Predictors of anal incontinence in patients with perianal fistulizing Crohn’s disease

AIM: to identify risk factors affecting the anal incontinence (AI) in Crohn’s disease. P

ATIENTS AND METHODS: a retrospective study included 191 patients with perianal fistulizing Crohn’s disease in February 2017 — September 2024. Sphincter function was assessed via Wexner’s scale and sphincterometry. The incontinence symptoms were revealed in 118/155 (76%) patients. AI according sphincterometry was fixed in 175/191 (90%) cases. Associations were examined between: clinical/ anamnestic parameters, incontinence symptoms, anal sphincter insufficiency (sphincterometry -confirmed), and risk factor effects on sphincter tone/voluntary contraction.

RESULTS: previous anal surgery, regardless of the number of operations, increases the likelihood of AI confirmed by sphincterometry (odds ratio (OR) = 4.1; 95% confidence interval (CI): 1.27–13.2; p = 0.02). When analyzing individual sphincterometry data, the effect of the duration of the perianal disease (OR = 1.11; 95% CI: 1–1.22; p = 0.04) and the number of fistula-related abscesses (OR = 1.49; 95% CI: 1.13–1.97; p = 0.005) on the reduction of maximum anal squeeze pressure was revealed. According to data obtained, the risk of a decrease in the maximum anal squeeze pressure increased in patients with chronic perianal lesions for more than 5.5 years (OR = 2.74; 95% CI:1.24–6.06, p = 0.012), as well as in patients with 2 or more actively draining collections (OR = 2.36; 95% CI:1.39–4.31, p = 0.005).

CONCLUSION: analysis of predictors for anal incontinence in patients with Crohn’s disease-related perianal lesions will help develop optimal treatment strategy for these patients, thus highlighting the need for further research in this area.

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