Diverticulitis is a common digestive condition characterized by the inflammation or infection of small, bulging pouches, known as diverticula, that form in the wall of the large intestine, or colon. The mere presence of these pouches is called diverticulosis. For individuals experiencing recurrent, severe, or complicated episodes—such as those involving abscesses, fistulas, or perforations—surgeons may recommend a colon resection, often a sigmoid colectomy. This procedure involves surgically removing the diseased segment of the colon and then reattaching the healthy ends (anastomosis). This surgery aims to eliminate the source of the severe inflammation and prevent future life-threatening complications.
Does Diverticulitis Return After Resection?
While a colon resection is an effective treatment, it does not eliminate the possibility of future flare-ups because the underlying condition of diverticulosis remains. The surgery removes the segment of the colon that was the most severely affected, typically the sigmoid colon. However, the potential for new pouches to form or existing ones to become inflamed persists in the remaining sections of the large intestine.
Recurrence rates after a successful resection vary widely, but they are significantly lower than the risk faced by patients who do not undergo surgery. Generally, the rate of recurrent diverticulitis after a colectomy is cited in the range of 5% to 15% over several years of follow-up. Some data suggest a recurrence rate as low as 2.14% after fifteen years, particularly when the initial surgery was for uncomplicated disease. When recurrence does occur, it most commonly happens in the segment of the colon immediately above the surgical connection (anastomosis).
The risk of a complicated recurrence—one that leads to an abscess or perforation—is low following elective surgery. The purpose of the resection is primarily to prevent the most severe and life-threatening complications that necessitated the initial operation. Therefore, while the potential for a mild, uncomplicated flare-up remains, the overall benefit of the surgery in reducing serious disease is substantial.
Primary Risk Factors for Re-Inflammation
Younger patients who undergo surgery for diverticulitis tend to have a higher risk of recurrence compared to older patients. This may be due to a more aggressive underlying disease process or a longer period of risk exposure following the operation.
The presence of persistent abdominal pain or other symptoms following the surgery is a significant predictor of future flare-ups. This suggests that the underlying functional issues of the colon, which may include irritable bowel syndrome-like symptoms, have not been fully resolved. Certain disease characteristics, such as a history of complicated diverticulitis involving an abscess, also elevate the risk of future episodes.
Patients who continue to smoke cigarettes are at a greater risk of complications and recurrence. Obesity is consistently linked to a higher incidence of diverticulitis episodes, which remains a factor even after a portion of the colon has been removed. The use of chronic immunosuppressive medication, such as corticosteroids, also increases the likelihood of a severe or complicated recurrence.
Dietary and Lifestyle Changes to Prevent Flare-Ups
Adopting specific dietary and lifestyle modifications is the strategy patients can employ to reduce the risk of future diverticulitis episodes. A high-fiber diet is recommended, as it promotes regular bowel movements and reduces pressure within the colon, which contributes to diverticula formation. Adults should aim for a daily fiber intake of approximately 25 grams for women and 38 grams for men, sourced from whole grains, fruits, vegetables, and legumes.
It is important to increase fiber intake gradually to prevent uncomfortable side effects like bloating and gas. This increase must be paired with sufficient fluid consumption, as water is necessary for fiber to soften stool and pass smoothly through the digestive tract. Dehydration can lead to constipation, which increases colonic pressure and potentially the risk of inflammation.
Regular physical activity helps maintain healthy bowel function by stimulating the intestinal muscles and encouraging consistent movement. Maintaining a healthy body weight also lowers the risk of recurrence, as excess weight is a known risk factor for developing the condition. Current medical understanding indicates that nuts, seeds, and popcorn are safe to consume and are not associated with causing diverticulitis flare-ups. These foods are sources of fiber and are now encouraged as part of a healthy, preventative diet.