P238 A pilot study on the prevalence of obstructed defaecation syndrome among female patients of an inflammatory bowel disease cohort

Abstract

Obstructed defaecation syndrome(ODS) is a complex mechanical-functional disorder leading to difficult or inadequate rectal emptying. Prevalence ranges from 3.4% in the general population up to 23% in middle-aged women. However, the prevalence of ODS in inflammatory bowel disease(IBD) patients has not been assessed previously. We aim to describe the prevalence of ODS in an IBD patient cohort and to identify associated risk factors. A total of 74 female subjects were recruited, 26 of whom have ulcerative colitis(UC) and 48 have Crohn’s disease(CD). Consented subjects were required to complete two questionnaires: baseline characteristics and a validated ODS scoring tool(Table 1 and 2). A score above 1 was considered to be positive. Parity, hysterectomy, menopause and body mass index (BMI) were assessed for both their univariate and multivariate association with ODS. Obstructed Defaecation Syndrome scoring tool Obstructed Defaecation Syndrome scoring tool In our study, the mean age was 45.8. The mean total ODS score was 5.37 out of 31 (SD = 3.26); CD and UC patients had similar scores (mean 5.23 and 5.62 respectively). 90.5% of patients scored more than 1 on ODS scoring tool. Patients with ileal CD and left sided UC have higher ODS scores(mean6.38and6.09 respectively). After univariate analysis, ethnicity, parity, previous episiotomy or vaginal tear, history of hysterectomy and prolapse surgery did not affect the overall ODS score. This may be due to low numbers in each subgroup. We found that postmenopausal IBD patients (mean 6.7) have higher scores in comparison to premenopausal patients (mean 4.87) (p = 0.03). In particular, postmenopausal women tend to use more laxatives (mean 0.62) compared with premenopausal women (mean 0.09) (p = 0.002); and have more defaecation daily (mean 1.90) compared with premenopausal women (mean 1.13) (p = 0.017). Surprisingly the IBD patients with a BMI< 30 strain at defaecation more frequently (mean 1.43) than people with BMI >30 (mean 0.86) (p = 0.029). ODS is common in our female IBD cohort with prevalence of 90.5%. ODS is severe amongst ileal CD and left sided UC. Postmenopausal status and low BMI were associated with an increased frequency of ODS. ODS should be considered as a contributing cause of symptoms in the IBD population especially in the postmenopausal women. All study patients will be followed up for proctologic and anorectal physiological investigations to exclude any confounders.