany diverticulitis, occurring as your digestive system responds to the inflammation and infection in the colon. These symptoms can range from mild queasiness to severe vomiting that prevents you from keeping food or liquids down.

This symptom manifests as:

• Persistent nausea that worsens with eating
• Loss of appetite due to feeling sick
• Occasional or frequent vomiting
• Increased saliva production

The nausea and vomiting occur because inflammation in the colon can disrupt normal digestive processes and trigger signals to the brain’s vomiting center. Additionally, the pain associated with diverticulitis can itself cause nausea. When the inflammation is severe, it may partially obstruct the intestine, leading to increased nausea and vomiting. These symptoms can also lead to dehydration, which further complicates the condition and makes medical evaluation important.

4. Changes in Bowel Habits

Diverticulitis often causes significant disruptions to your normal bowel patterns. These changes can vary considerably from person to person, with some experiencing constipation while others develop diarrhea.

Common bowel changes include:

• Constipation: Difficulty passing stools or decreased frequency of bowel movements
• Diarrhea: Loose, watery stools occurring more frequently than normal
• Alternating patterns: Switching between constipation and diarrhea
• Incomplete evacuation: Feeling like you haven’t fully emptied your bowels
• Increased urgency: Sudden, strong need to have a bowel movement

These changes occur because the inflammation and swelling in the colon affect its normal function. When the colon wall is inflamed, it may not absorb water properly, leading to diarrhea. Conversely, if the inflammation causes narrowing of the intestinal passage, constipation may result. The unpredictability of these symptoms can be distressing and significantly impact quality of life, making it difficult to plan daily activities.

5. Abdominal Bloating and Distension

Many people with diverticulitis experience noticeable bloating and visible swelling of the abdomen. This occurs as gas and fluids accumulate in the intestines due to the inflammatory process and altered digestive function.

Bloating symptoms include:

• Feeling of fullness or tightness in the abdomen
• Visible swelling or distension of the belly
• Increased abdominal girth
• Discomfort that worsens after eating
• Difficulty wearing normal clothing due to abdominal expansion

The bloating associated with diverticulitis differs from normal digestive bloating. It tends to be more persistent and may be accompanied by tenderness when the abdomen is touched. The inflammation can slow down the movement of gas and stool through the intestines, leading to accumulation and distension. This symptom can be particularly uncomfortable when combined with the abdominal pain characteristic of diverticulitis, creating a sensation of pressure from within.

6. Tenderness When Touching the Abdomen

Abdominal tenderness is a significant clinical sign of diverticulitis. This symptom refers to pain or discomfort that occurs when pressure is applied to the abdomen, particularly in the lower left quadrant.

Characteristics of abdominal tenderness:

• Point tenderness: Pain localized to a specific spot when pressed
• Guarding: Involuntary tensing of abdominal muscles when touched
• Rebound tenderness: Pain that worsens when pressure is suddenly released
• Sensitivity to light touch: Even gentle pressure causes discomfort

Healthcare providers often check for abdominal tenderness during physical examination as it helps confirm the diagnosis of diverticulitis. The tenderness occurs because the inflamed area of the colon is closer to the abdominal wall, and pressure from outside causes pain in the affected tissue. Severe tenderness, especially rebound tenderness, can indicate more serious complications such as peritonitis (inflammation of the abdominal lining) and requires urgent medical evaluation.

7. Blood in the Stool

While more commonly associated with diverticulosis, blood in the stool can occasionally occur with diverticulitis. This symptom requires immediate medical attention as it may indicate bleeding from the inflamed or infected diverticula.

Blood in stool may appear as:

• Bright red blood: Indicating bleeding from the lower colon or rectum
• Dark, tarry stools: Suggesting bleeding from higher in the digestive tract
• Blood mixed with stool
• Blood on toilet paper after wiping
• Maroon-colored stools

In diverticulitis, bleeding occurs when the blood vessels near the inflamed diverticula become damaged. The amount of blood can range from small streaks to significant bleeding. It’s important to note that while diverticular bleeding is usually painless and more associated with diverticulosis, when it occurs with the pain and fever of diverticulitis, it suggests a more complex presentation. Any rectal bleeding should prompt immediate consultation with a healthcare provider to determine the cause and appropriate management.

8. Frequent and Painful Urination

Some people with diverticulitis, particularly women, may experience urinary symptoms. This occurs when the inflamed section of the colon is located close to the bladder, causing irritation to the bladder wall.

