Alamo RZ, Quigley EMM. Irritable bowel syndrome and colonic diverticular disease: overlapping symptoms and overlapping therapeutic approaches. Curr Opin Gastroenterol. 2019; 35:(1)27-33

Colonic diverticular disease. 2010. (accessed 13 February 2023)

Bharucha AE, Knowles CH, Mack I Faecal incontinence in adults. Nat Rev Dis Primers. 2022; 8:(1)

Bretto E, D'Amico F, Fiore W, Tursi A, Danese S. Lactobacillus paracasei CNCM I 1572: a promising candidate for management of colonic diverticular disease. J Clin Med. 2022; 11:(7)

Barroso AO, Quigley EM. Diverticula and diverticulitis: time for a reappraisal. Gastroenterol Hepatol (N Y). 2015; 11:(10)680-688

Carabotti M, Falangone F, Cuomo R, Annibale B. Role of dietary habits in the prevention of diverticular disease complications: a systematic review. Nutrients. 2021; 13:(4)

Cohen E, Fuller G, Bolus R Increased risk for irritable bowel syndrome after acute diverticulitis. Clin Gastroenterol Hepatol. 2013; 11:(12)1614-9

Fedirko V, Kopetz S, Daniel CR. Diverticular disease and cancer risk: more than a gut feeling. J Natl Cancer Inst. 2023; 115:(1)12-13

Hawkins AT, Wise PE, Chan T Diverticulitis: an update from the age old paradigm. Curr Probl Surg. 2020; 57:(10)

Heitmann PT, Vollebregt PF, Knowles CH, Lunniss PJ, Dinning PG, Scott SM. Understanding the physiology of human defaecation and disorders of continence and evacuation. Nat Rev Gastroenterol Hepatol. 2021; 18:(11)751-769

Järbrink-Sehgal ME, Andreasson A, Talley NJ, Agréus L, Song JY, Schmidt PT. Symptomatic diverticulosis is characterized by loose stools. Clin Gastroenterol Hepatol. 2016; 14:(12)1763-1770.e1

Jaung R, Robertson J, O'Grady G, Milne T, Rowbotham D, Bissett IP. Limited evidence of abnormal intra-colonic pressure profiles in diverticular disease - a systematic review. Colorectal Dis. 2017; 19:(6)O168-O176

Lohsiriwat V, Jitmungngan R. Enhanced recovery after surgery in emergency colorectal surgery: Review of literature and current practices. World J Gastrointest Surg. 2019; 11:(2)41-52

National Institute for Health and Care Excellence. Diverticular disease: diagnosis and management. NICE guideline NG147. 2019. (accessed 14 February 2023)

National Institute for Health and Care Excellence. NICE guideline Irritable bowel syndrome in adults: diagnosis and management. Clinical guideline CG61. 2017. (accessed 14 February 2023)

Painter NS. The cause of diverticular disease of the colon, its symptoms and its complications. Review and hypothesis. J R Coll Surg Edinb. 1985; 30:(2)118-22

Rustom LBO, Sharara AI. The natural history of colonic diverticulosis: much ado about nothing?. Inflamm Intest Dis. 2018; 3:(2)69-74

Saldana Ruiz N, Kaiser AM. Fecal incontinence - Challenges and solutions. World J Gastroenterol. 2017; 23:(1)11-24

Schultz JK, Azhar N, Binda GA European Society of Coloproctology: guidelines for the management of diverticular disease of the colon. Colorectal Dis. 2020; 22:5-28

Spiller R. Is it diverticular disease or is it irritable bowel syndrome?. Dig Dis. 2012; 30:(1)64-9

Strate LL, Morris AM. Epidemiology, Pathophysiology, and treatment of diverticulitis. Gastroenterology. 2019; 156:(5)1282-1298.e1

Tursi A. Current and evolving concepts on the pathogenesis of diverticular disease. J Gastrointestin Liver Dis. 2019; 28:225-235

Tursi A, Scarpignato C, Strate LL Colonic diverticular disease. Nat Rev Dis Primers. 2020; 6:(1)

Talutis SD, Kuhnen FAH. Pathophysiology and epidemiology of diverticular disease. Clin Colon Rectal Surg. 2021; 34:(2)81-85

Wilkins T, Embry K, George R. Diagnosis and management of acute diverticulitis. Am Fam Physician. 2013; 87:(9)612-20

Diverticular disease, diverticulitis and the impact on continence

23 February 2023
Volume 32 · Issue 4


Diverticulosis and the subsequent progression to diverticular disease and diverticulitis is becoming more prevalent in western countries. The cause for this progression is not known. Diverticulitis is a significant health burden – both financially to healthcare systems, and to the patients it affects in terms of morbidity. There is a dearth of research pertaining to diverticulitis and its impact on continence. This article examines the parallels between irritable bowel syndrome and diverticular disease, which have many symptom similarities, the overlap between the conditions, and the impact on continence. Current studies regarding the role of fibre in managing diverticular disease are also discussed.

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.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content