Ileal Anal Pouch Dysfunction and Quality of Life

The ileal pouch–anal anastomosis (IPAA) remains the standard of care for restoration of anal continuity in patients undergoing total proctocolectomy across disease etiology, including ulcerative colitis, indeterminate colitis, or familial adenomatous polyposis. Pouch function is a direct result of the complex concept of this pouch physiology. Numerous studies have reported high satisfaction results in patients undergoing pouch reconstruction. However, there is still a subset of patients who report poor pouch function. As IPAA construction's sole purpose is lifestyle improvement and modification in patients whose only other option is a permanent ostomy, patient satisfaction and quality of life (QOL) are arguably the most important metrics in the evaluation of pouch success. Historically, pouch function and QOL metrics were based on physician-derived criteria, namely fecal incontinence and urgency. Newer research has shed light on the importance of patient input regarding pouch symptoms and consequences and the subsequent perception of QOL. Surprisingly or not, these differ from the symptoms physicians had previously valued. Significant work has been completed in developing standardized tools and metrics to continue to evaluate the QOL for these patients. Foundationally understanding and valuing the patient experience, expectations, and subsequent effect on QOL is critical in counseling pre- and postoperatively IPAA patients. Additionally, understanding the effect of their experiences on QOL is a cornerstone in supporting patients in any intervention concerning their continued disease process and should be tailored and done so in a team-based approach, inclusive of the patient themselves.