Urinary symptoms may include:

• Increased frequency of urination
• Burning sensation or pain during urination
• Urgent need to urinate
• Difficulty emptying the bladder completely
• Lower abdominal pressure related to urination

These symptoms occur because of the anatomical proximity of the sigmoid colon (the most common site of diverticulitis) to the bladder. The inflammation can spread to affect nearby structures, a phenomenon called “sympathetic inflammation.” In some cases, a fistula (abnormal connection) can develop between the colon and bladder, leading to more severe urinary symptoms including urinary tract infections or the passage of gas or fecal material in the urine. Women are more susceptible to urinary symptoms with diverticulitis due to anatomical differences.

9. Loss of Appetite and Unintended Weight Loss

A decreased desire to eat is a common symptom of diverticulitis, often resulting from the combination of nausea, abdominal pain, and general feeling of being unwell. When prolonged, this can lead to unintended weight loss.

This symptom presents as:

• Reduced interest in food
• Feeling full after eating only small amounts
• Aversion to certain foods, particularly those high in fiber
• Weight loss without trying
• Weakness or fatigue due to reduced caloric intake

The loss of appetite occurs for several reasons. Pain and nausea naturally suppress hunger signals. Additionally, many people unconsciously avoid eating because they associate food with increased discomfort. The body’s inflammatory response also produces chemicals called cytokines that can suppress appetite. If loss of appetite persists for several days or is accompanied by significant weight loss, it’s important to seek medical attention. Prolonged poor nutrition can impair healing and immune function, making recovery more difficult.

10. Fatigue and General Weakness

Feeling exhausted and weak is a common but often overlooked symptom of diverticulitis. This occurs as your body directs energy toward fighting the infection and inflammation, leaving you feeling drained and tired.

Fatigue in diverticulitis manifests as:

• Persistent tiredness that doesn’t improve with rest
• Lack of energy for normal daily activities
• Mental fog or difficulty concentrating
• Muscle weakness
• Increased need for sleep
• Feeling physically and emotionally drained

The fatigue associated with diverticulitis has multiple causes. The inflammatory process requires significant energy expenditure by the immune system. Fever increases metabolic rate, further draining energy reserves. Poor nutrition due to decreased appetite and nausea means your body isn’t getting adequate fuel. Additionally, pain and discomfort can disrupt sleep patterns, leading to sleep deprivation. The combination of infection, inflammation, poor nutrition, and disrupted sleep creates a profound sense of exhaustion that can persist even after other symptoms begin to improve.

What Causes Diverticulitis?

Understanding the causes of diverticulitis can help you recognize risk factors and take preventive measures. Diverticulitis develops when one or more diverticula (small pouches that bulge out from the colon wall) become inflamed or infected.

The main causes and contributing factors include:

Bacterial Infection: The primary cause of diverticulitis is when bacteria that normally live in the colon become trapped inside a diverticulum. This can happen when fecal matter or undigested food particles block the opening of the pouch, creating an environment where bacteria multiply and cause infection.

Low Fiber Diet: A diet lacking in fiber is one of the most significant risk factors. Fiber helps soften stool and promotes regular bowel movements. Without adequate fiber, stools become hard and require more pressure to pass through the colon, which over time can lead to the formation of diverticula and increase the risk of inflammation.

Age: The risk of developing diverticulitis increases significantly with age, particularly after 40. As we age, the walls of the colon naturally weaken, making it easier for diverticula to form and become inflamed.

Obesity: Excess body weight, particularly around the abdomen, increases the risk of diverticulitis. Obesity is associated with chronic inflammation throughout the body and may contribute to inflammation in the colon.

Lack of Physical Activity: A sedentary lifestyle has been linked to increased risk of diverticulitis. Regular exercise helps promote normal bowel function and may reduce inflammation.

Smoking: Tobacco use increases the risk of developing diverticulitis and experiencing complications from the condition.

Certain Medications: Regular use of certain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and opioids, may increase the risk of diverticulitis.

Genetics: Family history plays a role, suggesting that some people may be genetically predisposed to developing diverticula and subsequent diverticulitis.

Prevention Strategies for Diverticulitis

While not all cases of diverticulitis can be prevented, certain lifestyle modifications can significantly reduce your risk of developing this condition or experiencing recurrent episodes.

Increase Fiber Intake: Gradually increase your daily fiber consumption to 25-35 grams per day. Good sources include whole grains, fruits, vegetables, legumes, and nuts. Fiber adds bulk to stool and helps it pass more easily through the colon, reducing pressure on the intestinal walls. However, increase fiber gradually to avoid gas and bloating, and if you already have diverticulitis, consult your healthcare provider before making dietary changes.

Stay Hydrated: Drink plenty of water throughout the day, aiming for at least 8 glasses daily. Adequate hydration works together with fiber to keep stools soft and promote regular bowel movements. Water helps fiber do its job effectively in the digestive system.

