Abstract Background Ulcerative colitis (UC) causes chronic mucosal inflammation of the colon and rectum. Despite clinical and endoscopic remission, a significant number of patients continue to experience functional anorectal symptoms that are often disproportionate to mucosal healing and substantially impact quality of life. Aims 1. To assess manometric parameters in UC patients with mucosal healing, with and without anorectal symptoms, compared to healthy reference values. 2. To identify factors associated with altered anorectal function in these patients. Methods A prospective, single-center study conducted from March 2022 to December 2024 included UC patients in endoscopic remission, with or without anorectal complaints. Anorectal manometry values were compared to gender-specific healthy reference ranges. Anorectal disorders were classified per the London classification. Associations between demographic, disease-related factors, manometry results, and disorder prevalence were analyzed. Results Fifty-seven UC patients in endoscopic remission (49% female; median age 47.4 years, IQR 30.8–69.5) were included—38 with anorectal symptoms and 19 asymptomatic. Symptomatic patients were older (median 50.2 vs. 39.8 years, p = 0.037) and had higher BMI (median 26.5 vs. 23.1 kg/m², p = 0.004). Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores were lower in symptomatic patients (median 50.5 vs. 67, p 0.001). The prevalence of anorectal disorders was as follows: disorders of rectal sensation (71.9%), anal tone and contractility (64.9%), and rectoanal coordination 45.6%. Specific disorders are illustrated in figure 1: In univariable analysis, histologic active inflammation was significantly associated with dyssynergia (p = 0.029) and rectal hypersensitivity (p = 0.013). Receiving IBD treatment was correlated with less rectal hyposensitivity (p = 0.031). Multivariable analysis did not show significant associations, possibly due to small sample size. Comparison of anorectal pressure values in UC patients to healthy reference ranges showed that both women and men had significantly higher mean anal resting pressure and rectal pressure during defecation (all p 0.001). Women exhibited higher residual anal pressure during defecation, as well as increased first sensation and urgency volumes (all p 0.011). Men had lower anal squeeze pressure (p = 0.017), a higher rectoanal gradient (p = 0.002), and a greater percentage of anal relaxation (p 0.001) compared to healthy male references. Conclusion Despite endoscopic remission, UC patients exhibit a high prevalence of anorectal dysfunction with significant differences in manometric parameters compared to healthy individuals. Conflict of interest: Dr. Richter, Vered: None Eindor, Adi: No conflict of interest Shalem, Tzippora: No conflict of interest Bermont, Anton: No conflict of interest Cohen, Daniel L: No conflict of interest Shirin, Haim: No conflict of interest Broide, Efrat: No conflict of interest
Richter et al. (2026) studied this question.