Disclaimer: This article does not constitute medical advice. Always seek advice from a qualified medical practitioner about your own symptoms, diagnosis and treatment.
- Which Symptoms Need Which Level Of Help?
- Why Do Members Find This Decision So Confusing?
- What Do The Warning Signs Actually Mean?
- Do You Need A Fever To Go To A&E?
- What Happens When Members Wait?
- Does Going To A&E Mean A Hospital Admission?
- How Do Doctors Decide Between Home Treatment And Hospital?
- What Tests Will Doctors Use When You Arrive?
- Can You Wait It Out At Home?
- How Does This Decision Feel?
- Frequently Asked Questions
- Can I Go To A&E Without A Fever?
- Is Severe Gas And Bloating An Emergency?
- Can I Take Ibuprofen For Diverticulitis Pain?
- How Long Should I Wait For Symptoms To Improve?
- Can Diverticulitis Be Life-Threatening?
- What Can I Do If My Doctor Cannot See Me For Weeks?
- Key Takeaways
- Sources
- Stop Guessing. Start Understanding
This article is based on anonymised discussions from our Diverticulitis Club group on Facebook. We changed all names and locations.
Go to A&E (called the ER in the United States) or call 999 (111 in USA) if you have severe tummy pain with vomiting, a swollen tummy, or an inability to pass stool or wind, if you bleed heavily from your bottom, or if you show signs of sepsis such as confusion, pale or blotchy skin, a very high or low temperature, or fast breathing. The NHS lists these as the emergency signs for diverticulitis. Ask for an urgent GP appointment or call NHS 111 in the UK if your tummy pain gets worse or does not go away, you have a high temperature or feel hot, cold or shivery, you see blood or slime in your poo, or you cannot keep fluids down.
A fever is not a requirement for either step. Members in our group describe emergency surgery and sepsis without one. Going to A&E also does not mean a hospital bed: a US study of 240 people diagnosed with diverticulitis in an emergency department found that doctors sent 4 in 10 home on oral antibiotics. This article sets the medical criteria beside what members told us, so you can see how others made the decision.
Which Symptoms Need Which Level Of Help?
The NHS separates symptoms into two urgency levels. The table below follows the NHS wording, and NHS Inform (Scotland) adds a third row for people who suspect diverticulitis but have no red flags.
Level Of Help | Symptoms | What The NHS Says To Do |
Emergency | Severe tummy pain with vomiting, a swollen tummy, or an inability to poo or fart. Heavy bleeding from the bottom. Confusion, pale or blotchy skin, a very high or low temperature, or fast breathing. | Call 999 or go to A&E |
Urgent | Blood or slime in your poo. Tummy pain that gets worse or does not go away. A high temperature, or feeling hot, cold or shivery. Repeated sickness with no fluids staying down. Diarrhoea for more than 7 days or sickness for more than 2 days. | Ask for an urgent GP appointment or get help from NHS 111 |
Suspected diverticulitis, no red flags | Symptoms that fit diverticulitis, such as constant lower tummy pain. | Contact your GP as soon as possible (NHS Inform) |
Sources: NHS and NHS Inform. The NHS says the symptoms of diverticulitis resemble those of other conditions such as irritable bowel syndrome, so a doctor needs to examine you before anyone can name the cause.
Why Do Members Find This Decision So Confusing?
Members ask this question in our group, and the replies show why it feels so hard to answer. Diverticulitis pain varies between people, fever does not always appear, and advice from clinicians can be brief. One new member described a flare that did not match his usual pattern.
“This time is different. I am on my second flare-up in three weeks, both in different spots. I really don’t want to deal with the emergency room, and it takes about three weeks to get in to see my doctor. Is there a benefit to going in and having him push my stomach and say yup, it’s diverticulitis?”
Dale, Minnesota
Another member asked the question that sits behind many posts. Her gastroenterologist had told her she would recognise the pain, and that answer did not help.
“I asked her what the pain feels like and she said, ‘You’d know it.’ I’m so scared I’ll have a flare and not check it in time.”
Louise, Manchester
A third member had pain without the signs she expected.
“I do not have a fever but I am in some pain. So gassy, my stomach is gurgling, and no blood when I went to the bathroom. It’s just the pain that is knocking me to my knees.”
Rosemary, Stockport
These members share one problem: none of them had a clear signal to act on, and diverticulitis does not always send one. The sections below separate what the medical sources say from what members experienced.
What Do The Warning Signs Actually Mean?
