It’s not well understood what causes the inflamed colonic swellings in diverticulitis, but some medications can increase the risk or worsen symptoms.
Diverticular disease is a common condition that occurs with age. Pockets called diverticula develop in the colon but often do not cause symptoms. However, when they become inflamed, they lead to pain, bloating, constipation, and/or diarrhea.
This article will discuss how medications can interact with diverticulitis and ways the symptoms of diverticulitis might be treated with home remedies and prescription and over-the-counter medications.
Drugs that may increase the risk of diverticulitis
Many factors are thought to coalesce to cause diverticular disease. Factors can include diet, genetics, lifestyle, and the microbiome (the community of microbes, such as bacteria, viruses, and fungi) in the gut. Some people may not be able to avoid diverticular disease even by taking steps to reduce their risk.
In some cases, drugs such as the following may increase your risk of bleeding and perforations (holes) in the bowel during a flare-up of diverticulitis:
- Steroids: A few studies have shown that steroid medications may increase the risk of complications from diverticulitis. In particular, intestinal perforations are more common in people taking steroids.
- Opioids: In three studies, taking opioids for pain was identified as increasing the risk of perforations. Commonly prescribed opioids include codeine, hydromorphone, fentanyl, morphine, Opana (oxymorphone), OxyContin (oxycodone), and Vicodin (hydrocodone).
- Calcium channel blockers: These drugs can lower blood pressure. People taking these drugs have an increased risk of perforations and bleeding with diverticulitis. Commonly prescribed calcium channel blockers include Cardene (nicardipine), Cardizem (diltiazem), Norvasc (amlodipine), Procardia (nifedipine), and Verelan (verapamil),
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Several studies have shown that the risk of bleeding into the diverticula is higher in people who take NSAIDs. Over-the-counter NSAIDs include Advil or Motrin (ibuprofen) and Aleve or Naprosyn (naproxen).
- Aspirin: Studies show that people who take aspirin (a type of salicylate) long-term for the prevention of heart disease have an increased risk of diverticular bleeding.
- Anticoagulants and antithrombotics: These medicines are used to prevent blood clots, but may also increase the risk of diverticular bleeding. They include the blood thinners Jantoven (warfarin) and Plavix (clopidogrel).
NSAIDs in conditions that cause bleeding
NSAIDs are drugs used to reduce inflammation and treat pain. They work by blocking enzymes in the body that control inflammation, among other bodily processes. They can also affect how blood clots. Because they may increase the risk of bleeding in some people, they should be used with caution in people with diverticulitis.
Common brand names include the over-the-counter NSAIDs Advil, Motrin, Aleve, and Naprosyn. Prescription NSAIDs include Celebrex (celecoxib), Indocin (indomethacin), and Mobic (meloxicam).
Discuss any changes to the medications you take with a health care provider before you stop taking them or change the number or schedule of doses. A health care provider can recommend whether a change may be beneficial and prevent problems caused by changing medications without their advice.
Additional risk factors for diverticulitis
Some of the other factors that can contribute to the development of diverticulitis include:
- Age: Diverticular disease is more common with age.
- Eat more red meat: Diets high in red meat are associated with an increased risk of diverticular disease.
- lack of exercise: Weight-bearing exercise may protect against the development of diverticula.
- Low fiber diet: Eating more fiber-rich foods may help reduce the risk of diverticular disease.
- have obesity: A diagnosis of obesity is linked to a higher risk of diverticulitis.
- Smoking cigarettes: Smoking is linked to the development of diverticular disease and diverticulitis.
Diverticulitis is uncomplicated in about 80% of cases. It can usually be treated at home with rest, a low-fiber or liquid diet, and pain management. In some cases, however, prescription medication may be needed.
More often, medications are used to treat complicated diverticulitis. This can take place either in the hospital or at home.
If needed, antibiotics are prescribed for several days to about a week. They can be used longer term if there is a need. One or more antibiotics can be prescribed at the same time. Antibiotics aren’t always given for home-treated diverticulitis, but they can be given intravenously (IV) in the hospital.
Here are some examples of antibiotics used:
Some people may have abdominal pain that persists after the acute symptoms improve. A low dose of tricyclic antidepressants can be used in these cases. It’s important to stay in close contact with a health care provider in the first few weeks after a diverticulitis flare-up to manage pain and avoid complications.
Treating Diverticulitis Pain Without Prescription Drugs
The pain from diverticulitis usually gets better after a few days and should go away within a few weeks. There are several ways to relieve the pain or discomfort of diverticulitis without taking prescription medication.
Tylenol (acetaminophen) might be recommended for pain. Other pain relievers, including NSAIDs (such as ibuprofen or naproxen sodium), can be avoided when treating pain caused by diverticulitis.
Short courses on NSAIDs might be helpful and allowed for some people. But it is generally necessary for those with a history of bleeding or gastrointestinal problems to avoid them. People with diverticulitis should ask a health care provider what pain relievers to take during a flare-up and afterward.
A liquid diet or a low-fiber diet may be recommended when symptoms of diverticulitis begin. Some studies have shown that using a liquid diet may not be necessary, but some people feel better on a liquid diet for a few days.
After two or three days, a health care provider may suggest adding more foods back into the diet. This includes low fiber foods at the start and up to a high fiber diet.
A diet high in fiber can cause bloating or discomfort at first. Working with a health care provider to understand how to change the diet from liquid or low fiber to high fiber will help.
Using a heating pad is one way to relieve pain without resorting to medication. Some people find that applying heat to the abdomen helps relieve abdominal discomfort.
There is no evidence that shows how much heat to use or how best to use it for diverticulitis. However, it is a relatively inexpensive and simple way to try to cope with pain.
To avoid burns, follow the instructions on the heating pad. People should not sleep on a heating pad or apply it directly to the skin. In addition, it should only be used for the recommended duration indicated in the safety instructions.
When to Seek Medical Care
People with symptoms of diverticulitis (abdominal pain, bloating, constipation, or diarrhea) should see a healthcare professional for a diagnosis. This is true even if it is not the first time that diverticulitis has broken out.
A diagnosis is important to make sure there are no complications and to confirm that you do have diverticulitis. The symptoms are so similar to many other digestive disorders that these other causes must be ruled out.
Symptoms such as severe abdominal pain or bleeding, vomiting or diarrhea that won’t stop, or fainting are reasons to seek immediate emergency care.
It is important to remember that not everyone can completely avoid diverticular disease as it is partly due to genetics. Over-the-counter and prescription medications can also impact the development of diverticulitis.
Diverticulitis was once treated with antibiotics. It has been shown that antibiotics are not always helpful and are reserved for when they are clearly needed. Pain relievers can help, but it’s important to discuss which ones to use with a healthcare provider.
People who are concerned about developing diverticulitis should talk to a healthcare provider about their risk. Lifestyle changes, along with medical care, healthy eating, and exercise, can reduce the risk of diverticulitis.