Anorectal Pressure Profile in IBD Patients as Compared to Non-IBD Patients With Fecal Incontinence

Abstract

Introduction: Fecal incontinence is reported in up to 25% of patients with inflammatory bowel disease (IBD). Although diarrhea burden plays a major role in the pathophysiology of fecal incontinence in IBD patients, anorectal sensory and musculoskeletal function has also been shown to be altered in this patient population. There is limited data showing decreased rectal compliance with active IBD. Aim: To compare the anorectal manometry (ARM) pressure profile of IBD patients with active disease presenting with FI versus non-IBD patients with FI. Methods: A retrospective chart review of all IBD patients who were referred for ARM with an indication of FI was done. Among those we identified patients with disease activity found on endoscopy or histology and excluded patients with total proctocolectomy and patients in remission at the time of referral. Those patients (N=6) were matched with controls (N=12) with FI who had no IBD of similar age and BMI in a 2:1 ratio. Comparison of anorectal pressure profiles using 2 tailed t-test was done. Results: Six patients with active IBD (disease location: rectal disease-3, ileal disease-2 and left colon-1) were included and data regarding demographics, disease duration, disease characteristics and data regarding clinical, endoscopic and histological disease activity were obtained (Table 1). Results of ARM are depicted in Table 2. The mean and maximal resting rectal and anal sphincter pressures were higher in IBD patients than non-IBD group and comparable to healthy volunteers. The maximal squeeze anal and rectal pressures were almost two times higher than the non- IBD group, though not statistically significant. The sensory level for first sensation, urge to defecate, discomfort and maximum rectal compliance were lower in those with active IBD.Table: Table. Demographic characteristics on IBD patients with active disease.Table: Table. Comparison of anorectal manometry results of IBD patients with active disease and fecal incontinence and non IBD patients with fecal incontinenceConclusion: Patients with active IBD with FI have a different anorectal pressure profile compared to non IBD patients who suffer from FI. The major difference in anorectal pressure profile appears to be in the anal squeeze pressures, possibly representing a compensatory mechanism; sensory threshold on the other hand were low. Based on these results we suggest that management of FI in IBD should focus on treatment of inflammatory and non-inflammatory diarrhea burden before considering biofeedback and pelvic floor retraining. More studies are needed to assess the anorectal function in patient with IBD.