When is Diverticulitis Surgery Needed?

Have you ever felt sudden abdominal pain and wondered if it could be something more than a stomach upset? For some individuals, these symptoms may point to diverticulitis, a condition that affects the colon and can cause discomfort, digestive changes, and in some cases, serious complications.

Diverticulitis occurs when small pouches, called diverticula, that form in the walls of the colon become inflamed or infected. While mild cases can often be managed with medication and dietary adjustments, more severe or recurrent cases may require surgical intervention to prevent complications and maintain long term colon health.

What is Diverticulitis?

Diverticulitis develops from a condition called diverticulosis, where small pockets form along weak spots in the colon wall. These pouches are common, particularly in older adults and often cause no symptoms. However, when they become inflamed or infected, diverticulitis occurs.

Surgeon in a light blue protective gown and cap preparing for a colonoscopy procedure.

How Diverticula Form

Diverticula usually develop due to increased pressure inside the colon. Factors such as low fibre intake, constipation and ageing of the colon wall can contribute to their formation. While many people live with diverticula without noticing them, inflammation or infection can trigger diverticulitis.

Common Symptoms

Symptoms of diverticulitis vary depending on severity. Mild cases often involve abdominal pain, usually on the lower left side, bloating, and changes in bowel habits. Severe cases can include fever, nausea, vomiting, and persistent abdominal tenderness. In some instances, complications such as abscesses or perforation may occur.

Risk Factors for Diverticulitis

Understanding what increases the likelihood of developing diverticulitis can help you take proactive steps to reduce risk and recognise early warning signs.

Age and Lifestyle

The risk of diverticulitis rises with age. Diets low in fibre, lack of physical activity, obesity and smoking have all been associated with higher rates of diverticular complications.

Medical History

Individuals with chronic constipation or prior episodes of diverticulitis may be more susceptible to recurrent inflammation. Certain medications, such as steroids or non-steroidal anti-inflammatory drugs, may also increase risk.

Family History

A family history of diverticular disease can predispose individuals to developing diverticula or experiencing complications later in life.

Managing Diverticulitis Without Surgery

Not all cases of diverticulitis require surgery. Many mild to moderate episodes can be managed through lifestyle changes and medical treatment.

Medication

Antibiotics may be prescribed if an infection is present. Pain management and medications to regulate bowel movements may also help relieve symptoms.

Dietary Adjustments

During an acute episode, a liquid or low residue diet can allow the colon to rest. Once symptoms improve, gradually increasing fibre intake helps prevent future episodes and supports colon health.

Monitoring and Follow Up

Regular follow up with your doctor ensures that the condition is resolving and helps detect any early signs of recurrence or complications.

When Surgery Becomes Necessary

While many patients recover with conservative treatment, surgery is generally considered if diverticulitis leads to complications such as abscess formation, perforation of the colon, fistula, obstruction or recurrent severe episodes. In some cases, elective surgery is recommended after multiple attacks to prevent future problems. The most common procedure is a colectomy, where the affected portion of the colon is removed. In some cases, a temporary colostomy may be needed to allow the colon to heal before normal bowel continuity is restored.

Lifestyle and Preventative Measures

Even after recovery from diverticulitis, certain lifestyle measures can help reduce the risk of future episodes and support long term colon health.

Instruments for colonoscopy being held by a doctor wearing blue gloves.

Diet and Hydration

Eating a diet rich in fibre, including fruits, vegetables and whole grains, promotes regular bowel movements and reduces pressure in the colon. Staying well hydrated is also essential for healthy digestion.

Physical Activity

Regular exercise supports bowel function and helps maintain a healthy weight, reducing stress on the colon.

Monitoring and Early Action

Promptly addressing any new symptoms, such as abdominal pain or changes in bowel habits, allows for early intervention and reduces the likelihood of complications.

Getting the Right Support for Diverticulitis

Understanding how diverticulitis develops and when surgery may be needed can help you take control of your digestive health and plan for the future. Each step, from early detection to ongoing management, plays an important role in keeping your colon healthy and reducing the risk of complications.

At The Surgeons, led by Dr Chew Min Hoe, we provide personalised assessments, evidence based treatment plans and long term guidance tailored to your needs. Book an appointment to discuss your symptoms, explore your options and receive practical advice on managing diverticulitis for better long term well-being.

Meet Our Colorectal Specialist in Singapore

Dr Chew Min HoeMedical DirectorSenior Consultant, General & Colorectal SurgeonMBBS (Singapore), MRCS (Edinburgh), MMed (Surgery), FRCS (Edinburgh)

Dr Chew Min Hoe has devoted over 25 years of service to the public sector and was the founding Head of the Department of Surgery at Sengkang General Hospital (SKH). His clinical specialty is General and Colorectal Surgery with special niche interests in colorectal cancer, advanced pelvic tumours, hereditary conditions as well as perianal surgery. He is highly involved in education and research, and has published more than 100 peer-reviewed articles.