Diverticulitis develops when small, balloon-like pouches called diverticula in the wall of the large intestine, or colon, swell, become inflamed, or get infected. The condition starts with diverticulosis, which means creating these pouches in the first place. Diverticulosis is very common in people over 50, but usually causes no problems.
Diverticulitis occurs when these pouches become infected, affecting only about 5% of people with diverticulosis. The condition often begins when a small piece of hardened stool gets trapped in a pouch, irritates it, and creates a microscopic tear. This tear allows bacteria to leak out, causing infection and pain.
Risk factors include obesity, not exercising regularly, smoking, and frequently using certain pain relievers like aspirin or NSAIDS (e.g., ibuprofen, Advil®, Motrin®, nonsteroidal anti-inflammatory drugs).
Diverticulitis often strikes suddenly with an acute illness, starting with the main symptom of severe, constant pain in the belly, usually on the lower left side. This pain is often accompanied by signs of infection, such as a fever and chills, along with nausea or vomiting and changes in bathroom habits, which can manifest as either new constipation, rectal bleeding, or diarrhea. Doctors use a CT scan (a detailed, 3-D X-ray) to confirm the diagnosis, check the extent of the inflammation, and look for any serious complications.
Treatment depends entirely on how severe the infection is, distinguishing between uncomplicated (mild) and complicated (serious) cases.
For most healthy people with mild, uncomplicated diverticulitis, doctors often skip antibiotics and instead focus on helping the colon heal naturally. This supportive care usually involves management at home by resting and following a clear liquid diet for a short period to “rest the bowel,” with a gradual return to solid foods as the pain improves.
However, antibiotics remain absolutely necessary and are advised for patients who are immunocompromised, frail, have severe comorbidities, present with signs of systemic infection, or whose initial mild symptoms do not improve after conservative observation.
Complicated diverticulitis cases, which may involve gastrointestinal bleeding, an abscess (a pocket of pus), a perforation (a hole in the colon wall), or a fistula (an abnormal tunnel), are serious and always require immediate hospitalization and strong Intravenous (IV) antibiotics.
When a localized abscess is present, its size dictates management: clinicians can typically cure small abscesses (less than 3–4 cm) with IV antibiotics alone, while radiologists often perform CT-guided percutaneous drainage to treat larger abscesses by draining the pus through a tiny tube—often avoiding emergency surgery.
A complete rupture or hole in the colon (perforation), causing widespread abdominal infection (peritonitis), is life-threatening and requires urgent surgery to immediately remove the damaged colon segment and achieve definitive source control.
To calm inflamed diverticulitis, especially in mild, uncomplicated cases, the main focus is on supportive care to rest the colon and manage pain.
The core strategy is to temporarily minimize the work your digestive system has to do, allowing the inflamed pouches to heal. This is done in phases to let the inflammation subside. Doctors will usually recommend you start with a liquid diet for the first few days (typically one to three days) to effectively “rest the bowel” and reduce stool output that could irritate the diverticula. You should consume clear broth, pulp-free juices (like apple or white grape), water, sports drinks, plain gelatin, and ice pops (without fruit bits) during this initial stage.
As your symptoms improve, you’ll gradually add low-fiber foods to your diet to avoid introducing bulky material while your colon heals. Eat items like eggs, white bread, white rice, cooked and peeled fruits or vegetables (such as canned peaches or mashed potatoes), and lean, tender meat.
Once fully recovered (usually two to four days after starting the low-fiber diet), you can gradually return to a high-fiber diet to help prevent future flare-ups.
Controlling the pain will help keep you comfortable and promote rest, so acetaminophen (Tylenol®) is the preferred over-the-counter pain reliever. Additionally, applying heat, such as using a heating pad on the lower abdomen, can often provide quick relief from cramping and pain.
Cannabis may help with diverticulitis, primarily by alleviating key symptoms like pain and inflammation. The effects of cannabis are mediated through the endocannabinoid system (ECS), which is a network of receptors and compounds throughout your body, including your gastrointestinal tract, that plays a vital role in maintaining gut health, managing visceral pain, and regulating inflammation.
The main receptors in this system are CB1 and CB2, and while CB1 is mostly in the brain, CB2 receptors are abundant in the immune cells and the tissues of the gut, making them key targets for anti-inflammatory and motility-regulating action in digestive conditions like diverticulitis.
Studies have noted that the concentration of these CB1 and CB2 receptors increases in the gut when conditions like diverticulitis are present, suggesting the body is already trying to use this system to respond to the inflammation.
Cannabinoids also exert a positive influence on gut microbial balance and other receptor types like TRPV1 and many other anti-inflammatory and pain-relieving targets. These actions make up the larger concept of the endocannabinoidome.
The organic compounds in cannabis, including major cannabinoids like tetrahydrocannabinol (THC) and cannabidiol (CBD), may offer relief through several mechanisms. The main appeal of using cannabinoids for diverticulitis is their anti-inflammatory potential, as CBD shows promise for irritable and inflammatory bowel conditions, demonstrating an ability to reduce inflammatory markers like certain cytokines (immune signaling proteins) that drive the swelling and damage in the colon. CBD also increases auto-regulatory endocannabinoids that correct motility and pain relief.
