Patients with ileal pouch anal anastomosis (IPAA) have a 50% risk of developing pouchitis. Patients with IPAA may also experience abdominal and pelvic pain, bloating, and difficulty with pouch evacuation. These symptoms may be secondary to non-relaxing pelvic floor dysfunction (N-RFPD), an often unrecognized condition affecting the ileal pouch.We hypothesize that patients with chronic pouchitis are more likely to have non-relaxing pelvic floor dysfunction compared to patients without chronic pouchitis. Aims: To assess the prevalence of N-RPFD and clinical features in IPAA patients with and without chronic pouchitis who have presented with symptoms suggestive of a pouch evacuation disorder. Methods: We reviewed themedical records of patients with ulcerative colitis (UC) and IPAAwho underwent high resolution anorectal manometry (ARM), balloon expulsion and pouch sensation in response to inflation of a balloon from January 2007 to April 2012. History of pouchitis (based on clinical, endoscopic, and histologic findings) was recorded. N-RPFD was identified by abnormal ARM, abnormal defecography, or inability to expel a 50 mL balloon from the lower bowel despite addition of >200g weight. The balloon expulsion test was not performed in 3 patients. Results: Forty-two patients were identified for the study: 24 (57%) with chronic pouchitis and 18 (43%) with no history of pouchitis. All patients with a history of pouchitis had recurrent or antibiotic-dependent pouchitis. Data are shown in the table. Patients with history of pouchitis were more likely to have N-RPFD and abnormal balloon expulsion test, although this did not meet statistical significance. There were no differences in age, gender or average resting anal sphincter pressures. The volumes at first sensation, first urge to defecate, and first discomfort were not significantly different between the chronic pouchitis group and the group who never had pouchitis, suggesting no differences in pouch compliance in the two groups. Five of the 42 patients with evidence of N-RPFD completed a formal program in pelvic floor retraining with biofeedback. All 5 patients had improvement in symptoms of impaired pouch evacuation. Conclusions: The prevalence of N-RFPD is 55% in patients with IPAA performed for UC and appears to be more common in patients with (vs. without) a history of chronic pouchitis. These findings suggest that abnormal pouch emptying dynamics are common in patients with IPAA, and based on limited evidence N-RFPD is a treatable comorbidity. Further studies of pouch emptying dynamics should be explored to further characterize the impact of N-RPFD on pouch health.