Chapter 42 - Women’s Health Issues and Ileal Pouch Surgery

Abstract

Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of choice for ulcerative colitis (UC) and familial adenoma polyposis. This surgical intervention allows resection of colon, while offering intestinal continuity with fecal continence, discontinuation of most UC-related medications and reduction in the risk of colitis-associated neoplasia. As a proportion of these patients are women of child-bearing age, it is important to understand the impact on reproductive health and function. Although limited data exists, RPC and IPAA do not seem to adversely affect menstrual function. In general, sexual function is reported to improve post-surgery with the ability to achieve orgasm unaltered. However, dyspareunia is commonly reported post RPC and IPAA. 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. However, 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.