Ulcerative colitis (UC) is a chronic inflammatory disorder of the large intestine. Individuals with UC will have chronic, recurring bouts of bloody diarrhea due to breakdown of the lining of the digestive tract. They may also have severe anemia due to blood loss and poor immune function due to malabsorption. Ulcerative colitis can be severely debilitating. It definately decreases the quality of life for those who have difficulty managing the disease.
For many the condition can be managed with medications. Drug therapy must be long-term (life long) because there is no cure for the condition. It can be costly and does not always prevent flare-ups. As well UC can predispose one to the development of colorectal cancer, which is one of the top three causes of death in adults in the US related to cancer.
Surgery is an alternative. There are two main surgery procedures for patients with UC. One involves removal of the colon, sparing the rectum, and the other invovles removal of the total colon including the rectum and attachment of the small intestine to the anus; called Ileal pouch anal anastomosis (IPAA).
Both surgical options carry a greater cure rate and lower the risk of developing colorectal cancer. However, there are other medical risks associated with the surgery that may alter normal organ function for other systems in the body. A recent review published in the journal Gut focused on fertility outcome in women after an IPAA.
Surgical procedures such as the IPAA carry a risk for infertility due to scar tissue build up and the possibility of damaging organs or blood vessels. The report examined more than 189 studies that had information relevant to IPAA and infertility in women. After careful consideration a study population of more than 500 women were included in this review.
Rates of infertility in women rose dramatically post surgery for ileal pouch anal anastomosis. The most common cause of infertility was blockage of the fallopian tubes by scar tissue. The authors conclude that infertility rates may be as high as 50% for women undergoing the IPAA procedure, this compared to a rate of 15% in the general population. Women who chose to treat their uclerative colitis with medications had a similar rate of infertility to those women in the general population. The study did not conclude on the rates of infertility for other surgical procedures treating UC, but the authors suggest that they may be closer to 15%.
This review represents an important step for supplying adequate informed consent for women considering surgical treatment for ulcerative colitis. Before this study a definative rate of infertility due to IPAA could not be given and some women may have undergone a procedure with more risk than they understood. Infertility is defined as the inability to conceive after attempting for 12 consecutive months.
Reference
1. Waljee A et al. "Three fold increase risk of infertility: a meta-analysis of infertility after pouch surgery in ulcerative colitis." Gut 2006 June 13.
Posted by Dr. Christina Gutierrez on June 28, 2006 11:33 AM