Each warning sign points to a specific problem. Harvard Health names three complications of diverticulitis: an abscess, a perforation and a fistula. The NHS adds a blockage in the bowel, and says a perforation can cause a severe infection of the abdominal lining called peritonitis. Leicester Bowel Clinic links severe, sudden and unrelenting pain, persistent fever, vomiting that stops you keeping fluids down, rectal bleeding and an inability to pass wind or stool with the need for hospital care.
Warning Sign | What It Can Point To | Source |
Severe tummy pain with vomiting, a swollen tummy, or no stool or wind passing | A serious complication, listed by the NHS as an emergency | NHS |
A tummy that feels tender, hard or enlarged | A perforation, where bowel contents spill into the abdomen | Harvard Health |
Unable to pass stool or wind | A possible bowel obstruction | Leicester Bowel Clinic |
Heavy bleeding from the bottom | An emergency in the NHS guidance | NHS |
Confusion, pale or blotchy skin, a very high or low temperature, fast breathing | Possible sepsis | NHS |
A temperature that stays above 38°C (100.4°F), with chills, weakness or fatigue | Infection | Leicester Bowel Clinic |
Do You Need A Fever To Go To A&E?
No. The NHS lists a high temperature as one of five urgent signs and does not make it a condition for seeking help, and the first two signs on its emergency list involve severe pain, vomiting, a swollen tummy or a blocked bowel, with no mention of temperature. Members described emergency care without a fever. One member went to the ER with no fever and no blood, and had emergency surgery.
“I did not have a fever and no blood. Went to the ER. Emergency surgery. Go to the ER.”
Joanne, Leeds
Another member had a longer stay.
“I didn’t have a fever but ended up having an emergency sigmoid colectomy and spent 16 days in hospital because of sepsis. Please go.”
Noreen, Adelaide
A third member has learned to read her own pattern.
“I never get a fever when I have an attack of diverticulitis. It’s the pain that tells me when I need medical help.”
Lesley, Swindon
Members disagreed on what pain without a fever means. One member asked whether antibiotics help when no infection shows. A member with three days of severe cramps, no fever and no appetite had taken them and reported a clear change.
“I’m not a doctor. I told him what was going on and gave him my history, and he gave me what he thought I needed. After two days on the antibiotics the pain went down by 70%, so something helped.”
Alice, Wolverhampton
Another member in the thread cautioned that a missing fever does not rule out infection.
“Some people have infection without a fever. I can’t tell you whether it’s an infection flare or not. I suggest you go to your doctor.”
Denise, Cardiff
A doctor decides whether antibiotics suit you. Harvard Health says treatment for uncomplicated diverticulitis can mean observation only or an oral antibiotic started straight away, and that a doctor chooses between them after assessing your symptoms, examining your abdomen and, if needed, ordering blood tests or a CT scan.
What Happens When Members Wait?
Several members in the thread waited and then needed emergency care. Their accounts share one pattern: the pain worsened suddenly after a period of hoping it would pass. One member asked another what a perforation feels like, and the reply was short.
“Deep gripping pain.”
Yvonne, Brighton
Yvonne had tried to wait it out before her bowel perforated. A second member described the same sequence and its outcome.
“I also waited, and ended up with a perforation and an abscess. I am now two weeks post surgery.”
Maeve, Cork
An abscess is a collection of pus, and Harvard Health says doctors drain it with a needle under CT guidance if antibiotics do not clear it. A member whose mother developed one described how quickly her condition changed.
“My mum’s abscess could have turned into sepsis really quickly. It meant four days in hospital on two IV antibiotics, then another ten days of antibiotics at home. She was still recovering three months later. Better to be safe than sorry.”
Karen, Auckland
Another member reported that her mother needed the abscess drained and that the hospital told the family emergency surgery would have followed without the visit.
“My mum had hers drained today and they said she would have needed emergency surgery if she had not gone in.”
Wendy, Bristol
Noreen, quoted earlier, had sepsis twice, and her second episode ended in emergency surgery. Another member’s surgery left her with a temporary colostomy, and she described how things ended.
“I went through that last spring and had my colostomy reversed in the autumn.”
Faye, Wellington
The NHS confirms that some people with complications need a colostomy, where the bowel is brought out through a hole in the tummy and a bag collects the poo.
Does Going To A&E Mean A Hospital Admission?
No. Sirany and colleagues reviewed every patient evaluated in the emergency department of one metropolitan health system with a main diagnosis of diverticulitis between 2010 and 2012, and they published the results in the Journal of the American College of Surgeons in 2017. They included only people diagnosed by CT scan who had follow-up. The table sets out what happened to the 240 patients, whose average age was 59.1 years.
