Introduction

Bowel, bladder and sexual dysfunction symptoms in patients with Inflammatory Bowel Disease (IBD) are common. Treatment with biofeedback, medication, neuromodulation or surgery can improve quality of life. Unfortunately, few patients proactively report symptoms for reasons including: embarrassment, lack of awareness of associations / treatment options or concerns about consultation time.

Aims & Methods

Between February-April 2024, patients with IBD attending infusion units and outpatient clinics at a tertiary hospital in the United Kingdom were asked to complete the validated ICIQ-IBD (International Consultation on Incontinence Questionnaire for IBD patients), and the ICIQ-MLUTS / ICIQ-FLUTS (Male / Female Lower Urinary Tract Symptoms) questionnaire, which assesses bowel, bladder and sexual dysfunction symptom frequency and impact on quality of life (QoL) using a 5 point scale of never-always. Presence of symptoms was defined as those rated more than ‘never’. Regular symptoms were those occurring ‘most of the time’ or ‘always’. Patients were asked to rate QoL, bowel and sexual symptoms during both remission and relapse. Patients with unclassified IBD, microscopic colitis, stomas and J-pouches were excluded.

Results

One hundred and sixteen patients received the questionnaire. Sixteen were excluded on clinical grounds and 30 due to incomplete questionnaire data leaving 70 for analysis. Thirty-three (47%) were female, 38 (54%) had Crohn’s disease (CD) and 32 (46%) ulcerative colitis (UC). All patients were on biologics (96%) and/or JAK inhibitors (7%). Median age was 36 (range 20-77). Faecal urgency was the most commonly reported symptom, with 55 (79%) reporting symptoms during relapse and 45 (64%) during remission. Regular symptoms during remission were present in 9 (13%). Faecal incontinence (FI) was reported in 51 (73%) during relapse and 30 (43%) during remission. Regular FI symptoms were present in 6 (9%) during remission. Of those patients reporting to be sexually active (n=57), sexual dysfunction was common, reported in 41 (72%) during relapse and 25 (44%) during remission. Urinary incontinence (UI) was reported in 12 (17%) patients, with 10 (14%) patients reporting the presence of both UI and FI. Even during remission, patients commonly reported a bowel-control related QoL impact, with 31/70 (44%) reporting disruption to family, 36/70 (51%) to social and 38/67 (57%) to working life. Fourty-three out of 70 (61%) patients worried about getting to a toilet in time and 24/54 (44%) reported feeling less attractive to their partner.

Table 1: Bowel, sexual and bladder symptom frequency

N = 70

^A Symptoms reported more than ‘never’

^B Symptoms reported ‘most of the time’ or ‘always’

^C&D assessed using the ICIQ-IBD

^E patients reporting 'not applicable' excluded (n = 57)

Conclusion

Bowel, bladder and sexual dysfunction symptoms are common in IBD patients and negatively impact QoL. Even during remission, symptoms are more common than in the background population and interfere with QoL. An appreciation of the prevalence of these symptoms with proactive screening may facilitate triage to pelvic floor services for targeted care.