Exercise Regularly: Engage in moderate physical activity for at least 30 minutes most days of the week. Exercise promotes normal bowel function, helps maintain a healthy weight, and may reduce inflammation throughout the body. Activities like walking, swimming, cycling, or yoga can all be beneficial.

Maintain a Healthy Weight: If you’re overweight or obese, work toward achieving a healthy body weight through balanced diet and regular exercise. Excess weight, particularly abdominal obesity, increases the risk of diverticulitis.

Quit Smoking: If you smoke, seek support to quit. Smoking increases the risk of diverticulitis and makes complications more likely.

Limit Red Meat Consumption: Some studies suggest that high consumption of red meat may increase the risk of diverticulitis. Consider replacing some meat meals with plant-based protein sources like beans, lentils, and tofu.

Respond to Bowel Urges: Don’t delay when you feel the need to have a bowel movement. Holding in stool can lead to constipation and increased pressure in the colon.

Consider Probiotics: Some research suggests that probiotics (beneficial bacteria) may help maintain a healthy gut environment, though more studies are needed. Discuss with your healthcare provider whether probiotics might be appropriate for you.

Limit NSAID Use: If possible, avoid regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, as these may increase diverticulitis risk. Always consult your healthcare provider before stopping any prescribed medication.

Frequently Asked Questions About Diverticulitis

How is diverticulitis different from diverticulosis?

Diverticulosis refers to the presence of diverticula (small pouches) in the colon wall without inflammation or infection. Many people have diverticulosis without any symptoms. Diverticulitis occurs when one or more of these pouches become inflamed or infected, causing pain and other symptoms. Think of diverticulosis as the condition and diverticulitis as the complication.

Are diverticulitis symptoms different in women than in men?

The core symptoms of diverticulitis are generally the same for both sexes, but women may be more likely to experience urinary symptoms such as frequent or painful urination due to the proximity of the reproductive organs to the colon. Women may also be more likely to report the pain to healthcare providers earlier, potentially leading to earlier diagnosis. Hormonal factors may play a role in symptom presentation as well.

When should I seek emergency medical care for diverticulitis?

Seek immediate medical attention if you experience severe, persistent abdominal pain, high fever (above 101°F or 38.3°C), inability to keep down liquids, vomiting blood, blood in your stool, or signs of dehydration. These symptoms may indicate complications such as perforation, abscess, or peritonitis that require urgent treatment.

Can diverticulitis go away on its own?

Mild cases of diverticulitis may sometimes improve with rest and dietary modifications, but it’s important to consult a healthcare provider for proper diagnosis and guidance. Untreated diverticulitis can lead to serious complications including abscesses, perforation, peritonitis, or fistulas. Medical evaluation ensures appropriate management and helps prevent complications.

How long do diverticulitis symptoms typically last?

With appropriate management, symptoms typically begin to improve within 2-3 days and resolve within 7-10 days. However, the duration can vary depending on the severity of the inflammation and whether complications develop. Some people may experience lingering symptoms for several weeks, particularly fatigue and changes in bowel habits.

Can stress cause diverticulitis?

While stress doesn’t directly cause diverticulitis, it may contribute to flare-ups in people who already have diverticula. Stress can affect digestive function, alter gut bacteria balance, and potentially increase inflammation in the body. Managing stress through relaxation techniques, adequate sleep, and regular exercise may help reduce the risk of diverticulitis episodes.

Is diverticulitis a chronic condition?

Diverticulosis (having diverticula) is a chronic condition—once pouches form, they don’t go away. However, diverticulitis (inflammation or infection) is an acute condition that occurs in episodes. Some people experience only one episode in their lifetime, while others have recurrent episodes. Following preventive strategies can help reduce the likelihood of recurrence.

What foods should I avoid if I have symptoms of diverticulitis?

During an acute episode of diverticulitis, your healthcare provider may recommend a low-fiber or clear liquid diet temporarily to allow the colon to heal. This might mean avoiding nuts, seeds, popcorn, raw vegetables, and whole grains during the acute phase. However, once symptoms improve, gradually reintroducing high-fiber foods is typically recommended for long-term prevention. Always follow your healthcare provider’s specific dietary recommendations.

Can young people get diverticulitis?

While diverticulitis is most common in people over 40, younger individuals can develop it, particularly if they have risk factors such as obesity, low fiber diet, lack of exercise, or genetic predisposition. When diverticulitis occurs in younger people, it may sometimes be more aggressive and have a higher risk of recurrence, making prevention strategies particularly important.

References:

• Mayo Clinic – Diverticulitis
• National Institute of Diabetes and Digestive and Kidney Diseases – Diverticulosis and Diverticulitis
• Johns Hopkins Medicine – Diverticular Disease
• National Center for Biotechnology Information – Diverticulitis
• NHS – Diverticular Disease and Diverticulitis