Abstract Background Pelvic floor disorders (PFD) such as fecal incontinence (FI) and obstructed defecation syndrome (ODS) are common in patients with inflammatory bowel disease (IBD), yet often go unreported, delaying diagnosis and treatment. As therapeutic options for IBD expand, addressing refractory functional symptoms has become increasingly important for improving patient quality of life. Aim: To characterize pelvic floor dysfunction in IBD patients presenting with FI and ODS, and to compare their findings with those of non-IBD patients. Methods This single-center retrospective study included IBD patients evaluated for PFD between 2015 and 2024. Patients underwent anorectal manometry, transrectal ultrasound (TRUS), and defecography for evaluation of FI or ODS. A control group of non-IBD patients who underwent assessments for PFD was used for comparison. Demographic, clinical, and functional parameters were collected and analyzed. Results A total of 70 IBD patients and 147 control patients were included. There were no significant differences between the groups in terms of age, gender, or parity. Pelvic surgery was more common in the control group (P = 0.01), whereas abdominal surgery was more prevalent in the IBD group (P 0.0001). Among IBD patients, 67% presented with fecal incontinence (FI) and 33% with obstructed defecation syndrome (ODS); 60% were female, and Crohn’s disease was the predominant diagnosis in both subgroups. IBD patients with PFD, whether FI or ODS, demonstrated lower anal resting and squeeze pressures compared to controls. Among FI patients, low resting pressure was significantly more common in the IBD group (54% vs. 30%, P 0.0001), and rectal hypersensitivity was more prevalent (37% vs. 17%, P = 0.008). Dyssynergia was observed in both groups (62.5% IBD vs. 73% controls, P = 0.07), without a significant difference. In the ODS subgroup, IBD patients had significantly lower resting (39% vs. 10%, P = 0.04) and squeeze pressures (37% vs. 70%, P = 0.04) compared to controls. Rectal hyposensitivity was frequent in both groups (IBD: 64%, controls: 69%, P = 0.09), with no significant difference in dyssynergia prevalence. Conclusion Lower resting and squeeze pressures were observed in IBD patients. FI in IBD patients appears to be associated with increased rectal hypersensitivity, while dyssynergia is common across both IBD and non-IBD populations. Recognizing these functional impairments is essential for timely and effective management of pelvic floor dysfunction in IBD. Conflict of interest: Dr. Livne Margolin, Moran: Speaker’s fees from illy-Lili Maradey-Romero, Carla: No conflict of interest Yehuda-Margalit, Reuma: No conflict of interest Levartovsky, Asaf: No conflict of interest Kopylov, Uri: speaker fees from Abbvie, Janssen, Medtronic, MSD and Takeda, research support from Takeda, Medtronic, and Janssen, and consulting fees from Takeda, Medtronic, and Abbvie. Carter, Dan: Personal Fees: speakers fees from Takeda, Janssen, Abbvie, Taro and Lapidot Tarp and consultancy fees from Takeda Taro and Lapidot
Margolin et al. (Thu,) studied this question.