Group Or Outcome | Result |
Patients included | 240 (55% women) |
Admitted to hospital | 144 patients (60%) |
Discharged home on oral antibiotics | 96 patients (40%) |
Discharged patients who returned to the ED or were readmitted within 30 days | 12.5% |
Admitted patients who were readmitted | 15% (similar to the discharged group, p = 0.65) |
Discharged patients who needed emergency surgery | 1 patient (1%), 20 months after the visit |
The authors concluded that doctors can safely discharge patients with uncomplicated diverticulitis on oral antibiotics when CT findings inform the decision, and that doctors should admit patients with complicated diverticulitis on CT for surgical consultation.
The study answers a narrow question. It shows that an A&E visit often ends with a prescription and a trip home, and that the CT scan drives the decision. It does not show that staying at home without an assessment is safe, because every patient in the study had a scan. It is also a retrospective review from one US health system, so its figures will not match every hospital. Two members described the home-treatment route from their own visits.
“I was in the ER on Tuesday night. The pain was so persistent and nothing eased it. I came home with two antibiotics, and that sure beats being in that much pain.”
Beth, Columbus
“I prefer to be treated at home. It just takes time. IV antibiotics are stronger but it’s the same end result for me.”
Gwen, Sheffield
How Do Doctors Decide Between Home Treatment And Hospital?
Doctors sort diverticulitis into two groups. Harvard Health describes uncomplicated diverticulitis as inflammation confined to one section of the colon with no complicating factors, and complicated diverticulitis as disease with a specific complication such as an abscess, a perforation or a fistula. The table compares how each group is usually treated.
Feature | Uncomplicated Diverticulitis | Complicated Diverticulitis |
Meaning | Inflammation in one section of the colon with no complicating factors | An abscess, perforation or fistula is present |
Usual setting | At home | In hospital |
Antibiotics | Observation only, or an oral antibiotic | Intravenous antibiotics, usually for longer |
Further steps | A CT scan if symptoms have not responded after 3 to 5 days of antibiotics | A needle drain for an abscess, surgery to repair a perforation or remove a fistula |
Harvard Health says most people start to feel better within three days, and that people who chose observation alone should contact their doctor if symptoms do not improve, and should not wait three days if symptoms worsen. NHS Inform says more severe diverticulitis may need hospital care, particularly if you have a history of serious complications from diverticulitis or have had symptoms of diverticular disease from a young age.
What Tests Will Doctors Use When You Arrive?
The NHS says a GP asks questions about your symptoms and may arrange a blood test or a poo sample, and that further tests can include a CT scan or a colonoscopy or flexible sigmoidoscopy. Leicester Bowel Clinic adds that doctors examine your abdomen by pressing on it, and use blood and urine tests to check for infection or inflammation and imaging to look for complications. A CT scan sits at the centre of the decision between home and hospital in the Sirany study.
Members have mixed feelings about the examination. One member rang her GP, who wanted her to attend, and she asked for a phone consultation first.
“The GP wanted me to go in, but I asked for a phone call because last time they spent ages prodding my already painful tummy. I just want them to tell me if I need antibiotics.”
Hilary, Exeter
Her doctor prescribed tablets after the call and told her to attend if she worsened during the week. Another member found a route that avoids the ER.
“My own doctor will arrange a CT scan so I don’t have to go to the ER. ER visits are expensive right now, during deductible season.”
Tina, Atlanta
Cost and waiting times shaped decisions for members in this thread. They do not change the NHS emergency criteria above.
Can You Wait It Out At Home?
Harvard Health says a mild case of diverticulitis with minimal pain in the lower abdomen can resolve on its own within a day or two, and that you should seek immediate medical attention if symptoms are not going away or you feel worse, with increasing pain, fever, bloody stools, or bloating with vomiting. Members set their own thresholds, and these differ widely. One member keeps a score.
“I measure the pain from one to ten. Anytime it’s over a 6, I go to emergency.”
Marjorie, Tampa
Another member uses mobility as her test.
“If the pain is so bad you can barely walk, then go now.”
Bernadette, Galway
A third member has had severe flares and never attended A&E.
“I’ve had very bad flare-ups and never needed to go to A&E. It drags you down, but you keep going.”
Clive, Bolton
These rules of thumb work for the people who use them, and they do not replace medical criteria. The NHS describes the pain that needs urgent advice as worsening, persistent or severe, and sets no number. Clive’s experience shows that flares vary. Yvonne’s and Maeve’s experiences show what happens when a flare turns out to be the serious kind. A thread that asks “should I go?” also attracts members with strong experiences of going, so the “go now” replies lean towards urgency. Treat them as experiences and not as a threshold.
How Does This Decision Feel?
Some members describe living with flares as isolating. One member wrote about how little others understand.
