Ileal pouch-anal anastomosis function following childbirth

Juhász, Éva; Fozard, Basil; Dozois, Roger R.; Ilstrup, Duane M.; Nelson, Heidi

doi:10.1007/bf02052444

Cited by 113 publications

(94 citation statements)

References 12 publications

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“…17 Previous reports from the Mayo Clinic found that functional outcome after childbirth in women after IPAA was not compromised. 18 The present study confirms these earlier reports in a larger number of women with longer follow-up. A more complete understanding of delivery-related complications and functional outcomes awaits analysis.…”

Section: Discussionsupporting

confidence: 82%

Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Farouk¹,

Pembérton²,

Wolff³

et al. 2000

Annals of Surgery

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267

187

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ObjectiveTo assess long-term outcomes after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) with specific emphasis on patient sex, childbirth, and age. Summary Background DataChildbirth and the process of aging affect pelvic floor and anal sphincter function independently. Early function after IPAA is good for most patients. Nonetheless, there are concerns about the impact of the aging process as well as pregnancy on long-term functional outcomes after IPAA. MethodsFunctional outcomes using a standardized questionnaire were prospectively assessed for each patient on an annual basis. ResultsOf the 1,454 patients who underwent IPAA for CUC between 1981 and 1994, 1,386 were part of this study. Median age was 32 years. Median length of follow-up was 8 years. Pelvic sepsis was the primary cause of pouch failure irrespective of sex or age. Functional outcomes were comparable between men and women. Eighty-five women who became pregnant after IPAA had pouch function, which was comparable with women who did not have a child. Daytime and nocturnal incontinence affected older patients more frequently than younger ones. Incontinence became more common the longer the follow-up in older patients, but this was not found in younger patients. Poor anal function led to pouch excision in only 3 of 204 older patients. ConclusionsIncontinence rates were significantly higher in older patients after IPAA for CUC compared with younger patients. However, this did not contribute to a greater risk of pouch failure in these older patients. Patient sex and uncomplicated childbirth did not affect long-term functional outcomes.Early reports of function after ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) have indicated favorable outcomes, with an excellent quality of life for more than 90% of patients.1-3 Areas of concern remain, however, regarding long-term functional outcome after vaginal delivery and the natural aging process, which may affect pelvic floor function regardless of sex. 4,5 Chronic ulcerative colitis has a bimodal distribution of incidence based on age, with a peak at 25 years and a second peak at 60 years.6 A selected group of older patients choose, in the absence of contraindications, to undergo IPAA. Short-term follow-up has shown that such patients may have comparable or only marginally worse functional outcomes compared with younger patients. 7-9Our aim was to assess long-term outcomes after IPAA for CUC with specific reference to the impact of age, aging, and childbirth to determine how these factors affect the incidence of pouch failure. METHODSBetween January 1981 and December 1994, 762 men and 692 women were identified from the Mayo Ileal Pouch Registry as having undergone proctocolectomy, endoanal mucosal resection, and hand-sewn ileal J pouch-anal anastomosis for CUC. Ethical permission to review patient records was obtained from the Institutional Review Board.

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Section: Discussionsupporting

confidence: 82%

Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Farouk¹,

Pembérton²,

Wolff³

et al. 2000

Annals of Surgery

Self Cite

267

187

View full text Add to dashboard Cite

show abstract

“…Unlike patients who have active disease at the plications in pregnancy. The most common side effects in this subset of patients during pregnancy are increased onset of pregnancy who remain active or worsen, patients with active ulcerative colitis who can be brought into stool frequency and incontinence, likely due to the pressure of the gravid uterus on the pelvic floor above the remission with aggressive drug therapy have an improved prognosis approaching that of patients whose disease was ileal pouch [26]. It is reasonable to anticipate a return to baseline pouch functioning postpartum.…”

Section: Effect Of Pregnancy On Inflammatory Bowel Diseasementioning

confidence: 99%

“…Furthermore, patients who have undergone ileal pouch-anal anastomosis surgery have higher rates of cesaCorticosteroids are also frequently used to control flares of IBD. Human studies have shown them to be rean section [26]. It is unclear, however, if the mode of delivery was altered in these patients out of necessity in well tolerated, with no significant increase in fetal complications as compared to the control population [2,14].…”

Section: Medical Treatment Of Ibd During Pregnancy and Lactationmentioning

confidence: 99%

Inflammatory Bowel Disease and Pregnancy: A Review

Jospe

Peppercorn²

1999

Dig Dis

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Inflammatory bowel disease often occurs during peak reproductive years. Rates of conception, pregnancy outcome and disease course during pregnancy should be discussed prior to attempted conception. The majority of patients whose disease is well controlled prior to pregnancy should expect a fertility rate comparable to the general population, and an uncomplicated pregnancy with a favorable outcome. The disease should continue to be pharmacologically or surgically controlled as necesssary during pregnancy; the majority of drug options available to pregnant patients being without detriment to the fetus. No predictable inheritance pattern has been established and, at this time, there is no ability to screen prenatally.

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“…Cesarean section should be recommended in CD patients with active perianal disease (45). In IBD patients with an ileoanal pouch studies have indicated that vaginal delivery after ileal pouch anal anastomosis (IPAA) is safe and not associated with long-term changes in pouch function (23,46,47). However, a study suggests that vaginal delivery increases the risk of sphincter muscle injury, which could have a long-term effect on pouch function (43).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes of women with inflammatory bowel disease

Tunç¹,

Akbulut²,

Parlak³

et al. 2013

Med gl Ins stit Zlatibor

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Background:In ammatory bowel diseases (IBD) generally affect women of childbearing age. In this study we investigated the effects of IBD on pregnancy, pregnancy outcomes and on newborns by comparing with a healthy control group.Methods: Data on the productive history were collected both in the question-and-answer format, and also from hospital records. The control group was made up of healthy volunteers of the same age group, who were living in the same region and who had a similar sociocultural structure. Control group data were also collected by asking questions on reproductive history in the question-and-answer format, and also from the obstetrical medical records.

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Ileal pouch-anal anastomosis function following childbirth

Cited by 113 publications

References 12 publications

Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Functional Outcomes After Ileal Pouch-Anal Anastomosis for Chronic Ulcerative Colitis

Inflammatory Bowel Disease and Pregnancy: A Review

Pregnancy outcomes of women with inflammatory bowel disease

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