Anal function during pregnancy and postpartum after ileal pouch anal anastomosis for ulcerative colitis.
OBJECTIVE
Total proctocolectomy and ileal pouch anal anastomosis (IPAA) is now a common procedure for ulcerative colitis (UC). Moreover, it has been reported that fertility is preserved in women who undergo this procedure, many of whom can experience normal delivery.


METHODS
We assessed the perinatal outcomes and changes in anal function in four women, aged from 27 to 35 years, who gave birth after undergoing IPAA for UC. Pregnancies were confirmed 15-111 months after IPAA, three women had full-term pregnancies, and one gave birth after 31 weeks' gestation.


RESULTS
Cephalic delivery with a vacuum extractor was used for one patient, and another underwent cesarean section. The other two patients experienced normal delivery. None of the patients needed artificial insemination and none had any symptoms of intestinal obstruction during their pregnancy. After delivery, two patients suffered a transient increase in bowel frequency and soiling, which gradually resolved.


CONCLUSIONS
Although transient anal dysfunction occurred in the puerperal period, there were no changes in anal function during pregnancy. Therefore, there are no factors directly prohibiting pregnancy and vaginal delivery in women who undergo IPAA for UC.
Kitayama
Taku
T
Department of Surgery, Division of Gastrointestinal and Colorectal Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.
Funayama
Yuji
Y
Fukushima
Kouhei
K
Shibata
Chikashi
C
Takahashi
Ken-ichi
K
Ogawa
Hitoshi
H
Ueno
Tatsuya
T
Hashimoto
Akihiko
A
Sasaki
Iwao
I
D000328:Adult; D001003:Anal Canal / Q000502:physiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000601:surgery*; D039021:Colonic Pouches; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods; D014620:Vacuum Extraction, Obstetrical / Q000379:methods