Ileal pouch anal anastomosis: pregnancy--before, during and after.

Most females having surgery for ulcerative colitis are young and in the childbearing age years. Quality of life is usually improved following surgery as is sexual function. The improvement is likely related to an improvement in the physical well-being of individuals. On the other hand, recent evidence suggests that surgery has a significant negative effect on the ability of females to conceive, likely due to adhesion formation. Most women who do conceive have few or no problems with the pregnancy. Although some surgeons recommend that women have a caesarian section rather than delivering vaginally to avoid the risk of injury to the anal sphincter, there is little evidence to support this policy. In conclusion, most women can be assured that their overall well-being and sexual function will be improved following surgery for ulcerative colitis but must be counseled that they may experience difficulties conceiving. Strategies to minimize this complication are needed.