Pregnancy may increase incontinence after ileal pouch-anal anastomosis

A systematic review and meta-analysis of eight studies involving 1,350 women assessed pouch function during and after pregnancy following ileal pouch-anal anastomosis. Incontinence was more likely after pregnancy, while most measured outcomes did not differ significantly by delivery mode.

Eight studies included 1,350 women with prior IPAA.
Post-pregnancy incontinence odds were higher (OR 1.61).
Most pouch outcomes did not differ by delivery mode.
Evidence is limited by older studies and heterogeneous reporting.

Researchers searched five databases through June 2025 for studies of pregnancy and pouch-related outcomes in women who had previously undergone ileal pouch-anal anastomosis (IPAA). The systematic review and meta-analysis included eight studies and 1,350 women; mean follow-up after delivery was 79.2 months. Outcomes included continence, stool frequency, urgency, pouchitis and pouch failure.

During pregnancy, pooled estimates were 39.4% for incontinence and pad use was reported by 21.8%. Pouchitis was reported in 8% and pouch outlet obstruction in 10.9%. In pairwise analyses, the odds of incontinence were higher after pregnancy (OR 1.61, 95% CI 1.09–2.38). Daytime and nighttime stool frequency did not change significantly. Cesarean delivery was associated with a small reduction in nighttime bowel movements (weighted mean difference −0.22); other outcomes did not differ significantly by delivery mode.

The findings suggest pouch function is generally stable, although incontinence may worsen after pregnancy. The authors report that delivery mode did not meaningfully affect long-term pouch outcomes, supporting individualized decisions rather than a routine delivery-mode preference based on these outcomes alone. Interpretation is limited by heterogeneity in outcome reporting and the predominance of older studies.

In practice

For women with a prior ileal pouch-anal anastomosis who are considering or experiencing pregnancy, the pooled evidence suggests that pouch function is broadly stable, but incontinence may become more likely after pregnancy. The analysis found no meaningful long-term pouch-outcome differences by delivery mode overall, so these findings do not support selecting a delivery mode solely to protect pouch function. The evidence comes from eight studies, many older, with heterogeneous outcome reporting; decisions should therefore be individualized and the estimates interpreted cautiously.

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Source

Surgical Endoscopy: Association between pregnancy and delivery mode and long-term pouch function in women with prior ileal pouch-anal anastomosis: a systematic review and meta-analysis ↗

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