Determinants of long-term function and general well-being in patients with an ileoanal pouch

Angela J Khera; Janet W Chase; Michael Salzberg; Alexander J V Thompson; Rodney J Woods; Amy Wilson-O'Brien; Michael A Kamm

doi:10.1002/jgh3.12452

Determinants of long-term function and general well-being in patients with an ileoanal pouch

JGH Open. 2020 Nov 12;5(1):91-98. doi: 10.1002/jgh3.12452. eCollection 2021 Jan.

Authors

Angela J Khera^{1

2}, Janet W Chase¹, Michael Salzberg², Alexander J V Thompson^{1

2}, Rodney J Woods³, Amy Wilson-O'Brien², Michael A Kamm^{1

2}

Affiliations

¹ Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.
² Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne Victoria Australia.
³ Department of Colorectal Surgery St Vincent's Hospital Melbourne Victoria Australia.

Abstract

Background and aim: Fecal incontinence and/or evacuation difficulty are common after ileoanal pouch surgery. This study aimed to determine whether the development of these symptoms can be predicted so that preventive measures might be instituted.

Methods: A consecutive series of 46 patients with ulcerative colitis (median age at surgery, 41 years; 50% female) and a functioning pouch for a duration ≥12 months was included. Assessment utilized medical record review and questionnaires on pre- and postoperative bowel function, quality of life, and psychological well-being. Pouch function was assessed by the Colorectal Functional Outcome score (0 = no impairment, 100 = worst impairment). Good pouch function was defined as a score ≤24.

Results: Fecal incontinence occurred in 67% preoperatively and 54% postoperatively; evacuation difficulty occurred in 65% and preoperatively and 85% postoperatively. The postoperative median Colorectal Functional Outcome score was 20 (range 2-74), with 44% of patients >24 (poor pouch function). Preoperative nocturnal fecal incontinence (odds ratio [OR] 4.92, 95% confidence interval [CI] 1.2-19.4, P = 0.02) and pouchitis (OR 5.41, 95% CI 1.2-23.7, P = 0.02) were associated with poor pouch function after multivariable regression analysis. Postoperative satisfaction, psychological well-being, and quality of life were significantly better in those with good pouch function, while poor sleep, impaired work, and sexual dysfunction were independently associated with poor pouch function.

Conclusions: Functional bowel symptoms are common before and after pouch surgery and are associated with the impairment of patient-reported outcomes. Preoperative nocturnal fecal incontinence predicts poor pouch function. Therapeutic focus on continence, bowel evacuation, psychological well-being, and quality of life should begin before surgery.

Keywords: evacuation difficulty; fecal incontinence; functional outcome; ileoanal pouch.