It’s not well-understood what causes inflammation of outpouchings of the colon in diverticulitis, but certain medications may increase the risk or worsen symptoms.
Diverticular disease is a common condition that occurs as people age. Outpouchings called diverticula develop in the colon but often don’t cause symptoms. When they become inflamed, however, they lead to pain, bloating, constipation, and/or diarrhea.
This article will discuss how medications may interact with diverticulitis and the ways that diverticulitis symptoms might be treated through home remedies and prescription and over-the-counter (OTC) drugs.
Drugs That Can Increase the Risk of Diverticulitis
It’s thought that many factors merge to cause diverticular disease. Factors may include diet, genetics, lifestyle, and the microbiome (the community of microbes, such as bacteria, viruses, and fungi) in the gut. It might not be possible for some people to avoid diverticular disease even when taking steps to lower their risk.
In some cases, medications such as the following can raise your risks of bleeding and perforations (holes) in the intestine during a flare-up of diverticulitis:
- Steroids: A few studies have shown that steroid medications can increase the risk of complications from diverticulitis. In particular, bowel perforations are more common in people who take steroids.
- Opioids: In three studies, taking opioid medications 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 medications can lower blood pressure. People who take 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 in diverticula is higher in people who take NSAIDs. OTC 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 drugs are used to prevent blood clots, but they can 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 medications that are used to reduce inflammation and to treat pain. They work by blocking the enzymes in the body that control inflammation, among other body processes. They can also have an effect on how blood clots. Because they can increase the risk of bleeding in some people, they should be used with caution in people with diverticulitis.
Common brand names include the OTC 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 healthcare provider before you stop taking them or change the number or scheduling of doses. A healthcare provider can recommend whether a change may be beneficial and avoid problems caused by altering medications without their advice.
Additional Diverticulitis Risk Factors
Some of the other factors that may contribute to the development of diverticulitis include:
- Age: Diverticular disease is more common as people age.
- Eating 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 developing diverticula.
- Low-fiber diet: Eating more high-fiber foods may help lower the risk of diverticular disease.
- Having obesity: A diagnosis of obesity is connected to a higher risk of diverticulitis.
- Smoking cigarettes: Smoking is linked to developing 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 medications might be needed.
More often, medications are used to treat complicated diverticulitis. This could take place either in the hospital or at home.
When needed, antibiotics are prescribed for several days to about a week. They may be used longer term if there is a need. One or more antibiotics may be prescribed at the same time. Antibiotics aren’t always given for diverticulitis that’s treated at home, but they may be given by intravenous (IV) line in the hospital.
Examples of antibiotics used include:
Some people might have abdominal pain that continues after the acute symptoms improve. A low dose of tricyclic antidepressants might be used in these cases. It’s important to keep in close contact with a healthcare provider in the first weeks after a flare-up of diverticulitis to manage pain and avoid complications.
Treating Diverticulitis Pain Without Prescription Medication
Diverticulitis pain usually improves after a few days and should resolve within a few weeks. There are a few ways to ease pain or discomfort from diverticulitis without taking prescription drugs.
Tylenol (acetaminophen) might be recommended for pain. Other pain medications, including NSAIDs (such as ibuprofen or naproxen sodium), may be avoided when treating pain from diverticulitis.
Short courses of NSAIDs might be helpful and allowed for some people. But it usually is necessary for those who have a history of bleeding or gastrointestinal problems to avoid them. People with diverticulitis should ask a healthcare provider about which pain medications to take while in a flare-up and afterward.
A liquid diet or a low-fiber diet might be recommended when diverticulitis symptoms start. Some studies have shown that using a liquid diet might not be needed, but some people feel better being on a liquid diet for a few days.
After two or three days, a healthcare provider might suggest adding more foods back into the diet. This includes low-fiber foods at first and working up to a high-fiber diet.
Eating a high-fiber diet can cause bloating or discomfort at first. Working with a healthcare provider to understand how to scale up the diet from liquids or low fiber to high fiber will help.
Using a heating pad is a way to relieve pain without resorting to medications. Some people find applying heat to the abdomen will help with abdominal discomfort.
There is no evidence that shows how much heat to use or how it might be best used for diverticulitis. However, it’s a relatively low-cost and simple way to try to cope with pain.
To avoid burns, follow the directions on the heating pad. People shouldn’t sleep on a heating pad or apply it directly to the skin. Plus, it should only be used for the recommended amount of time listed in the safety instructions.
When to Seek Medical Care
People who have symptoms of diverticulitis (abdominal pain, bloating, constipation, or diarrhea) should seek care from a healthcare provider for a diagnosis. This is true even if it is not the first time the diverticulitis has flared up.
A diagnosis is important to ensure that there are no complications and to confirm that you indeed have diverticulitis. The symptoms are so similar to many other digestive conditions that those other causes should be ruled out.
Symptoms such as severe abdominal pain or bleeding, vomiting or diarrhea that won’t stop, or fainting are reasons to get care immediately at an emergency department.
It’s important to remember that not everyone can avoid diverticular disease completely because it is partly due to genetics. Both over-the-counter and prescription drugs also may have an impact on the development of diverticulitis.
Diverticulitis used to be treated with antibiotics. It has been shown that antibiotics are not always helpful and are reserved for when they clearly are needed. Pain medications can help, but it’s important to discuss which ones to use with a healthcare provider.
People who are concerned that they may develop diverticulitis should talk to a healthcare provider about their risk. Lifestyle changes, along with medical care, a healthy diet, and exercise, may reduce the likelihood of diverticulitis.