Diverticular disease, diverticulitis and the impact on continence

Diverticulosis is a bowel condition where small pouches of mucosa (diverticula) protrude from the muscular intestinal wall (National Institute for Health and Care Excellence (NICE), 2019). These, have been described, as ‘herniations’ of mucosa and submucosa through the muscularis, along the mesenteric border. This is seen as an area in the bowel wall where blood vessels (vasa recta) penetrate the bowel wall, leading the muscle to be weaker and more vulnerable to developing these pocket-like protrusions (Aydin and Remzi, 2010) (Figure 1).

The presence of one or more sac-like diverticula is termed ‘diverticulosis’. Most people with this condition do not have symptoms, so it is difficult to determine the level of incidence within any population and, as such, it is often diagnosed as an incidental finding on colonoscopy (Hawkins et al, 2020). Diverticulosis was rarely described in the medical literature before the 1900s, but is increasing in prevalence, particularly in western countries. Given that life expectancy has increased over the past 100 years, along with the advent of sophisticated colonic imaging and cancer screening programmes, this is unsurprising (Rustom and Sharara, 2018). It could be surmised that it has been a problem for longer than it has been discussed in the literature – life expectancy in previous centuries was shorter, making it less likely to occur, and if it did occur it was potentially not diagnosed.