Inflammatory Bowel Disease (IBD)
Dr Dipesh Vasant

Guts UK/Dr Falk Spr Trainee Audit/Quality Improvement Award Winner 2018

Dr Dipesh Vasant photograph
Dr Dipesh Vasant, Guts UK/Dr Falk SpR Trainee Audit/Quality Improvement Award 2018

Institution: University of Manchester
Title: Anorectal dysfunction in ulcerative colitis: a cross sectional survey
Project start date: 23rd July 2018
Completion date: 22nd July 2019


Controlling our bowels is something that we often take for granted. However, three out of every four people affected by Inflammatory Bowel Disease (IBD) have regular ‘accidents’ or are ‘caught short’. Understandably, they are worried about controlling the release of wind, liquid or solid stools from the bowel. These distressing symptoms lead to suffering, social embarrassment and reduced quality of life. Many people are too embarrassed to even tell their doctor.

Unfortunately these symptoms can occur even when there is no active inflammation present in the gut. For these patients current IBD medication does not improve bowel control. Due to a lack of research in this population, we do not know how many people are affected, which means this remains an underreported, undiagnosed and undertreated problem. This is important because people without active bowel inflammation have no prospect of improving with the usual medicines used for this condition. Again, due to lack of awareness, these medicines are often wrongly prescribed in this situation. This project will for the first time quantify the number of people who have problems controlling their bowels without evidence of active bowel inflammation.

To carry out the work Dr Vasant and his colleagues will enlist two hundred people with Ulcerative Colitis (a type of Inflammatory Bowel Disease) and request that they complete some simple questionnaires anonymously about their bowel symptoms and other relevant aspects of their health. He will use a specific questionnaire for bowel control that has been tried and tested and proven to work for this purpose. The questionnaire results will then be used to find out how many people have difficulty controlling their bowels. All participants will then be asked to provide a stool sample. The stool sample will be checked for inflammation levels. Dr Vasant and his colleagues will then compare inflammation levels from the stool tests with the questionnaire results, which will enable them to find out how many people without active inflammation have problems controlling their bowels.

This project will identify, define and raise awareness of the problem caused by symptoms in the absence of active inflammation, which are often under-reported and difficult to treat.  It will also enable health professionals to recognise these patients, make a positive earlier diagnosis, avoid futile medical treatments when objective evidence of inflammation is lacking, and make timely referrals for potentially more effective treatments such as pelvic floor services when appropriate.

Scientific publications from this research

Current perspectives on the diagnosis and management of functional anorectal disorders in patients with inflammatory bowel disease.

I would like to thank Guts UK for supporting this project. We aim to raise awareness of anorectal dysfunction in patients with quiescent Inflammatory Bowel Disease and in doing so provide renewed hope to this often neglected group of patients.

Dr Dipesh Vasant