Perianal and Incontinent Dermatitis in Patients after Ileal Pouch Anal Anastomosis for Ulcerative Colitis

Background: Perianal incontinent dermatitis (PID) is a recurrent problem for patients after an Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative Colitis.

Purpose: To identify PID characteristics (occurrence, location and severity), perceived contributing and alleviating factors and quality of life of patients after IPAA.

Method: Twenty Ulcerative Colitis patients (75% male, age 37.1 (SD=12.45) yrs), who had undergone the IPAA, completed a self-administered questionnaire on perceived contributing and alleviating factors to PID,  QoL and a diet and bowel diary each day they experienced PID.   Data were collected on food intake, stool characteristics and severity (redness, skin loss, rash) of PID at 1,3,6,9 and 12 month visits.

Results:  All patients experienced PID within the first year. The majority (75%) reported daily episodes of PID in the first month, while 25% reported 3 episodes a week. The number of patients with daily episodes of PID steadily decreased (3 months=60%; 6 months=25%; 9 months=10% and 12 months=5%) and 35% had no PID after nine months.  For patients’ who experienced PID, the majority (85%) had no skin loss while 15% had skin loss with a red shade of skin tone.  Frequent liquid stool (42.2 %) or a diet high in roughage, fat and spices (42%) were perceived as the most common contributing factors to PID. Moisture barrier ointments were helpful to 40% of patients in alleviating PID. PID negatively impacted quality of life in 58% of patients.

Conclusion:  The frequency of PID decreases over time possibly as bowel function improves and with an increased awareness of the perceived contributing and alleviating factors to PID.  Frequent patient follow-up and education about PID may improve patients’ management of PID and their QoL within the first year of an IPAA.