Diverticulitis

What is diverticulitis during pregnancy?

Diverticulitis is inflammation (usually due to infection) of a diverticulum, a pouch that has bulged out from the intestines. Diverticula often develop over time, in places where the intestinal wall is weak, usually in the colon (the large intestine). Known as diverticulosis, the condition of having multiple diverticula develops over time, provoked by a variety of risk factors, many that you can control. Additionally, there is a congenital type of diverticulum, called a Meckel diverticulum, which bulges from the distal (lower) part of the small intestine. This is due to an error during embryology, but it too can get infected (Meckel diverticulitis). The significance of diverticulitis in pregnancy is that it is one of a handful of conditions causing abdominal pain that must be distinguished from one another, yet pregnancy often makes such distinction more challenging than when youre not pregnant. One reason for this is that diverticulitis usually occurs in the sigmoid colon, causing pain in the left lower quadrant (LLQ) of the abdomen, while Meckel diverticulitis causes pain around the umbilicus, appendicitis causes pain that begins around the umbilicus and moves to the lower right, and an inflamed gallbladder (cholecystitis) gives you right upper quadrant (RUQ) pain. As pregnancy advances, however, contents of your gastrointestinal (GI) tract shift around, so the location of the pain is not as useful to the diagnosis as it is when youre not pregnant.

How common is diverticulitis during pregnancy?

Diverticulitis is rare during pregnancy, but in the United States, an estimated 2.5 million people are affected with diverticular disease, which includes diverticulitis and other complications of diverticulosis, such as diverticular bleeding. In western countries, diverticulosis is present in approximately 20 percent of people in their forties and in increasingly higher percentages of people with increasing age, while Meckel diverticulum is present in an estimated 2 percent of the population. Increasing age, obesity, smoking, lack of exercise, lack of dietary fiber, high intake of dietary fat and red meat, and use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin increase your risk of having diverticulosis. For those who do have diverticulosis, there is an estimated 10 to 25 percent chance of developing diverticulitis at least once in life, with 15 to 20 percent of such people developing severe complications. Although older age is a risk factor, both for having diverticulosis in the first place and for having an episode of diverticulitis, once you have had diverticulitis, younger age is a risk factor for having multiple episodes.

How is diverticulitis during pregnancy diagnosed?

Doctors may initially perform an abdominal ultrasound to reveal evidence of an inflamed diverticulum, but computed tomography (CT) scanning of the abdomen is the gold standard for diagnosing the condition. The dosage of ionizing radiation imparted to an embryo or fetus during a single abdominal CT scan of the mother is substantial but is below the limit that is thought to cause birth defects, even during the most radiation-sensitive time, the early fetal period, running from 8 to 15 weeks gestation. Nevertheless, doctors try to avoid CT throughout pregnancy and instead order magnetic resonance imaging (MRI), which also is good at revealing diverticulitis.2 For women whose condition is very urgent, however, MRI has a disadvantage of having a longer preparation time, in which case CT may be necessary. As for colonoscopy, which is very good for diagnosing and monitoring diverticulosis, this procedure must be avoided when diverticulitis is suspected because the inflammation entails a high risk of perforation with colonoscopy, which depends on an instrumented tube inserted through the rectum and up as far as the sigmoid colon.

Does diverticulitis cause problems during pregnancy?

In addition to causing you continued abdominal pain, as well as fever, nausea, and vomiting, diverticulitis can lead to an abscess requiring draining by a surgeon, plus the diverticulum can rupture, leading to peritonitis, infection of the abdominal cavity. Both complications are life-threatening. 

Does diverticulitis cause problems for the baby?

Any kind of severe abdominal condition in the mother threatens the baby because it threatens the mothers life. Apart from threatening the mothers life, any fever associated with diverticulitis puts the fetus at risk of birth defects and also may affect brain development during early childhood.

What to consider about taking medications when you are pregnant or breastfeeding:

• The risks to yourself and your baby if you do not treat the diverticulitis
• The risks and benefits of each medication you use when you are pregnant
• The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat diverticulitis during pregnancy?

Moderate to severe cases of diverticulitis require treatment with antibiotics, of which regimens can be selected that are considered safe during pregnancy. When diverticulitis is limited and mild, antibiotics are not always needed. In either case, your fever must be treated with an antipyretic (fever-fighting) drug, such as acetaminophen (used in the United States) or paracetamol (used in several other countries. You should not take nonsteroidal anti-inflammatory drugs (NSAIDs), nor aspirin, for the fever. Not only might these medications harm the embryo or fetus, if taken at certain times in the pregnancy, but they are known to cause diverticulitis, so they can actually worsen your condition.

Who should NOT stop taking medication for diverticulitis during pregnancy?

If your doctor prescribes an antibiotic, you must take the full course of the treatment, unless the doctor decides to switch you to a different antibiotic.

What should I know about choosing a medication for my diverticulitis during pregnancy?

It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.

You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.

What should I know about taking a medication for my diverticulitis when I am breastfeeding?

Antibiotic regimens are available that are effective in the setting of diverticulitis and also safe in nursing mothers. Acetaminophen and paracetamol are thought to be relatively safe in nursing mothers.

What alternative therapies besides medications can I use to treat my diverticulitis during pregnancy?

As noted above, mild, limited cases of diverticulitis may not
require antibiotics. If you are admitted to the hospital with diverticulitis, generally, you will be NPO (nil per os), meaning nothing through the mouth in order to give your GI tract a rest. In such cases, you are supported with intravenous fluids, and then you are weaned to a liquid diet, and finally back onto solids. Initially, the solid diet is a low to no fiber diet, which is precisely the opposite of what you need to eat when you have diverticulosis but without diverticulitis. The rationale is that fiber irritates an inflamed diverticulum. However, by helping everything move through your intestines, fiber helps to prevent the formation of additional diverticula and also helps to prevent existing diverticula from becoming inflamed. In the past, people with diverticulosis were told to avoid eating seeds, corn, and popcorn, but this is no longer the recommendation. Once you have recovered from an episode of diverticulitis (but not while you have diverticulitis), doctors often will recommend supplemental fiber products, such as psyllium (such as MetamucilTM).  

In cases of repeated diverticulitis, either of the same diverticulum or of diverticula in a particular segment of intestine, the recommended treatment is surgery to resect (remove) of the affected segment and to attach the two healthy ends (end-to-end anastomosis). In some cases, a big portion of the colon needs to be resected (hemicolectomy). In other cases, surgeons need to hold off on anastomosing the two loose ends and create a temporary colostomy, a diversion of the colon to an opening created outside of the abdomen, where a special bag is attached. When your condition is improved, the anastomosis can be performed and the colostomy closed. Whenever possible, such surgical treatments are delayed until after pregnancy.

What can I do for myself and my baby when I have diverticulitis during pregnancy?

Follow the instructions of your physician. Be assured that the condition is treatable and that recovery is possible. After you have fully recovered, engage in regular exercise and adopt a diet that contains adequate amounts of fiber.

Resources for diverticulitis in pregnancy:

For more information about diverticulitis during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:

• Mayo Clinic. Diverticulitis. 
• Cleveland Clinic. Diverticular disease