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Ileal pouch pressures after defecation in continent and incontinent patients
R L Grotz1, J H Pemberton, A Ferrara
1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Unlabelled:
After ileal pouch-anal anastomosis, a pouch/anal canal pressure gradient is present such that mean pressures in the anal canal exceed pressures in the pouch facilitating fecal continence. Such a relationship was not present in incontinent patients.
Purpose:
Our aim was to evaluate characteristics of pouch pressures dynamically in continent and incontinent patients following ileal pouch-anal anastomosis (IPAA).
Methods:
A multichannel microtransducer catheter was positioned in eight continent patients and nine incontinent patients after IPAA. Twenty-four-hour recordings of pouch pressures and large pressure wave contractions were recorded when patients were awake, asleep, and after evacuation.
Results:
When patients were awake, pouch pressures were similar. However, nocturnal pouch pressures were higher in the incontinent group (P < 0.05). Large pressure wave amplitude was higher in incontinent patients when awake and asleep (P < 0.05). Moreover, pouch pressures failed to decline in the incontinent group after evacuation, unlike continent patients.
Conclusion:
Compared with continent patients, incontinent patients after IPAA had persistently high phasic and basal pouch pressures at night and following pouch evacuation.