“I suffer in silence and nothing seems to work. I go for my regular check-ups. I don’t think anybody understands how much this disease affects us.”
Moira, Inverness
One member who had a perforation and an abscess chose to have the diseased section of her colon removed, and she hoped it would end the attacks. Members also support each other through surgery. When a member posted that she would have surgery at 7 am and wear a colostomy for a while, other members replied to wish her well. Our forums and Facebook group give members somewhere to ask these questions before and after they decide.
Frequently Asked Questions
Can I Go To A&E Without A Fever?
Yes. The first two signs on the NHS emergency list do not involve a temperature, and its urgent list treats a high temperature as one sign among several. Members in our group describe emergency surgery and sepsis without a fever. The NHS says to call 999 or go to A&E for severe tummy pain with vomiting, a swollen tummy or an inability to poo or fart.
Is Severe Gas And Bloating An Emergency?
Gas and bloating alone are common in diverticular disease, and the NHS lists bloating as a symptom. Bloating becomes urgent when it appears with severe pain and vomiting, or when you cannot pass stool or wind. Harvard Health lists bloating with vomiting among the signs that need immediate medical attention.
Can I Take Ibuprofen For Diverticulitis Pain?
The NHS advises against it. It says not to take NSAIDs such as ibuprofen, or opioid painkillers such as codeine, because they can cause stomach problems or constipation and raise the risk of a hole in the bowel. The NHS lists paracetamol as the painkiller for diverticulitis. Members sometimes suggest ibuprofen in the group, so ask your GP or pharmacist before you take any painkiller.
How Long Should I Wait For Symptoms To Improve?
Harvard Health says people usually begin to feel better within three days of starting treatment, and that doctors usually order a CT scan if symptoms have not responded to antibiotics after three to five days. It also says not to wait three days if symptoms are getting worse.
Can Diverticulitis Be Life-Threatening?
Rarely. Leicester Bowel Clinic says most cases, even complicated ones, respond well to treatment, and that a bowel perforation or a ruptured abscess can in rare cases cause life-threatening complications. The NHS also describes serious complications as rare. Members in this thread urge each other to attend promptly for that reason. Our article on whether diverticulitis is a serious problem covers the outlook in more detail.
What Can I Do If My Doctor Cannot See Me For Weeks?
The NHS says to ask for an urgent GP appointment or to call NHS 111 when you have worsening pain, a high temperature, blood or slime in your poo, or sickness that stops you keeping fluids down. One member in the thread faced a three-week wait for an appointment during a second flare in three weeks. Outside the UK, your health service will have its own urgent advice line.
Key Takeaways
- The NHS says to call 999 or go to A&E for severe tummy pain with vomiting, a swollen tummy or no stool or wind passing, for heavy bleeding from the bottom, and for signs of sepsis.
- The NHS says to ask for an urgent GP appointment or call NHS 111 for worsening or persistent pain, a high temperature, blood or slime in your poo, or sickness that stops you keeping fluids down.
- A fever is not required. Members describe emergency surgery and sepsis without one.
- In a US study of 240 people diagnosed in an emergency department, 40% went home on oral antibiotics and 12.5% of them returned within 30 days.
- A CT scan drives the decision between home and hospital, and doctors usually treat complicated diverticulitis in hospital with intravenous antibiotics.
- Several members waited and then needed emergency surgery for a perforation or abscess, while others managed flares at home. Individual experience varies.
- The NHS advises against ibuprofen and opioid painkillers for diverticulitis pain.
Sources
- NHS: Diverticular disease and diverticulitis.
- NHS Inform. Diverticular disease and diverticulitis.
- Sirany AE, Gaertner WB, Madoff RD, Kwaan MR. Diverticulitis Diagnosed in the Emergency Room: Is It Safe to Discharge Home? Journal of the American College of Surgeons, 2017;225(1):21 to 25. PubMed 28450063.
- Harvard Health Publishing. Looking out for diverticulitis. Reviewed by Howard E. LeWine, MD.
- Leicester Bowel Clinic. When to go to the hospital with diverticulitis. Reviewed by Mr Sanjay Chaudhri.
Members who want to track their own symptoms can start the Food And Symptoms Diary, read our guide to the first signs of a diverticulitis flare, or find out how long a flare up lasts. You can also join the conversation in our forums and Facebook group. Reading what other members experienced will not tell you whether your own symptoms need A&E, but it shows you that you are not alone with the question.
Disclaimer: This article does not constitute medical advice. Diverticulitis affects everyone differently. Always seek advice from a qualified medical practitioner about your own symptoms, diagnosis and treatment.
