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Diverticulitis when You Are Pregnant

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Diverticulitis is inflammation of a diverticulum, a pouch that has bulged out from the intestines. Usually such inflammation is due to infection with bacteria. Diverticula (plural of diverticulum) 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 lower part of the small intestine. This is due to an error during embryology, but it too can get infected, resulting in what doctors call Meckel diverticulitis.

Diverticulitis in pregnancy is one of a handful of conditions causing abdominal pain that must be distinguished from one another. However, pregnancy often makes such distinction more challenging than when you’re not pregnant. One reason for this is that diverticulitis usually occurs in a part of the colon called the sigmoid colon. This causes pain in the left lower quadrant (LLQ) of the abdomen, while Meckel diverticulitis causes pain around the umbilicus (naval, belly button), 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 pain is not as useful to the diagnosis as it is when you’re not pregnant.

Diverticulitis is rare during pregnancy, but in the United States, an estimated 2.5 million people are affected with diverticular disease. Diverticular disease includes diverticulitis and other complications of diverticulosis, such as 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.

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

Doctors may initially perform 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 radiation to the 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 in revealing diverticulitis. 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. Colonoscopy, in which a tube is inserted through the intestinal tract, is very good for diagnosing and monitoring diverticulosis. However, this procedure must be avoided when diverticulitis is suspected, because the inflammation entails a high risk of perforation of the colon.

Moderate to severe cases of diverticulitis require treatment with antibiotics, of which regimens can be selected that are considered appropriate during pregnancy. When diverticulitis is limited and mild, antibiotics are not always needed. In either case, your fever must be treated with a fever-fighting drug, such as acetaminophen (used in the United States) or paracetamol (used in several other countries. You should not take non-steroidal 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 causes of diverticulitis, so they can actually worsen your condition. 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.

Once you have recovered from an episode of diverticulitis doctors often will recommend supplemental fiber products, such as psyllium. You also should consume a high fiber diet when you have diverticulosis. 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 create a temporary colostomy, a diversion of the colon to an opening created to the outside of the abdomen, where a special bag is attached. When the your condition is improved, the anastomosis can be performed and the colostomy closed. Whenever possible, such surgical treatments are delayed until after pregnancy.

After you have fully recovered, you should engage in regular exercise and adopt a diet that contains adequate amounts of fiber.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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