P-179 Perianal Dermatitis after Ileal Pouch Anal Anastomosis in Ulcerative Colitis

Abstract

Perianal dermatitis (PD) is a recurrent problem for patients after an Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative Colitis. PD occurs frequently in the initial 12 months when pouch adaptation occurs and pouch function improves. No studies have looked at the incidence, severity, contributing and alleviating factors and quality of life when PD occurs. Aim: To identify the characteristics (occurrence and severity), perceived contributing and alleviating factors and quality of life of patients with PD after IPAA for UC. This was a prospective quantitative study of 20 Ulcerative Colitis patients 18 years and older who agreed to participate and had undergone the IPAA between November 2009 to November 2010 at a large academic medical center. The participants completed a validated self- administered questionnaire on pouch function and PD factors, quality of life and recorded dietary intake and stool characteristics each day they experienced PD and 7 days prior to scheduled visits at 1, 3, 6, 9 and 12 months as routine surveillance. At each scheduled visit the investigator took a picture of the perianal area to confirm the presence or absence of PD and used an Incontinent Associated Dermatitis Scale (IADS) to assess location and severity. Twenty patients, 15 male and 5 female, mean age 36.7 ± 11.8 years experienced PD within the first year. Four (20) patients were handsewn anastomosis. The majority of the patients 15(75%) experienced daily episodes of PD in the first month while 5(25%) had 1–3 episodes a week. The number of patients with daily episodes of PD steadily decreased by 3 months 12(60%); 6 months 5(25%); 9 months 2(10%) and 12 months 1(5%) but a third 7(35%) of patients had no PD after nine months. Four patients with prolonged daily PD were done handsewn. Of the 20 patients who experienced PD, 17(85%) had no skin loss, 3(15%) had skin loss with a red shade of skin tone. Of the 110 episodes of PD, frequent stools 47(42.4%), liquid stool 39(31.6%), frequent wiping 35(31.6) and leakage of stool 15 (14.4) were perceived as contributing factors and use of moisture barrier creams 58(52.5%) and hygiene with use of wet wipes 26 (23.5) were perceived as alleviating factors to PD. Quality of life was negatively reported in 88(110) episodes with PD. PD is a recurrent problem that negatively impacts quality of life and occurs multiple times within the first year after an IPAA. The frequency of PD decreases incrementally over time as pouch function and adaptation improves and patients develop an awareness of the contributing and alleviating factors to the development of PD. Early detection and treatment of PD with assessment of pouch function by providers, as well as, patient education on the contributing and alleviating factors to PD may be helpful to decrease the occurrence and severity of PD and improve the IPAA patient’s quality of life within the first year. Nurse Implications: Advanced Practice Nurse led pouch clinics to frequently surveillance for PD and nurses role in educating on PD and the contributing and alleviating factors.