TITLE

Sacral nerve stimulation for faecal incontinence due to systemic sclerosis

AUTHOR(S)
Kenefick, N.J.; Vaizey, C.J.; Nicholls, R.J.; Cohen, R.; Kamm, M.A.
PUB. DATE
December 2002
SOURCE
Gut;Dec2002, Vol. 51 Issue 6, p881
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Faecal incontinence occurs in over one third of patients with systemic sclerosis. The aetiology is multifactorial. Conventional treatment is often unsuccessful. Sacral nerve stimulation is a new effective treatment for resistant faecal incontinence. Aims: To evaluate sacral nerve stimulation in patients with systemic sclerosis. Patients: Five women, median age 61 years (30-71), with scleroderma associated faecal incontinence were evaluated. All had failed maximal conventional treatment. Median number of preoperative weekly episodes of incontinence was 15 (7-25), median duration of incontinence was five years (5-9), and scleroderma 13 years (4-29). Methods: All patients were screened with temporary stimulation. Those who benefited underwent permanent implantation. At baseline and after stimulation a bowel diary, the SF-36 quality of life assessment, endoanal ultrasound, and anorectal physiology were performed. Results: Four patients were continent at a median follow up of 24 months (6-60). One patient failed temporary stimulation and was not permanently implanted. The weekly episodes of incontinence decreased from 15, 11, 23, and 7 to O. Urgency resolved (median time to defer < 1 minute (0-1) v 12.5 minutes (5-15)). Quality of life, especially social function, improved. Endoanal ultrasound showed an atrophic internal anal sphincter (median width 1.0 mm (0-1.6)). Anorectal physiology showed an increase in median resting pressure (37 prev 65 cm H[sub 2]O post) and squeeze pressure (89 v 105 cm H[sub 2]O). Stimulation produced enhanced rectal sensitivity to distension. There were no major complications. Conclusions: Sacral nerve stimulation is a safe and effective treatment for resistant faecal incontinence secondary to scleroderma. The benefit is maintained in the medium term.
ACCESSION #
9737579

 

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