Womenʼs Health Issues After Ileal Pouch Surgery

Abstract

: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for patients with ulcerative colitis and familial polyposis who require colectomy. This surgical intervention allows for resection of colon, while offering intestinal continuity with fecal continence, discontinuation of most medications related to ulcerative colitis and reduction in the risk of colitis-associated neoplasia. As a proportion of these patients are women of childbearing age, it is important to understand the impact on reproductive health and function. Although limited data exist, restorative proctocolectomy/IPAA does not seem to adversely affect menstrual function. In general, sexual function is reported to improve postsurgery with the ability to achieve orgasm unaltered. However, dyspareunia is commonly reported post restoratively. Of concern, there are data to suggest that fertility is decreased post-IPAA. The reasons stated are pelvic adhesions and obstruction of fallopian tubes. Laparoscopic approach may improve fertility outcomes by reducing postoperative adhesions as compared with the open approach. Once achieved, pregnancy in patients with IPAA is characterized by a transient increase in stool frequency that resolves postdelivery. Whether vaginal delivery or cesarean section is preferred route of delivery in these patients is still controversial. But commonly cesarean section is advocated for patients' post-IPAA to prevent anal sphincter injury and long-term effects on pouch function. All of these issues should be included in the discussion with women who are contemplating IPAA, so they are well aware of them before deciding on the best management plan.

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): ulcerative colitis

“…Most studies included both patients with end ileostomy or RP/IPAA and considered open surgery, with infertility rates ranging from 20 to 90% (in the general population, the fertility rate is 2-8%) [186].…”

“…In a series of 43 women followed at the Mayo Clinic, there was an increase of stool frequency, incontinence and pad usage with return to prepartum status after delivery [196]. All studies on the outcome of pregnancy in women post-IPAA report a favorable outcome [186,197]. There is no scientific evidence about specific vitamin deficiencies during pregnancy in these patients, so their folate intake does not differ from that of healthy women.…”

Overlooked Long-Term Complications of Colorectal Surgery

“…Females can develop alterations in sexual desire, arousal, and satisfaction, while also suffering from dyspareunia. 22 In addition, women can develop infertility issues, which may have more to do with mechanical function affecting the ovaries and fallopian tubes. Sexual dysfunction in females is probably often unrecognized after pelvic surgery and frequently, the only "hard evidence" of dysfunction is infertility.…”

“…Differences in female postoperative are hypothesized to be due to adhesive disease and scarring of the fallopian tubes and other reproductive structures from pelvic dissection. 22 Intrapelvic adhesions are hypothesized to complicate normal passage of a fertilized ovum from the ovary through the fallopian tubes. 25 In addition, a high rate of damage to the fimbria hydrosalpinx or tubal injury may occur after pelvic surgery.…”

The impact of inflammatory bowel disease on sexual health in men: A scoping review

“…Variations in anatomy, biology and psychology mean men and women are likely to experience sexual health in IBD differently. To date, the literature on sexual health in IBD has predominantly focused on women (Bharadwaj, Philpott, Barber, Graff, & Shen, 2014;Bonthala & Kane, 2018;Johnson & McLeod, 2006;Moleski & Choudhary, 2011;Moody, Probert, Srivastava, Rhodes, & Mayberry, 1992;Rosenblatt & Kane, 2015;Sanders, Gawron, & Friedman, 2016;Timmer, Bauer, Kemptner, Furst, & Rogler, 2007;Trachter, Rogers, & Leiblum, 2002) and mens sexual health needs have been largely overlooked (Allocca et al, 2018).…”