Incontinence and Quality of Life in Ulcerative Colitis Patients After Total Proctocolectomy with an Ileal Pouch Anal Anastomosis- A Cross-Sectional Study

Introduction: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical procedure performed on patients with ulcerative colitis (UC) to avoid the need for permanent stoma. The objective of this study was to assess the quality of life and fecal incontinence in UC patients after IPAA and compare the quality of life among different subgroups. Methods: This cross-sectional study included all UC patients who had underwent IPAA between 2017 and 2021 at Shahid Faghihi Hospital, Shiraz, Iran. Fecal incontinence was evaluated using Wexner questionnaire, while quality of life was assessed using the inflammatory bowel disease questionnaire (IBDQ). Patients were categorized into groups based on the severity of their fecal incontinence, classified as no/mild (0-4) or moderate to severe (≥5), according to their Wexner scores. Differences between groups were assessed using independent sample t-test, Mann–Whitney U, Chi-square, or Fisher’s exact tests based on the type of variables. Results: A total of 138 patients completed the Wexner questionnaire, and 119 completed the IBDQ questionnaire. The mean age of participants at the time of questionnaire completion was 43.39 years (±11.16). Among the included patients, 19% experienced moderate to severe fecal incontinence. These patients had lower scores across all domains and the total score of IBDQ compared to patients with no/mild fecal incontinence. Additionally, those who underwent IPAA more than four years ago had significantly lower scores in the social function domain (P=0.047) and total score of IBDQ (P=0.027). Conclusion: Patients with fecal incontinence and those who have undergone IPAA for a longer duration have better quality of life scores.