Ileal Pouch Function Pregnancy and Delivery

There are at least two theoretical premises regarding a negative effect of pregnancy on pouch function. The first concerns the volumetric increase of the uterus, with a consequent increase of endoabdominal pressure (besides a direct compression effect on the reservoir). The second concerns the worsening of sphincterial function (it may already have been compromised after surgery) after vaginal delivery [50]. Surprisingly, most authors emphasise that pregnancy influences pouch functionality in a small way [47, 51-53], limited to a few cases of slight worsening and temporary incontinence, which generally disappears after delivery.

Even though this topic has been discussed for a long time, vaginal delivery is considered safe by most authors. Two large, retrospective, controlled series compare pouch function after vaginal delivery with pouch function in nulliparous [47] or after caesarean delivery [52], showing no differences. All authors emphasise, moreover, that episiotomy, especially medial episiotomy, must be avoided. We should conclude, therefore, considering the risks connected with caesarean delivery, it must be reserved for cases in which there is obstetrical indication.

In 2005, the authoritative group of Fazio [54] published a work that seems to refute what has been so far written. Recognising that the effects of delivery on sphincterial function in the short term are reduced, it emphasises a high incidence of sphincter injuries that can be detected with endorectal ultrasonogra-phy. Using the words from the title of this work, "a word of caution" is essential because, in the long run, functional response to this sphincter damage will need to be assessed. The authors suggested the opposite of what thus far appears in the literature, as they advise a planned caesarean delivery. In light of this work, it is necessary to carefully evaluate each patient in an attempt to assess the risk/benefit ratio between the two delivery modalities.

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