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

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.
In this consecutive series of 46 patients, with a functioning pouch for ulcerative colitis, high rates of fecal incontinence and evacuation difficulty were reported by patients preoperatively. After pouch creation, the rate of fecal incontinence decreased, and evacuation difficulty increased. Postoperative satisfaction, psychological well‐being, and quality of life were significantly better in those with good pouch function, highlighting the importance of recognizing symptoms early and providing appropriate treatment.