Abstract Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), significantly impacts quality of life with symptoms such as fecal incontinence, urgency, constipation, and pain present in up to 80% of patients with active disease. Pelvic floor dysfunction (PFD), defined by abnormal tone or coordination of pelvic floor musculature, shares substantial symptom overlap with IBD, making the two conditions difficult to distinguish. Consequently, PFD is often underrecognized in patients with IBD, leading to misattribution of symptoms to active disease, unnecessary escalation of biologic therapy, and prolonged corticosteroid exposure. This study aims to identify risk factors for PFD in patients with IBD to aid in the diagnosis of PFD and promote the utilization of pelvic floor therapy. We retrospectively reviewed adult patients with IBD who underwent anorectal manometry and/or MR defecography at a single institution between January 1st, 2019, and January 1st, 2024. Patients demonstrating PFD on imaging were included, and associations with clinical variables were evaluated using Fisher’s exact test with a significance threshold of α = 0.05. During the study period, 40 patients with IBD underwent anorectal manometry and/or MR defecography (26 with CD, 14 with UC). PFD was identified in 23 CD patients (88.5%) and in all 14 UC patients (100%), totaling 37 patients included in the analysis. Fisher’s exact test showed that a significantly greater proportion of CD patients with PFD had current or prior biologic therapy compared with UC patients (14/23 vs. 2/14, p = 0.0073). No significant differences were observed between CD and UC patients with PFD in regards to perianal disease (8/23 vs. 1/14, p = 0.1120), surgical history (8/23 vs. 3/14, p = 0.4766), female sex (19/23 vs. 9/14, p = 0.2546), or pregnancy history among females (10/19 vs. 7/9, p = 0.2495). Similarly, rates of dyssynergic, high-tone, and low-tone PFD did not differ significantly between groups (p = 0.5077, p = 0.5077, and p = 0.100, respectively). Among patients with IBD who underwent pelvic floor evaluation, PFD was highly prevalent in both CD and UC. The only distinguishing factor was greater biologic exposure among CD patients, while other clinical characteristics and PFD subtypes did not differ significantly between IBD types. Given the limited risk factors but high prevalence of PFD identified in this cohort, it is difficult to predict who may benefit from PFD screening. This highlights the potential role of routinely incorporating PFD assessment into IBD care, regardless of disease subtype. Larger, multicenter studies are warranted to validate these results and to determine the impact of incorporating routine PFD screening to prevent misattribution of symptoms to active inflammation, potentially avoiding unnecessary treatment escalation.
Johnsky et al. (Thu,) studied this question.