Cannabinoids like THC work in part by interacting with the CB2 receptors on immune cells, essentially helping to calm the exaggerated immune response that causes the acute inflammation in the diverticula. For patients experiencing a flare-up, the most reported benefit of cannabis use is symptom control, with THC being well-known for its pain-relieving (analgesic) properties, which can interrupt the pain signals traveling from the inflamed gut to the brain, offering relief from the severe abdominal cramping and discomfort common with diverticulitis.
Additionally, patients with inflammatory gastrointestinal issues often report that cannabis helps to improve appetite and reduce related symptoms like nausea and vomiting, and the activation of CB1 receptors in the gut is also associated with slowing down intestinal movement, which could help rest the colon during a flare-up.
Yes, cannabidiol (CBD) may potentially help with the symptoms of diverticulitis. But its role is primarily for symptom management, not as a cure for the condition itself. There is no direct research on this topic, so we don’t yet know the best recommended dosage, route, or frequency.
Recent studies highlight CBD’s strong anti-inflammatory potential, showing it can help reduce the levels of pro-inflammatory chemicals like cytokines that cause the painful swelling in the diverticula.
Furthermore, CBD effectively relieves the severe abdominal pain, nausea, and discomfort that occur during flare-ups. It serves best as a complementary option to improve quality of life and manage symptoms, but patients should not use it to replace standard medical treatments such as antibiotics or prescribed therapies for the underlying infection and inflammation.
It is best to always discuss CBD use with a doctor to ensure it is a safe complementary treatment option.
The healing time for diverticulitis largely depends on whether the condition is uncomplicated or complicated. Most cases of uncomplicated or mild diverticulitis tend to resolve quickly, usually going away on its own within about one week.
In these milder cases, even without specific medical treatment, around 95 out of 100 people will see their symptoms disappear within this seven-day period. If a doctor prescribes antibiotics for mild diverticulitis, the typical course of medication generally lasts for seven to ten days.
For more severe cases, which are classified as complicated diverticulitis and involve issues like abscesses or perforations, the recovery is longer and requires hospital care.
About 80 out of 100 people with complicated diverticulitis will clear the infection within a few weeks when treated with antibiotics.
This treatment often starts with intravenous, or IV, antibiotics given in the hospital for about three to five days, followed by a switch to oral antibiotics for an additional ten to fourteen days. It is important to note that full healing after a severe episode, which may involve complications or surgery, can take several weeks.
A healthcare provider usually recommends a follow-up colonoscopy four to eight weeks after the initial symptoms subside to confirm that the colon has fully healed and to check for other potential issues.
The primary treatment for mild diverticulitis is generally supportive care, including bowel rest, adequate hydration, and a clear liquid diet (CLD). However, the drug of choice for the intense pain that comes with it is acetaminophen. For high-risk or complicated infections, an antibiotic like amoxicillin-clavulanate is often used.
Yes, medical marijuana may help relieve some digestive symptoms. It is mainly used for symptom management, like reducing abdominal pain, nausea, and cramping, and improving appetite. Cannabinoids and some terpenes can help regulate gut motility, inflammation, and microbiota in the short and long-term.
Yes, heavy marijuana use can cause several dose-dependent problems related to the colon, especially with chronic, heavy use. It can affect the colon by decreasing motility (slowing down movement), which can contribute to constipation, nausea, or vomiting if taken in excess. The condition linked to chronic use is cannabinoid hyperemesis syndrome (CHS), which causes severe, cyclical vomiting, abdominal pain, and dehydration, and may require emergency care.
Additionally, a history of high cannabis use has been associated with increased mortality in colon cancer patients. However, this is likely confounded by the severity of the disease and desperation for relief.
You should avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, because they increase the risk of intestinal bleeding and perforation. Opioid painkillers and corticosteroids (like prednisone) should also be avoided, because these drugs significantly increase the risk of complications such as constipation, flare-ups, and colon perforation.
The safest over-the-counter pain reliever is generally acetaminophen, but always consult with your doctor before changing or stopping any prescribed medications.
The newest treatment for mild diverticulitis is conservative care (observation, liquid diet, and pain management), replacing routine antibiotics. When surgery is required, surgeons prefer minimally invasive laparoscopic techniques for chronic or complicated cases, making small incisions to promote faster recovery. They base the decision on each patient’s symptoms and quality of life.
The worst factors for diverticulitis are the use of NSAIDs, aspirin, and opioid painkillers, which significantly increase the risk of intestinal bleeding or perforation. Secondly, lifestyle factors such as obesity, smoking, and a low-fiber diet raise the risk of developing or worsening the condition.
Too much marijuana may not be good for your gut health; however, in lower or controlled doses, cannabinoids may ease inflammatory symptoms by reducing pain and inflammation in conditions like inflammatory bowel disease (IBD), but too much will slow down bowel movement, and doctors warn that this effect can dangerously increase the risk of intestinal blockage in diverticulitis cases.
Written by Chiagozie Ekemezie
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