Ileal pouch pressures after defecation in continent and incontinent patients.

Abstract

After ileal pouch-anal anastomosis, a pouch/anal canal pressure gradient is present such that mean pressures in the anal canal exceed pressures in the pouch facilitating fecal continence. Such a relationship was not present in incontinent patients. Our aim was to evaluate characteristics of pouch pressures dynamically in continent and incontinent patients following ileal pouch-anal anastomosis (IPAA). A multichannel microtransducer catheter was positioned in eight continent patients and nine incontinent patients after IPAA. Twenty-four-hour recordings of pouch pressures and large pressure wave contractions were recorded when patients were awake, asleep, and after evacuation. When patients were awake, pouch pressures were similar. However, nocturnal pouch pressures were higher in the incontinent group (P < 0.05). Large pressure wave amplitude was higher in incontinent patients when awake and asleep (P < 0.05). Moreover, pouch pressures failed to decline in the incontinent group after evacuation, unlike continent patients. Compared with continent patients, incontinent patients after IPAA had persistently high phasic and basal pouch pressures at night and following pouch evacuation.