Factors affecting anal continence after restorative proctocolectomy

Abstract

The aim of this multicentre study was to define the incidence of disordered continence after restorative proctocolectomy and ileoanal reservoir with respect to some factors which may influence the postoperative soiling rate. Two hundred and seven patients underwent the operation, 156 had their ileostomy closed and were all available for a functional assessment. Minor leakage was observed in 26.9% of cases, whereas 1.9% complained of troublesome faecal soiling. None had gross faecal incontinence. Patients over 45 years had significantly more soiling than those younger (45% vs 24%, p less than 0.05). Soiling was more prevalent in those with ulcerative colitis than with other diseases (35% vs 18% p less than 0.05). The soiling rate decreased after the first postoperative year from 34% to 21% (p less than 0.05). A bowel frequency higher than 5 evacuations/24 hours increased soiling from 20% to 48% (p less than 0.01). Pouchitis doubled the soiling rate from 26% to 50% (p less than 0.05) without there being any difference in sphincter function. Soiling was not significantly related to staged procedure, J-pouch, perineal complications or a long rectal cuff. Careful preoperative evaluation of the anal sphincter should be performed in older patients operated on for colitis as they are likely to leak during the first year following restorative proctocolectomy, especially in cases with diarrhoea or pouchitis.