The majority of men and women report an improved sexual life following restorative proctocolectomy because of better overall health. However, approximately 2% of men will have difficulties with sexual dysfunction while nearly 25% of women complain of painful intercourse, although this discomfort is usually improved over the pain experienced preoperatively. We also understand that most women with an ileal pouch-anal anastomosis can successfully conceive, yet the infertility rate among these patients is nearly tripled. Women who do become pregnant will often complain of increased stool frequency and worsened control over bowel motions as the pregnancy progresses and the enlarging uterus compresses the ileal pouch. These symptoms are usually tolerable and bowel habits typically return to normal within three months after delivery.
Lastly, many surgeons and obstetricians share the patients' concern about which mode of delivery should be utilized. While vaginal delivery would possibly benefit the health of the infant or mother, cesarean section might avoid irreparable damage to the ileal pouch, the sphincter muscles, or the nerves that control these muscles Fortunately, studies from three large centers, including the Cleveland Clinic Foundation, report that bowel function is not significantly altered by the mode of delivery. We are unsure, however, if these short-term similarities will continue to be comparable decades later when delayed effect of vaginal delivery combines with other detrimental factors to cause worsened bowel function. Therefore, we generally suggest delivery by cesarean section unless this approach introduces excessive risk to the infant or mother.
Scott A. Strong,
M.D. Staff Surgeon
