Crohns Colitis 360. 2023 Oct 20;5(4):otad063. doi: 10.1093/crocol/otad063.eCollection 2023 Oct.

Sigrid Young ¹, Briton Lee ¹, Scott Smukalla ², Jordan Axelrad ³, Shannon Chang ³

Author information

¹Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.

²Division of Gastroenterology, NYU Langone Health, New York, NY, USA.

³Division of Gastroenterology, Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA.

Abstract

Background: Fecal incontinence commonly occurs in patients with ulcerative colitis and ileal pouch-anal anastomosis. There is a paucity of manometric data in pouch patients. We aimed to better define manometric parameters in pouch patients with fecal incontinence.

Methods: We compared clinical and manometric variables in ulcerative colitis patients with pouch and fecal incontinence to ulcerative colitis patients with pouch without fecal incontinence and to non-ulcerative colitis patients with fecal incontinence. Manometric data for the 3 cohorts were compared to established normative data. An independent-samples t-test was performed for continuous variables, and chi-square test was used for categorical variables. Logistic regression was performed to identify predictors of incontinence in pouch patients (P < .05).

Results: Among 26 pouch patients with fecal incontinence (73% female), 26 pouch patients without fecal incontinence (35% female), and 84 patients with fecal incontinence without ulcerative colitis (68% female), there were no differences in anorectal pressures between patients with fecal incontinence. Lower pressures were observed in pouch patients with fecal incontinence compared to those without fecal incontinence. Resting pressure was similar between pouch patients with fecal incontinence and healthy controls (60.9 ± 36.1 mmHg vs. 66.9 ± 3.2 mmHg, P = .40). Female sex (P= .019) and defecatory disorders (P = .033) each independently predicted fecal incontinence in pouch patients.

Conclusions: Pouch patients with fecal incontinence have lower anorectal pressures compared to pouch patients without incontinence, though have similar pressures to non-ulcerative colitis patients with fecal incontinence. Pouch patients with fecal incontinence have similar resting pressures as healthy controls. Distinct manometric normative values for pouch patients are needed.