P228 Vaginal delivery is not associated with fecal incontinence in IBD women
S. Kanis*, C. Van der Woude
Erasmus Medical Center, Gastroenterology and Hepatology, Rotterdam, Netherlands
The best mode of delivery for pregnant women with inflammatory bowel disease (IBD)remains a continuing debate amongst physicians. Because patient reported outcomes (PRO) are increasingly included in the management of IBD patients the aim of this study was to investigate PRO on the influence of vaginal delivery (VD) on fecal incontinence (FI) in IBD women.
We conducted a PRO study on FI and distributed an online survey amongst all members of the Dutch Crohn's and colitis organization (CCUVN). FI was defined as sometimes, weekly or daily involuntary loss of liquid or solid stool. To assess FI complaints we used a validated score (Vaizey incontinence score). This scale has a minimum score of 0 (perfect continence) and a maximum score of 24 (totally incontinent).
In total 343 women (211 CD(61.5%), 123UC(35.9%), 9IBDU(2.6%)) responded (278 responders from a research panel consisting of 443 IBD women, 65 through social media). In total 174(51.2%) females were childless, 136(40.0%)had a VD, 14(4.1%) had both a VD and caesarian section (CS), 16(4.7%)only CS (3 unknown). Mean age was 41,8 years(SD 13). Median follow up after last delivery was 16 years(IQR 5.5-25.4).
In total 73 females(24,0%)never had FI complaints, 89(29,2%) seldom, 91(29,8%) sometimes, 27(8,9%) weekly and 24(8,1%) daily (35 had a stoma, 5 unknown). There were 213(70.0%) premenopausal and 91(30.0%) postmenopausal women (39 did not answer this question). Sixty- one women had perianal fistulizing disease of which 24(39.3%)had one or more VD.
The overall median Vaizey score was 7(IQR 5-10). There was no difference in Vaizey score between CD and UC/ IBDU. Vaizey score was higher in women with VD (median 8,IQR: 5-11) compared to women that never had a VD (median7,IQR: 4-9)(p=0.02). The Vaizey score was also higher in postmenopausal women (median 8, IQR:6-11) compared to premenopausal women (median 6, IQR4-9)(p=0.001).
VD was associated with FI (cOR 1.91, 95%CI: 1,21-3.026), correction for menopause and perianal fistulizing disease showed no independent association with VD (aOR 1.58, 95%CI: 0.92-2.73). Menopause had an association with FI (cOR 2.38, 95%CI: 1.40-4.10), also after correction for VD and perianal fistulizing disease (aOR 2,03, 95%CI 1.12-3.69). Perianal fistulizing disease was not associated with FI.
Women with children experience FI more often after menopause (66.1%) compared to before (45.9%)(p=0.03). Childless women also experienced FI more often after menopause (46.2%) compared to premenopausal women (33.3%) but this was not statistically significant (p=0.26).
This study shows that FI complaints in IBD women are not significantly associated with a vaginal delivery.