561 Inflammatory Bowel Disease and Non-Relaxing Pelvic Floor Dysfunction

Abstract

Symptoms of non-relaxing pelvic floor dysfunction may overlap with those of inflammatory bowel disease (IBD) and include abdominal and pelvic pain, bloating, and straining with bowel movements. Aim: To assess the prevalence of non-relaxing pelvic floor dysfunction (N-RPFD), clinical features, and response to pelvic floor biofeedback therapy in patients with ulcerative colitis (UC), Crohn's Disease (CD) and ileal J pouch dysfunction (IJPD) after Ileal j-pouch anal anastomosis(IPAA) with symptoms suggestive of disordered stool evacuation.. Methods: We reviewed the medical records of patients with IBD at our institution who underwent high resolution anorectal manometry (ARM) for clinical indications from January 2007-April 2012. We recorded and summarized data from their medical records. N-RPFD was characterized by high anal sphincter pressures (ASP) at rest (maximum .90mmHg), or inability to expel a 50 mL balloon from the rectum despite addition of .200g weight. Results: ARM was performed in 177 patients with IBD including 66 with CD, 62 with UC, and 49 with IJPD. There were 125 females and 52 males. The median age was 48 years, range 13-83. ARM was abnormal in 82/177 patients (46%): 80 had NRPFD and 2 patients had low anal pressures and fecal incontinence. In patients with IJPD, 35/49 (71%) had pouchitis and 20/35 pouchitis patients (57%) had N-RPFD. Among the14/ 49 (29%) who did not have pouchitis, 4/14 (29%) had N-RPFD. Among 22 patients with CD and UC who did not have diarrhea or rectal bleeding, 8 (36%) had N-RPFD. Twenty of 80 patients with N-RPFD underwent multiple pelvic floor retraining sessions with rectal sensor and EMG monitoring for anorectal biofeedback: 12/20 (60%) had improvement in symptoms, including 8/13 (62%) with IJPD. Conclusions: Non-relaxing pelvic floor dysfunction was confirmed in 45% of patients with IBD referred for a suspected disorder of stool evacuation. The prevalence of N-RPFD is highest in patients with pouchitis after IPAA. Importantly, 60% of patients with IBD and non-relaxing pelvic floor dysfunction improved with pelvic floor retraining. These data support the hypothesis that PFDmay be a contributing factor and in some cases a major cause of symptoms in patients with IBD.