Factors associated with nighttime incontinence following ileoanal pullthrough

Minor nighttime incontinence following colectomy, mucosal proctectomy, and ileoanal pullthrough remains a bothersome and incompletely understood problem. Of 277 ileoanal pullthrough procedures performed at this institution between 1982 and 1989, 38 were performed on patients with polyposis coli syndrome. These 38 polyposis patients were selected to study nighttime incontinence because they represented a select population in which sphincter injury due to technically difficult mucosal stripping was minimized (compared with the difficult and hazardous mucosal stripping in inflamed tissues present in ulcerative colitis). In this series, 12 patients (32%) experienced nighttime incontinence after ileoanal pullthrough; in 9 of the 12 patients, this complication had resolved within 6 months postoperatively. Females had a significantly higher rate of minor nighttime incontinence (57%) than males (17%). Pouch size was significantly smaller in patients with nighttime incontinence (138 mL) than in continent ones (191 mL). Higher stool frequency soon after surgery also correlated with higher incontinence rates. Factors that did not show association with nighttime incontinence in this series were preoperative and postoperative resting and squeeze and sphincter pressures, disease interval, parity, and previous surgery. We conclude that nighttime incontinence is a common complication that occurs even after "technically easy" mucosal proctectomies. Further investigation will almost certainly reveal it to be multifactorial in etiology.