Background
Anoperineal damage in Crohn’s Disease (CD) is caused by inflammation, its sequelae, and the surgery’s sequelae. Fecal incontinence (FI) is an important complaint reported by patients with CD. Literature data regarding to FI, anatomical and functional abnormalities and its associated clinical factors are controversial, with few surveys with a limited number of participants.1 The aim of this study is to analyze FI and the associated manometric and clinical findings in patients with CD.
Methods
Observational, cross-sectional study in patients older than 18 years old with CD under outpatient follow-up at a tertiary center, who, after sign informed consent, were submitted to specific questionnaire, anorectal manometry and medical record review.
The Jorge and Wexner Fecal Incontinence Scale was applied to grade incontinence.2
SPSS 21.0 (SPSS, Chicago, IL, USA) was used for statistical analysis, with description of categorical variables with absolute and relative frequency, and continuous variables with median and interquartile range (IIQ). To study the association, we used Pearson’s Chi-Square and Mann Whitney test. The null hypothesis was rejected with p<0.05.
Results
Of 104 patients with CD, 51% were male, median age of 41 years old (IIQ 29.2–50.0) and median disease duration of 6.1 years (IIQ 2.5 to 11 .5). Most of the sample was diagnosed between 17 and 40 years old, (68.3%), with non-penetrating, non-stricturing disease (63.4%), with colonic location (77.9%), isolated (30.8%) or with ileal involvement (47.1%); 78.8% had disease in remission and 11.5% had mild disease, representing 90,4% of our casuistic, according to the Harvey Bradshaw Index. Among patients; 41.3% had perianal disease, and 49% were incontinent, of these 66.7% had mild incontinence and 33.3% had moderate and severe incontinence. It was found association between FI and lower mean resting pressures (p=0.04) and lower mean squeeze pressures (p=0.04) along the anal canal. There was also association between FI and perianal disease (p=0.02), and FI and disease activity (p<0.01).
Conclusion
The study, unprecedented in America Latin, showed a high frequency of FI and found its association with disease activity, structural abnormalities (perianal disease) and anorectal disfunction (lower resting and squeeze pressures), reenforcing the importance of controlling CD activity. Furthermore, the data showed to be crucial during follow-up of CD patients the adequate manometric assessment and specialized evaluation for the management of FI.
References
1. Litta, F, Ratto C, et al. Anorectal function and quality of life in IBD patients with a perianal complaint, J Invest Surg. 2019 Oct 18;1–6
2. Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum 1993;36:77–97
